OBJECTIVES: To gain insight into the reimbursement landscape of pharmacological treatments against alcohol dependency. METHODS: We have conducted a manual search of 75 Health Technology Assessment (HTA) agencies’ websites for alcohol-related assessments published worldwide since 2001. All reports were categorized by HTA type, scope and outcome. Using a standardized set of categorical criteria, we investigated the recommendations for pharmacological treatments of alcohol disorders to identify common patterns in key decision drivers in this therapeutic area. RESULTS: We identified a total of 81 HTA reports dedicated to treatment of alcohol-related disorders. By the time of this study, 70% of the HTA reports were completed and therefore included into the analysis. The 57 published reports comprised 13 Single Technology Assessments (STA), 1 Multiple Technology Assessment (MTA), 6 Clinical Guidelines (CG), 14 Public Health Reviews, 6 Procedure / Intervention Assessments and 17 Literature Reviews. While 40 HTAs were mostly focused on public health impact of alcohol disorders and general organization of treatment, pharmacological treatment of alcohol dependence was assessed in 17 reports (within the scope of STAs, MTAs or CGs). Medications assessed the most were acamprosate and naltrexone. The vast majority of agencies have issued positive recommendations for these drugs, assuming they are used as second-line options and/or in combination with psychosocial interventions. Naltrexone was rejected by several agencies (e.g. AHTAPol, SIGN), partially justified by high risks / major adverse events and poor data supporting the benefits of the drug. CONCLUSIONS: Alcohol-related disorders attract attention of HTA agencies worldwide. Current research however shows that only a limited number of reports assess medications. One of the main decision drivers for approvals was the mere necessity of a pharmacological treatment which emphasizes a high unmet need in the management of alcohol dependence.