Based on the concept that alcoholism is a metabolic disease, and that the adrenal cortex is fundamentally implicated in this disease, a number of chronic alcoholics and patients in acute alcoholic states were treated with aqueous adrenal cortex extract (ACE), lipo-adrenal extract, desoxycorticosterone, testosterone and adrenocorticotropic hormone (ACTH). The treatment of 3 states of acute alcoholism Korsakoff''s psychosis, acute alcohol intoxication and delirium tremens, is described. Clinical criteria for evaluating treatment and various metabolic studies are reported. Whereas 2 patients with Korsakoff''s psychosis did not respond to treatment with ACTH, ACE was strikingly beneficial in 5 patients. Both ACE (70 patients) and ACTH (10 patients) are effective in terminating acute alcohol intoxication promptly. ACE is probably preferable to ACTH in this condition because of its more prompt sedative effect and because the patient''s appetite returns more quickly. Acutely intoxicated females in the reproductive age group (2 patients) did not respond to ACTH, whereas they did respond to ACE. In delirium tremens ACTH is strikingly beneficial (6 patients) and superior to ACE (40 patients), or ACE and desoxycorticosterone (20 patients), or conventional treatment (185 patients). The effect of ACTH in chronic alcoholism is being studied. The author postulated that delirium tremens represents the adaptation syndrome, and supported this by showing that alcohol causes marked depression of adrenal ascorbic acid in rats.