OBJECTIVE Medically ill alcoholics are frequently encountered in medical practice, yet little is known about this subgroup of alcoholics. Anecdotal evidence suggests that current treatment methods may be ineffective in some of these patients, and that many of them resist referral to treatment programs. In this pilot study, we sought to characterize this group, in order to determine whether further research was indicated. METHODS In the Minneapolis VA Medical Center, we conducted a retrospective chart review of 61 alcoholics from 3 groups of alcohol-dependent patients: medical inpatients who accepted transfer to treatment, medical inpatients who refused transfer, and ambulatory patients requesting treatment. The groups were compared on demographic, physical, psychological, and laboratory characteristics, and on compliance with medical appointments. Most Important Findings: As might be expected, inpatients were older and sicker than ambulatory patients, but also demonstrated fewer nonmedical complications of alcoholism. On psychological testing, those who transferred were more likely to exhibit anxiety and depression, while the ambulatory patients were more antisocial. Inpatients who transferred differed from those who refused in having fewer previous treatments and less severe medical illness and in showing more compliance with medical recommendations in general. CONCLUSIONS These findings raise the possibility that these groups may significantly differ from one another, and suggest that further research on the characteristics of medically ill alcoholics is indicated. Improved characterization could potentially lead to more effective treatment approaches.