Laura Wolfe, M.D., is an adult psychiatrist who works for Kaiser Permanente in Santa Clara, California. Her experience treating a man with PTSD is helpful in understanding the role of SSRIs.

Reviewing the new medications for alcoholism brings us into a pharmacologic netherworld. Nothing is very clear, and when you think you've finally come to a conclusion, a new study comes along to cast a fresh fog over everything.

Guess what: Antabuse (disulfiram) is back in fashion, over a half century after its initial approval by the FDA. You have probably seen some of the infomercials funded by Odyssey Pharmaceuticals and published as supplements by the usual journals.

By now, it is clear that the most effective treatment for alcoholism is consistent attendance at AA (Alcoholics Anonymous) meetings. Not only have outcome studies shown that AA attendance promotes abstinence, but in addition, therapy aimed specifically at encouraging AA attendance has been shown to robustly increase the chances that patients will actually go to meetings and get sponsors (Alcohol Research and Health, 1999;23:93-98).

Dr. Gitlow, let's get right into the issue of benzodiazepines. A typical scenario for many of us in office practice is that we will see a patient recently out of detox who will say, "Well doctor, I have always had terrible anxiety whether I have been drinking or not, I have tried this and I have tried that, and if I can't take something that will help my anxiety, I am sure I am going to start drinking again."

Susan Hochstedler, RN, CADAC, is a nurse at Addison Gilbert Hospital in Gloucestor, MA. She works full-time with substance abusers in The Discovery Program, an addictions day treatment program.

Things were bound to get ugly. The total market for antipsychotics is $10 billion, there are five very similar atypicals jockeying for an extra nibble of that huge pie, and each atypical is backed by an aggressive pharmaceutical firm. You do the math.

If you who have chosen to spend inordinate amounts of your precious time reading these pages over the last year, you will remember the February 2003 (TCR, 1:2) issue in which TCR slammed Zyprexa for causing diabetes. Well, we're going to slam Zyprexa again this year, but not quite as viciously.

Tired of industry-funded antipsychotic trials? The NIMH comes to the rescue with the "CATIE" project (Clinical Antipsychotic Trials of Intervention Effectiveness). Blissfully un-industry-funded researchers have enrolled 1500 schizophrenic patients at 50 different sites, and have randomly assigned them to Zyprexa, Seroquel, Risperdal, Geodon, or Trilafon (perphenazine).

Dr. Buse, as an endocrinologist with a specialty in diabetes, I'm hoping you can help educate both myself and my psychiatrist readers about diabetes and antipsychotics. To begin with, we've been hearing a lot lately about the "metabolic syndrome." What is it?