Conclusions
People with concurrent mental disor
ders, such as major depression and alco
hol and nicotine dependence, are
increasingly prevalent in clinical prac
tice and generally have poor response
to treatments, which can be costly.
Nevertheless, there is growing evidence
that contemporaneous treatment for
depressive disorder and smoking cessa
tion is preferable to treatment of either
condition alone, even in the presence
of alcohol dependence. In such cases,
combining different pharmacological
agents in conjunction with CBT or
other psychotherapies appears to be
the preferred mode of treatment. New
medications such as topiramate that
could treat both alcohol and nicotine
dependence might simplify the use of
combination therapies if there is a con
comitant depressive illness. The devel
opment of more specific pharmacologi
cal strategies targeting the populations
most likely to respond—or working at
different phases of the disorder(s)—is
in its infancy. Among the various psy
chotherapies, CBT that emphasizes
group cohesion and social support
appears to be particularly useful for
treating depressed smokers with or with
out alcohol dependence. The necessity
of teaching mood management skills
among people with nicotine and alco
hol dependence who are also depressed
has not been established. New knowl
edge is needed to develop treatments
that might benefit special populations,
including women and teenagers. ■