As stated earlier, alcoholics more often than not present to treatment with comorbid conditions, most often illicit drug dependence, nicotine dependence, antisocial personality disorder, mood and affective disorders (especially major depression), and anxiety disorders (Grant et al., 2004, Drug and Al Dep., 74:223-234). Although the development of pharmacologic strategies to treat comorbid alcoholics is at an early stage, some advances are noteworthy. As noted previously, disulfiram for comorbid alcohol and cocaine dependence shows promise, and research is underway to evaluate topiramate for the same population. Similarly, researchers during the past two decades have shown that the selective serotonin reuptake inhibitors (SSRIs) ameliorate symptoms of depression, anxiety, or both conditions in at least some subpopulations of alcohol dependent patients (Pettinati et al., 2000, Alc. Clin. and Exp. Res., 24(7):1041-1049) and, importantly, do not lower seizure thresholds as do tricyclic antidepressants. However, despite some initial positive indications, SSRIs have not been shown to beneficially affect core symptoms of alcohol dependence (Garbutt et al. 1999, JAMA,281(14):1318-1325; Nunes and Levin 2004, JAMA, 291(15):1887-1896). Current NIAAA-supported studies that explore the use of existing medications to treat comorbid conditions include those in this slide.

The high comorbidity between alcohol and tobacco dependence poses special problems for alcoholism treatment. In addition to exacerbating health risks, smoking affects the process and course of alcoholism recovery and may serve as a precipitant to relapse. So far, first-line pharmacologic treatment for tobacco dependence, such as nicotine replacement and bupropion, have shown limited efficacy in alcoholic smokers; consequently, a need exists to develop effective drug therapies for co-occurring alcohol and nicotine dependence.