 - 1. meet criteria for current substance dependence excluding nicotine and alcohol; 2. report opiate use in the past month, have a drug screen positive for opiates, or require opiate containing medications for pain management; 3. meet criteria for a current major depressive or manic episode; 4. are currently psychotic or suicidal; 5. have an unstable or serious medical condition that would preclude use of the nicotine patch or naltrexone e.g., unstable angina pectoris, severe arrhythmia, recent congestive heart failure; 6. have aspartate aminotransferase or alanine aminotransferase levels of more than 3 times the reference range or elevated bilirubin levels; or 7. are currently pregnant or lactating, intend to become pregnant, or are not using a reliable means of birth control. 