People with addictions who are also suffering from depression can face some real difficulties in terms of finding and maintianing sobriety. My own experience is that many of the "chronic relapsers" I see have some underlying diagnosis that has been missed or not addressed thoroughly enough in previous recovery attempts. Of course sometimes it's just about the their willingness too...
Something I will typically do with clients is address the PAWS material early in our relationship. They've generally attempted recovery before without help and will invariably relate to some of the PAWS symptoms that show up. I find the timeline particularly resonates. I think I've posted it before, but I will again at the bottom of this post, just in case.
If a client reports with a history of severe depression, they may or may not have the ability and/or willingness to get medicated. Since I usually start seeing them during the "honeymoon" stage, I typically would explain PAWS to them and ask them if they'd be willing to take anti-depressants for a few months, starting now so that the meds have a couple of weeks to start working. When they're medicated for the depression we can focus on their CD issues for awhile, and in the process of doing that we'll likely uncover a lot of the thought processes that are leading to the depression.
Just a side-note, depression is typically anger turned inward. If you ask a depressed person "Who is most impacted by your depression" they will tell you who they are angry at. Then we start uncovering the resentments that are leading to the anger. Since resentments are always about unmet expectations, helping a client either change their expectations or simply accept that they're not going to be met will usually be quite helpful. Again, all of this can be close to impossible with a client who is not medicated, at least temporarily.
Here's that PAWS stuff:
Early Recovery:
1. Acute Withdrawal (4-14 days)
Most clients are very aware of the symptoms of withdrawal of their drug of choice, so this doesn't require much explanation other than to mention that it almost never goes past 7 days unless you're dealing with a heavy stimulant user who has not detoxed in a long time.
2. Honeymoon (30 days)
This is where the client feels "cured." The desire to drink has been magically lifted. Sometimes this is longer or shorter than 30 days depending on previous attempts at recovery, motivation, etc., but in my experience 30 days is about right.
3. PAWS (120 days)
The worst of the PAWS symptoms happen during this period, though they continue to show up periodically for a couple more years. This will include anhedonia, dysthimia, hypersomnia and/or insomnia, irritability, severe mood swings (particularly related to sugar intake and diet), hot flashes, cold sweats, dry mouth, difficulty focusing, sometimes difficulty speaking, overwhelming feelings of anger, pain, shame, guilt, or anything else that was repressed during the addiction, obsessive thinking about using, deep and abiding lonliness, sexual impotence, absence of sexual desire, and a general sense of feeling "not right." The most effective treatment for PAWS symptoms is regular exercise and a balanced, sugar-free diet.
4. Middle Recovery (Next 6 months).
As the fog of PAWS starts to fade This is where the individual starts to relearn how to be social without her or his drug of choice.
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