Jeff Case Study 1
Jeff Case Study
BY
Department of Counselor Education and Family Studies, Liberty University
Author Note
I have no known conflict of interest to disclose.
Correspondence concerning this article should be addressed to Student Name
liberty.edu
Jeff Case Study
Client Concerns
Symptoms Behaviors Stressors
Daily consumption of
alcohol
Consumes from 4-7 beers
workdays, and 6-8 beers on
weekends, including shots
of hard liquor
He has been informed that
he would be fired from his
job if he does not stop
drinking
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Increased need for more
alcohol
Involved in domestic
violence against his exwife
Divorced from his wife
Challenges maintaining his
thought due to drinking
alcohol
Working wjile under the
influence of alcohol.
Experincing strained
relationship with his
children and wife. Children
are in the sustody of the
ex-wife.
Increased hours of recovery
after drinking alcohol
Have custody of his
children while intoxicated
Reports of his ex wife
getting married
Challenges getting out of
bed after a night of
drinking
History of lateness to work
and missing work due to
drinking
Longer works days such as
staying 10-12 days at worj a
time.
Experienced sadness which
lasted 2 for months after his
wife left him
Experinces of sad times
which lasted 7-8 months
His days off froom work
could be Only works at
home for 4-5 days at a time
Loss of interest in normal
activities
Constarined
communication with his
children due to strained
relationship with his ex
wife
Experiencing extreme
fatigue
Jeff believe that alcohol
consumption makes you a
strong and bold man
A loss of appetite Weight loss (25-30 pounds)
Suicidal ideations and plans
Experiences of irritability
Assessment Jeff Case Study
The first recommended assessment for Jeff’s case will be the Alcohol Use Disorders
Identification Test (AUDIT). This assessment is a questionnaire that contains ten multiple-choice
questions designed to collect information on an individual’s drinking habits, effects, and
alcoholrelated issues. The assessment is self-administered and self-explanatory. A score of eight
Jeff Case Study 3
or more points indicates a possibility of Alcohol Use Disorder. Verhoog et al. (2020) conducted a
study on the use of AUDIT, comparing adults and students in higher education.
A similar test, AUDIT-C, which has a clear advantage because of its brevity, was also
authored by Verhoog et al. (2020) and was primarily designed to identify students who are in
need of further alcohol assessments and, secondarily, an assessment that requires targeted
interventions. As Jeff’s counselor, Jeff will be recommended to complete both versions of the
test to help assess Jeff’s daily consumption of alcohol and manage his symptoms of distress.
In addition to the AUDIT, Jeff would also be advised to complete the Alcohol, Smoking,
and Substance Involvement Screening Test (ASSIST). This tool will be helpful in screening low,
moderate, and high risks of substance use (Humeniuk & Ali, 2010). This assessment is an
eightquestion questionnaire that is easy to administer to clients. Another valuable tool in Jeff’s
case is Beck’s Depression Inventory, which will be used to assess Jeff’s symptoms of sadness,
loss of interest in everyday activities, extreme fatigue, loss of appetite, difficulty getting out of
bed, and suicidal ideation and plan. In addition to the mentioned assessment tools, the PHQ-9
or the Severity Measure for Depression-Adult tests would be helpful to test the levels of Jeff’s
symptoms for depression.
Diagnostic Impression
Alcohol Use Disorder (F10.20) and Major Depressive Disorder (F32.9)
Signs and Symptoms
DSM-5-TR Diagnostic Criteria: Alcohol Use
Disorder (F10.20) and Major Depressive
Disorder (F32.9)
Client’s Signs/Reported Symptoms:
Criterion A:
Feelings of depressed mood lasting all day.
Client reports feeling sad daily, reporting “sad
times” lasting for seven-eight months at a
time
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Criterion B:
No interest in engaging in normal activities.
Client report loss of interest in engaging in
normal activities. He reports his only interest
is drinking alcohol.
Criterion C: Significant weight loss Client reports weight loss of 25-30 pounds
and a loss of appetite
Criterion D: Daily extreme fatigue Client reports experiencing extreme fatigue
almost every day, including inability to get out
of bed to go to work due to loss of energy.
Client report that he never felt rested despite
hours of sleeping.
Criterion E: Recurrent suicidal ideation and
planning.
Client reports thoughts of ending his life and
also reports having a plan in place, however,
he hasn’t acted on the plan.
