CASE STUDY JEFF 1
Case Study Assignment: Jeff
Hanna Kracun
School of Behavioral Sciences, Liberty University
CASE STUDY JEFF 2
Client Concerns
Symptoms
Behaviors
Stressors
Feeling Sad
In a depressive state, four to
five episode of major
depression lasting about
seven to eight months each
time
He went through a divorce
from his wife
Fatigue
Not being able to sleep
In a depressive state
Loss of Appetite
He lost about twenty to thirty
pounds
In a depressive state
Heavily Drinking
The amount he was drinking
doubled in the last eighteen
months, can not go more than
ten hours without a drink
He always drank alcohol, but
it got worse after his wife left
Having Suicidal Thoughts
Having thoughts that it would
be better off if he was dead,
and thinking about how he
would do it
In a depressive state
Going Through Withdrawal
While at work he was craving
alcohol throughout the whole
After the divorce he increased
the amount of alcohol he was
CASE STUDY JEFF 3
shift, and he had to go home
and drink before he was able
to go to dinner, having a
headache, being hungover
drinking, so he started to
crave it
Feeling Hopeless
Contributing to his suicidal
thoughts
In a depressive state
Assessment
Within the last one hundred and sixty eight months Jeff has experienced signs and
symptoms of Major Depressive Disorder, and Alcohol Use Disorder. Jeff reported having trouble
sleeping, having suicidal thoughts, losing weight because he is not eating, and heavily drinking.
Jeff is a thirty three year old father who has recently gone through a divorce and now does not
get to see his children often. Jeff was arrested and charged for assault on his ex-wife because he
was so intoxicated, but he continues to drink thinking there is nothing wrong with the amount of
alcohol he is intaking. When doing research it was found that alcohol can intensify the symptoms
of depression because alcohol is a natural depressant (Zhu et al., 2020).
Diagnostic Impression
Signs and Symptoms
ICD-10 code F10.20 Severe,
Alcohol Use Disorder. Criterion A:
Must have at least two of the
symptoms in the last twelve months.
Client's Signs/Reported Symptoms:
Jeff showed both signs and eleven of the symptoms of
alcohol use, which puts him in the severe category.
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Alcohol is drunk in larger amounts
for a longer time period.
The amount of alcohol Jeff was drinking increased from
four to five beers without hard liquor to six to eight
beers with a few shots of hard liquor.
A desire or unsuccessful attempts to
try and control the amount of
alcohol consumed or trying to stop
drinking alcohol.
Jeff has gotten treatment before but refuses to admit he
has a problem with it, so he continues to drink.
Spending time in activities that
involved alcohol.
Jeff enjoys going out to drink with his friends and
family.
Failing to meet work requirements
due to alcohol use.
Jeff showed up late to work, and smelled like alcohol.
When drug tested at work he had high blood alcohol
levels. He has also been suspended three times.
Craving alcohol or having a strong
urge to use it.
Jeff would leave work early to go home and drink. He
also drank before going to dinner with his co-workers.
Continuing to drink even when it
leads to social or interpersonal
problems.
Jeff had material issues with his wife when he assaulted
her and problems with his children, but he still
continues to drink.
Giving up social, work related, or in
pleasurable activities because of
alcohol use.
Jeff does not get to see his children as much as he did
before because his ex-wife does not want him drunk or
even drinking around the children, and he prefers to
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drink.
Using Alcohol over and over in
situations that could be dangerous.
Jeff has shown up to work drunk and hungover before.
With the job in construction that he has it could be
dangerous.
Continuing to use alcohol despite
knowing the negative effects it
could have and the damage that
could be caused by alcohol.
Jeff has seen a counselor and has been made aware of
the damage, and he chose to stop the treatment because
of that.
Building up a tolerance.
Jeff is drinking more but he does not feel like he is
getting drunk like he was before.
Going through withdrawal.
Jeff is having symptoms of fatigue, headache, cravings,
being hungover, and needs a drink to get through the
day.
ICD-10 code F33.1 Moderate, Major
Depressive Disorder.Criterion A: Five or
more symptoms during the same two week
time period.
