If there is no further intervention, relapse rates in detoxified alcoholics are high, up to 85%, even after complete remission of bodily withdrawal symptoms. It has been suggested that one relevant mechanism contributing to the relapse risk is the exposure to stimuli (cues) that have regularly been associated with alcohol intake. Such stimuli can become conditioned cues that elicit alcohol craving and intake as conditioned responses. Current brain imaging studies indicate that dysfunction of dopaminergic, glutamatergic, and opioidergic neurotransmission in the brain reward system (ventral striatum including the nucleus accumbens) is associated with alcohol craving and brain activation elicited by alcohol-associated pictures. These findings point to specific indications for psychotherapeutic and additive pharmacological treatment options.