Alcohol is the main risk factor for death and disability. The treatment of alcohol dependence
(AD) is a complex activity as the variables are numerous; however, those which must necessarily be
taken into account are the type of AD, the internal comorbidities and the presence of any psychiatric
comorbidity. Liver problems are one of the most common causes of alcohol-related liver damage. 45%
of deaths from cirrhosis are alcohol-related. Thus, the treatment of AD must often deal with a more or
less severe liver disease, which influences the choice of anticraving drug. As chronic liver disease is
often present, and as in a substantial proportion of cases, because there is a correlation with viral infections
or with hepatocellular carcinoma (HCC), it is clear that hepatologists should make use of nonhepatotoxic
molecules. In cases of mild liver disease, all available drugs might be used, but we recommend caution because
the liver is usually fragile due to the harmful abuse of alcohol. In the advanced liver disease, the choice of treatment
is reduced. A psychosocial approach such as attending support groups could be the first choice. In cases of compensated
cirrhosis with or without HCC, or in cases of HCC without cirrhosis, metadoxine, acamprosate and baclofen can be used.
In decompensated forms the only drug tested to date has been baclofen. In alcohol-related liver disease a professional
team with hepato-alcohologists is also necessary, especially for liver transplantation programs.