Addiction pharmacotherapy aims to prevent drug abstinence symptoms, reduce drug craving and relapse, and normalize physiologic functions disrupted by chronic use of the drug. During the last 50 years, there has been an enormous revolution in pharmacotherapy for drug addiction. From abstinence as practically the only treatment option available, there are now multiple drugs on the market that have proved their efficacy in treating opiate and alcohol disorders. The present review will focus on the pharmacological treatments of the drugs whose consumption most affects individuals and society: alcohol and opiates. We will review the drugs most widely prescribed to prevent relapse and maintain abstinence, as well as those designed to reduce the consumption of short-acting drugs (e.g. maintenance therapies) since the 1960s. Methadone and buprenorphine are the most widely used maintenance therapies for opiate addicts, although new pharmacological depot systems of naltrexone are showing promising results. For alcohol use disorders, acamprosate, nalmefene and naltrexone are replacing disulfiram prescriptions, and a wide variety of new products are currently under study. The number of new pharmacological targets already on clinical trials and the advanced new ways to administer classic therapies can improve the success rate of the pharmacotherapy for opioid and alcohol addiction.