Alcohol dependence (AD) is a complex disease involving biologic, psychosocial, and environmental factors. Increasing evidence shows that the development of AD involves changes in neurotransmitter function in the areas of the brain associated with alcohol craving and reward. Although AD is gaining acceptance as a medical disease, management of AD rarely includes medical treatment. Pharmacotherapy ... [Show full abstract] is a useful adjunct to psychosocial therapy and can target the biologic changes associated with AD. Similar to the role of medications in depression, pharmacotherapy can improve the response to psychosocial therapy and should thus be initiated early in the course of treatment. By reducing cravings and alcohol-associated rewards, pharmacotherapy can reduce heavy drinking days, increase abstinence, and help patients focus on their treatment goals. Pharmacotherapy represents a valuable component of treatment and should be combined with psychosocial and behavioral interventions to address the multifactorial nature of AD in individuals with this disease.