• PTSD Symptom Scale - Interview [ Time Frame: 9 and 12 months ] [ Designated as safety issue: No ]
• Drinking Time Line Follow-back [ Time Frame: 9 and 12 months ] [ Designated as safety issue: No ]

• PTSD Symptom Scale – Interview
• Time-Line Follow-back Interview

• Beck Depression Inventory [ Time Frame: 9 and 12 months ] [ Designated as safety issue: No ]
• Penn Alcohol Cravings Scale [ Time Frame: 9 and 12 months ] [ Designated as safety issue: No ]
• Sheehan Disability Scale [ Time Frame: 9 and 12 months ] [ Designated as safety issue: No ]

• Beck Depression Inventory
• Penn Alcohol Cravings Scale
• Sheehan Disability Scale

This study will evaluate naltrexone and cognitive-behavioral therapy treatments for alcohol dependence and post-traumatic stress disorder (PTSD). Subjects will be randomly assigned a 6-month treatment of either: 1) naltrexone alone, 2) naltrexone with PTSD psychosocial therapy, 3) a placebo with PTSD psychosocial therapy, or 4) placebo alone. An enhanced medication management intervention will accompany all treatment conditions. Followup assessments will be completed at 9 and 12 months after treatment.

• Alcoholism
• Alcohol Dependence
• Post-Traumatic Stress Disorder

• Behavioral: Cognitive-Behavioral Therapy
• Drug: Naltrexone
• Drug: Placebo

• Active Comparator: Naltrexone alone
• Active Comparator: Naltrexone with CBT for PTSD
• Active Comparator: Placebo with CBT for PTSD
• Placebo Comparator: Placebo alone

Inclusion Criteria:

• Meets criteria for alcohol dependence and post-traumatic stress disorder.
• Heavy drinking in the past 30 days (an average of more than 12 alcohol drinks per week with at least 1 day of 4 or more drinks).
• Successfully complete medical detoxification.
• Exhibit clinically significant trauma-related symptoms.
• Live in a commutable distance to the University of Pennsylvania and agree to followup visits.
• Aged between 18 and 65 years old
• Able to provide an informed consent.
• Speak and read English.

Exclusion Criteria:

• Current diagnosis of any substance dependence other than alcohol, nicotine, or cannabis.
• Evidence of opiate use in the past 30 days.
• Significant risk of violence or history of serious violent behavior during the past year.
• Continued contact with an intimate partner if assault by the partner is the index trauma
• Changes in dosage or medication for any SSRI treatment in the three months prior to entering the study
• Unstable or serious medical illness.
• Current severe psychiatric symptoms.
• Mental retardation or another pervasive developmental disorder.
• Use of an investigational medication in the past 30 days.
• Pregnant, nursing or not using reliable contraception.