Ethanol has profound effects on cellular function, causes hormonal imbalance and either directly or indirectly results in nutritional deficiencies. Together with genetic and environmental factors these metabolic changes eventually cause functional and structural damage to liver, heart, central nervous system and other organs. In order to prevent organ injury the early recognition of the alcoholic patient is important. The combination of physician interview, questionnaire and laboratory markers of ethanol abuse [MCV, GGT, AST and others] is useful for the diagnosis of alcoholism. Abstinence is the most important therapeutic measure. The treatment of organ damage has so far been symptomatic. Initial results of trials of specific treatment of alcoholic liver disease are encouraging.