If there is a more severe psychiatric illness, a sequential model is sometimes required whereby the doctor starts by treating one disorder then moves on to the other one. The problem is there are still some people out there who believe that if the underlying depression is treated, for example, the alcoholism will go away. But, alcoholism is not a symptom, it is a disease. That said, there are three different kinds of therapeutic interventions we do. Medication treatment requires a very individualized assessment that considers the patient's own experience, family history, and underlying medically-related problems.
Psychotherapy treatment can be helpful if it is patient, supportive, and focused on sobriety.
Unfortunately, a lot of people delve right in trying to do a lot of quick problem solving. There are several cognitive behavioral techniques. When we encounter patients who are not quite willing to give up their addiction because of denial or a psychiatric difficulty I prefer to meet them halfway and keep them involved in treatment as long as we are not actively enabling or supporting destructive behavior. Some recovering individuals have remarked that Prozac does for them exactly what drinking did. A For some people, refusing medication may very well be helpful to maintaining their abstinence, but I am finding that less and less these days.