Multiple neurochemical pathways have been identified to be involved in mediating craving and relapse to alcohol. Additionally, animal models greatly assist in investigating pharmacological interventions of relapse behaviour. Opioidergic and glutamatergic systems play a key role in alcoholism as demonstrated by clinically effective compounds. Moreover, many new targets have been identified and several new compounds are currently undergoing clinical testing. Given the heterogeneity in treatment response, genetic and protein markers as well as endophenotypes are currently characterised for individualised pharmacotherapy.