Alexithymia is a term introduced by Sifneos in 1973 to describe, initially in psychosomatic patients, the inability to recognize and to express emotions. Since 1973, alexithymia has been also described in alcohol dependence. A review of these studies is proposed with the results of our study from the INSERM network "Dependence". Prevalence of alexithymia is high in alcoholic patients, between 40 and 60%. Some authors have found that alexithymia predicted poor outcome in these patients. The distinction between primary and secondary alexithymia and the relationships between depression and alexithymia are complex. The psychodynamic hypothesis that alexithymia could hold a central position secondary to early dysfunction in the construction of the psychic and somatic self can be put forward. In some circumstances, regression to this position, even after transient addictive filling-in, could lead to essential depression and to psychosomatic disease.