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Key Points Alcoholic liver disease (ALD) is characterized by a complex spectrum of histological lesions, ranging from steatosis to cirrhosis Alcoholic hepatitis is a specific entity, which is associated with a fast progression to cirrhosis and with liver failure and a poor outcome in its most severe form ALD is characterized by oxidative stress, disturbance of hepatocyte metabolism, liver inflammation, modifications in the regeneration process and translocation of bacterial products from the gut microbiota into the portal blood stream Because animal models do not reproduce the complete spectrum of alcohol-induced hepatic lesions, translational research based on human samples is crucial to identify new treatment options The best-documented treatment for severe alcoholic hepatitis is corticosteroids, but this treatment is not ideal and 40% of patients still die after a short period of time The future evaluation of new strategies in severe alcoholic hepatitis should focus not only upon survival, but also on surrogate markers of outcome, with a specific plan of development Abstract Alcoholic liver disease (ALD) is a complex process that includes a wide spectrum of hepatic lesions, from steatosis to cirrhosis