Liaison psychiatrists may have misgivings when surgeons and physicians refer patients with alcohol problems. Epidemiological overviews including meta-analyses have quantified the relationship of alcohol consumption to morbidity and mortality. Psychiatrists should be aware that alcohol dependence can obscure psychiatric diagnosis. In clinical practice, where a behaviour change is implicated, the diagnostic process is a first step in therapy. Liaison psychiatrists see many patients whose present physical symptoms have been attributed to depression or anxiety. Wernicke's syndrome is believed to be due to critical deprivation of thiamine in neurons in the mid-brain or thalamus. It often has a rapid onset following weeks of heavy drinking which have interfered with the absorption of thiamine from the intestine. It is possible that acamprosate or calcium homotaurinate acts to stabilize glutamate receptors left oversensitive in the newly abstinent alcohol-dependent patient.