The purpose of this study is to determine the effectiveness of naltrexone (Revia) or matched placebo combined with nicotine patch (Nicotrol) or placebo patch using a 2x2 design in reducing drinking and smoking in patients with both nicotine and alcohol dependence.

Eligible individuals will be randomly assigned to a 12-week trial of a fixed daily dose of either naltrexone (Revia) and nicotine replacement patch or placebos. All individuals will receive weekly coping skills and smoking-cessation behavioral therapy. Followup interviews will be conducted 3 and 6 months after treatment to determine smoking and drinking status and persistence of any dependence symptoms.

Inclusion Criteria:

• Meets criteria for alcohol dependence and nicotine dependence.
• Expresses a desire to cut down or stop drinking and smoking.

Exclusion Criteria:

• Currently meets criteria for dependence on substances other than alcohol and nicotine.
• Any history of opiate dependence or evidence of current opiate use.
• Significant medical disorders that will increase potential risk or interfere with study participation.
• Liver function tests more than 3 times normal or elevated bilirubin.
• Females who are pregnant, nursing, or not using a reliable method of birth control.
• Meets criteria for a major psychiatric disorder and is in need of or currently undergoing drug therapy.
• Inability to understand and/or comply with the provisions of the protocol and consent form.
• Treatment with an investigational drug during the previous month.
• Chronic treatment with any narcotic-containing medications during the previous month.
• Sensitivity to drug as evidenced by adverse drug experiences especially with narcotic- containing analgesics or opioid antagonists.
• Current treatment with disulfiram (Antabuse) or nicotine replacement therapy.
• More than 6 weeks of abstinence.

Double blind tablet and patch active study medications, and matched tablet and patch placebos