All physicians will encounter the alcohol withdrawal (up to 500,000/year in the USA require pharmacologic treatment). Increased symptom expression upon cessation of drug intake can involve many different systems (autonomic, sensory, motor, etc) and may be manifested as an increase or decrease in the function of various systems. The successful treatment of withdrawal is a critical point in the treatment of alcoholism because withdrawal symptoms present an immediate medical risk, and withdrawal related neurobiologic changes can promote neurotoxicity that increase risk for subsequent withdrawal related medical complications and produce changes that increase motivation toward relapse into continued alcohol use. The treatment of withdrawal is just the beginning of a longer-term treatment process to achieve continued abstinence. Alcohol withdrawal can vary from low-level symptoms that do not require pharmacologic intervention to severe life threatening symptoms such as seizures and delirium tremens (DT’s) that require hospitalization and robust medical intervention to avoid death. The 12-month prevalence of irritability, nervousness and depression following the cessation of drinking can be as high as 5% and the severity of the withdrawal syndrome is increased in individuals with higher alcohol intake and prior withdrawal and treatment episodes (for an increase in 10 drinks per week, there is a 2 times greater risk of withdrawal symptoms). The adaptive changes accounting for tolerance, the decreasing effect of the same dose of a drug over time, when unopposed by alcohol are the neurobiologic cause of the increased nervous system excitability that produces the symptoms of the alcohol withdrawal syndrome. Mild symptoms can be managed on an outpatient basis but more severe symptoms require hospitalization. Benzodiazepines, which reduce the increased excitability, are the preferred treatment and some anticonvulsants are effective in preventing seizures and reducing other symptoms and possibly reducing relapse. Treatment of withdrawal should be coordinated with longer term treatment followup.