Client's Signs/Reported Symptoms:
Jeff showed both signs and seven of the
symptoms.
Experiencing a depressive state in your mood
Jeff stated he feels sad, and feels low most of
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almost everyday in the last two weeks.
the day which can last for weeks at a time.
Lack of interest or pleasure in the activities
that they used to enjoy.
Jeff stated he lost interest in the activities he
usually enjoys doing.
Significant weight gain or loss without trying
to change your weight.
Jeff has a loss of appetite, and stated he lost
twenty five to thirty pounds during the times
where he was feeling sad.
Insomnia nearly everyday
Jeff stays awake most nights until about two
in the morning.
Experiencing agitation or retardation
Jeff did not report having this symptom.
Having fatigue or loss on energy
Jeff feels fatigue no matter how many hours
of sleep he gets a night.
Having feelings of guilt or worthlessness
Jeff reported feeling worthless.
Unable to concentrate or think normally
Jeff did not report having this symptom.
Having suicidal ideation, or constant recurring
thoughts of dying.
Jeff has had thought about committing suicide
and had a plan to do such.
Criterion B: Symptoms cause clinically
significant distress or impairment. In social,
or work related areas.
Jeff shows up late to work and leaves early.
He is now divorced and chooses alcohol over
seeing his children.
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Criterion C: The depressive episodes are not
attributed to the effects of substances or other
medical conditions.
Jeff drinks alcohol but he reported having
symptoms prior to drinking the way he
currently does.
Criterion D: Experienced at least one episode
that is not explained by schizophrenia.
Jeff reported having no signs of a
schizophrenia episode.
Criterion E: Never had a manic episode.
Jeff reports that he has never had any
psychotic or manic symptoms.
Other DSM-5-TR Conditions Considered
The other disorder that was considered was ICD-10 code F34.1 persistent depressive
disorder. This was considered because he stated he was feeling sad for the majority of his adult
life and these feelings started when he was about fifteen years old. Jeff stated that the symptoms
he was experiencing did not meet the requirements for major depressive disorder until about two
months after his life left him. That means these symptoms would have started around sixteen
months ago, which does not meet the requirements for persistent depressive disorder because the
symptoms have to be present for two or more years. Jeff also stated that these symptoms are not
constant; they come and go in waves, which means he could feel good for a few months at a
time.
CASE STUDY JEFF 8
Developmental Theories and/or Systemic Factors
When looking at Erik Erikson’s stages of development, the first time Jeff was made
aware of alcohol was when he was about seven years old. At this time Jeff was in stage four
which is the industry versus inferiority stage. During this stage family members, caregivers, and
household members are the center of your social life (MSEd, 2022). So, in this case Jeff would
have been paying attention to his family's behaviors which could have an effect on his
development. Based on research when a parent exposes alcohol to their child then they are at risk
for serious health concerns, and it could also hurt their development (Chu et al., 2022).
Adolescents watching their parents drink could normalize the behavior and make them feel that
no matter the amount or frequency of which you consume alcohol there is nothing wrong.
Multicultural and/or Social Justice Considerations
After reading Jeff’s case study it was concluded that the way his family raised him when
he was a child played a big role in his current mental health and the reason he normalized his
alcohol consumption. Jeff’s father drank his entire life and then Jeff was given a beer by his
father when he was about seven years old. Then he was given alcohol by his brothers because he
was told that's what “men do.” Now that Jeff is an adult he continues to drink an excessive
amount with his brothers, father, and his sister's husband. However, one of Jeff’s brothers did
cutt everyone on the family off due to the excessive drinking and told them he is not to have a
relationship with any of them until they become sober. Jeff also has two children who he does
not get to see often, and his ex-wife who left him because of his drinking, and the abuse she
experienced when he was drunk. With all of this information and using the model acronym
RESPECTFUL, family background and history would be at the top in Jeff’s case. When Jeff was
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a child his father made drinking alcohol everyday seem normal and he encouraged his child to
use the substance. Since Jeff was only about seven years old at the time this could affect his
growth, and brain development. Substance use is a learned behavior so this could explain why
even not what happens is that Jeff sees nothing wrong with drinking and does not want to get
help or stop even if that means he does not get to be a good father to his own children. Jeff’s
mother was feeling sad his whole life and was depressed. Research has shown that depression
could be genetic and if the parent has symptoms then the child is at risk for these symptoms
being present for them as well (Deng, X et al,. 2018).
