Homeless drinkers are one of the most vulnerable groups in society. This group is often encountered in many healthcare environments, often by mental health nurses. A review of assessments carried out with homeless drinkers accessing a primary care alcohol service was carried out. The review shows that homeless drinkers have a range of complex problems, including: severe dependence on alcohol; drug use; early life trauma; suicidality; aggression; and cognitive impairment. This group have difficulty engaging with conventional services, yet have very high level of needs—these needs may be better met by intensive case management using assertive community treatment and easier access to detoxification.