 Step 1: All subjects will complete 12 weeks of pharmacotherapy n 120 on naltexone 50 mg, 1 tablet daily, acamprosate 333 mg, 2 tablets 3 times daily, reduced to 4day for women 65kg, or a combination of the two. After a 3 week stabilization period, subjects will undergo complete formal assessment for anxiety and depression. Those subjects with a diagnosis of anxiety or depressive disorder regardless of drinking outcome will be offered the next step of care and followed up at 12-16 weeks. 