Treatment Recommendations
Key Issues for Treatment
●The suicidal ideations he has been experiencing.
●The amount of alcohol he is intaking.
●The sudden weight loss.
●The fact he self-medicates with alcohol.
Recommendations for Individual Counseling
In Jeff’s case it will be important to focus on his alcohol intake because that seems to be
what is causing him the most problems currently, and affecting his life in a negative way. So,
when doing research it was found that when treating substance abuse disorders that using
dialectical behavioral therapy (DBT) was a good fit (Maffei, 2018). This therapy focuses on
reducing the substance use, managing the uncomfortableness from withdrawals, reducing
cravings, avoiding triggers, building and coping skills. Something that could be utilized in
conjunction with the therapy is a twelve step program like AA. This would just provide extra
support to the therapeutic intervention they are receiving. It could be done in an individual or
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group setting, and help the client feel less alone, supported, and working on improving and
targeting the things we are already working on in therapy (Arenas, 2021). As far as medications
go for Jeff it would not be a good idea in his case. When mixing alcohol and medications it can
be dangerous and have other negative effects like him becoming addicted to a new substance.
Jeff might eventually need to be placed on an antidepressant because he is always feeling sad and
does meet the requirements for depression. However, alcohol is a depressant so some of the
symptoms might decrease as he is going through treatment to help with his addiction.
Specific Considerations
Having more than one disorder can affect the diagnostic impression, the decision process,
and the treatment planning. This is because there has to be a decision made on which one has the
highest urgency, if it is possible to work symptoms that are similar together, and how to make
progress to make a change in their life. It is important to treat the most life altering disorder or
symptoms that he is having first. For example you would not treat a client's anxiety before you
would treat their suicidal idealtion with actual danger of them committing suicide. But it is
possible to treat more than one disorder at a time if they have similar or simultaneous symptoms.
Substance use disorder can also affect the diagnostic impression, and the order of treatment
recommendations. In Jeff’s case you can not mix most medications with alcohol so medically we
could not treat another diagnosis of his if he is unable to stay sober. Another important factor
with that substance can cause a lot of symptoms which could appear to fall under different
disorders. So, it would be important to treat the substance use in a way that allows for the
diagnosis and symptoms from alcohol use and the spymots that could be contributed to other
disorders.
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References
Arenas, J. A. (2021). Alcohol and the brain: Recovery benefits of 12 step facilitation MSEd, K.
C. (2022). Industry vs. Inferiority in Psychosocial Development. Verywell Mind.
https://www.verywellmind.com/industry-versus-inferiority-2795736
Chu, J. T. W., McCormack, J., Marsh, S., Wells, A., Wilson, H., & Bullen, C. (2022). Impact of
prenatal alcohol exposure on neurodevelopmental outcomes: A systematic review. Health
Psychology and Behavioral Medicine, 10 (1), 973-1002.
https://doi.org/10.1080/21642850.2022.2129653
Deng, X., & Song, J. (2018). Correlation analysis between depression and family fitness in
chronic obstructive pulmonary disease inpatients: A cross-sectional study. Medicine
(Baltimore), 97 (52), e13946-e13946. https://doi.org/10.1097/MD.0000000000013946
Maffei, C., Cavicchioli, M., Movalli, M., Cavallaro, R., & Fossati, A. (2018). Dialectical
behavior therapy skills training in alcohol dependence treatment: Findings based on an
open trial. Substance use & Misuse, 53 (14), 2368- 2385.
https://doi.org/10.1080/10826084.2018.1480035
Zhu, C., Chen, Q., Si, W., Li, Y., Chen, G., & Zhao, Q. (2020). Alcohol use and depression: A
mendelian randomization study from china. Frontiers in Genetics, 11,
585351-585351.https://doi.org/10.3389/fgene.2020.585351
