Management of substance use disorders is challenging, there are no medications that directly treat the use disorders, substitution therapy in opioid use disorders and potential anti-craving medications for alcohol use disorder are the closest available. Successful management of withdrawal syndromes and craving can improve the chances of sobriety. The presence of underlying medical and psychiatric disorders can derail attempts at long term sobriety if not managed. This chapter provides information on medications commonly used in the management of withdrawal symptoms and co-morbid psychiatric disorders, such as depression and anxiety, in the dually diagnosed patient. Tables of medications from the following classes are included: benzodiazepines and other antianxiety agents, antidepressants, mood stabilizers, anticonvulsants and antipsychotic medications. Key points in the patient specific selection, dosing and monitoring of these medications and management of their side effects are identified. Insomnia can derail sobriety and needs to be addressed. Information on sleep hygiene and medications for insomnia are also presented. Information on the individualization of treatment is also discussed. It is important to note that many of the medications presented in this chapter are being used for both US FDA labeled and off-label indications.