Injectable Versus Oral Naltrexone Treatment of Alcohol Dependence In Serious Mental Illness (SMI)

Inclusion Criteria: 1. Males or females, age 18 to 69, with a DSM-IV diagnosis of Schizophrenia, Schizoaffective Disorder, Major Depressive Disorder (MDD) with Psychotic features, Bipolar Type I or Type II Disorder, or Psychosis not Otherwise Specified (NOS) Disorder; 2. DSM-IV diagnosis of Alcohol Dependence; 3. Level of Drinking: 1. At least four days of drinking in the 30 days prior to consent and/or during screening period OR 2. For prospective subjects who are currently in an inpatient or residential facility or recently discharged within 30 days prior to consent: At least 4 days of drinking during the period of time immediately prior to inpatient admission and/or during post-discharge. 4. Currently prescribed antipsychotic medications, mood stabilizers, or antidepressants. 5. One negative urine screen for opiates prior to start of medication and a self-report of no opioid use for at least 1 week prior to starting medication. 6. Currently involved in outpatient psychiatric treatment at one of the study sites (Hutchings Psychiatric Center, SUNY Upstate Adult Psychiatric Clinic, St. Joseph's Hospital, VA Medical Center) or at another location in the community. Exclusion Criteria: 1. Inability to give adequate informed consent; 2. Currently taking disulfiram (Antabuse), naltrexone, or acamprosate (Campral); 3. Current DSM-IV diagnosis of Opioid Dependence; 4. Current regular use of prescribed opioid analgesics, such as methadone, morphine, codeine, meperidine, and all other opioids. If the subject reports taking a prescribed opioid analgesic only occasionally, the study physician or nurse practitioner will contact the prescribing physician regarding the safety of study participation and the possibility of using an alternative. The principal investigator will make the final determination after obtaining the primary physician's recommendation regarding this criterion. 5. Current daily use of non-prescribed opioids. 6. Currently taking ibuprofen or other potentially hepatotoxic medications in amount and/or frequency judged by the Principal Investigator to pose clinically significant added risk of hepatic injury; 7. Female patients of childbearing potential who are sexually active, not sterile, and who deny using birth control; 8. Female patients who are pregnant or nursing; 9. Significant unstable medical problems, including any significant unstable psychiatric disorders. The study physician conducting the medical history and physical exam will exclude such clinically unstable individuals; 10. AST (aspartate aminotransferase test) levels: If AST is greater than 3x upper limit of normal; 11. Subjects who do not attend required screening appointments. Subsequent exclusion from the study for reasons related to non-attendance will be based on the judgment of the principal investigator; 12. In need of acute medical detoxification from alcohol in the judgment of the study physician based on results a score of 12 or more on the Clinical Institute Withdrawal Assessment of Alcohol Scale Based on DSM-III-R (CIWA-AD) and other information obtained; 13. Scheduled surgery within 3 months of intake; 14. Subjects who have pending legal proceedings whose outcome may lead to incarceration within 3 months