Criterion F: Consumption of alcohol in large
amounts.
Client reports consuming 6-8 bottles of beers
daily in addition to shots of liquor.
Criterion G: No plan to reduce alcohol
consumption
Client reports he doesn’t have a need to
reduce the amount of alcohol he consumes
daily. He reports he attended AA briefly.
Criterion H: Increased need to consume
alcohol on a daily basis
Client reports constant craving to drink
alcohol. His thoughts are centered on
consuming alcohol.
Criterion I: Poor work performances Client reports getting arriving late to work
and poor work performance due to alcohol
use. He also reports a decreased level of
socializing with friends or colleagues.
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Criterion J:
Strained relationship due to impacts of
alcohol consumption
Client reports a continuous use of alcohol
despite reoccurring problems
Related to his alcohol consumption. These
concerns have been raised by his family,
friends and his supervisors. He reports he has
been informed by his supervisor of the
possibility of being fired if he doesn’t stop
consuming alcohol.
Criterion K: Developed high alcohol tolerance Client reports that he has developed high
tolerance for alcohol, because his intake has
increased from drinking 4-8 bottles daily to 68
bottles of beers including liquor shots.
Other DSM-5-TR Conditions Considered
In addition to the identified diagnosis, other conditions were considered in Jeff’s case,
such as Substance/Medication-Induced Depressive Disorder. This condition was considered
because of the reported symptoms, such as daily consumption of alcohol, feelings of sadness
daily, no interest in everyday activities, loss of appetite, extreme fatigue, irritability, and suicidal
ideation. However, the reported symptoms do not meet the full criteria to diagnose Jeff with
Substance/Medication-Induced Depressive Disorder. Jeff’s ineligibility to meet the required
criteria of Substance/Medication-Induced Depressive Disorder is based partly on a lack of
information about Jeff’s physical status.
The client reported feelings of “sad times” when he was actively experiencing depressive
symptoms. Jeff reported that these periods occurred three to four times and lasted for seven to
eight months at a time. This was considered to be a possible episode of manic-depression;
however, this consideration was ruled out due to not entirely fitting into bipolar disorders or a
manic/hypomanic episode.
Jeff Case Study 6
Developmental Theories and/or Systemic Factors
Jeff is divorced from his wife, and his ex-wife is the primary custodian of the children. Jeff
also mentioned that his ex-wife is getting married again. Jeff reported that his relationship with
his ex-wife was not a cordial and peaceful one, including cases of domestic violence leading to
jail time. Jeff reported challenges communicating with his ex-wife, which has led to him
spending less time with his children.
Jeff reports signing up for Alcoholics Anonymous meetings with hopes that his wife
would come back to him, but when he realized that his wife was not coming back home, he
stopped attending and started drinking more than he used to before joining AA. Jeff is
considered to be in the sixth stage of Erikson’s Stages of Development. In this stage, people are
working to find their paths, developing relationships, forming intimacy, or isolating themselves.
Jeff is considered to be in this stage because he has established a relationship with his
family, and he appears to care about and value his job and relationships at work, which he
mentioned are very important to him. According to Gunderman (2022), “humans need
relationships, appropriate educational settings, work environment; a lack of these needs could
result in people becoming isolated and angry. Jeff reports being isolated from his immediate and
extended family members, which could lead to feelings of loneliness. Jeff’s loneliness could
influence his level of sadness, little or no interest in everyday activities, and intense suicidal
ideation.
Multicultural and/or Social Justice Considerations
Religious/Spiritual: Jeff reports growing up as a Baptist; however, he reports he has not
attended church since his grandmother’s funeral. Jeff also reports that he does not welcome the
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inclusion of a spiritual/biblical approach in his counseling sessions with the counselor at this
time.
Family background history: Jeff reports he started drinking alcohol with his father and
brothers at the age of seven years old. He reports that his father and brothers consumed alcohol
daily in large quantities, which lasted for an extended period. Jeff reports having a strained
relationship with one of his brothers, who does not drink and has isolated himself from their
family due to their habit of drinking alcohol. There is a possibility of alcohol addiction and
depression in Jeff’s family because he reported a history of his mother being a “sad kind of
woman.”
Treatment Recommendations
Key Issues for Treatment
•Suicidal ideation
•Feelings of sadness
•Weight loss (25-30 pounds) due to a loss in appetite,
•Daily consumption of alcohol
•Challenges stopping alcohol use
Recommendations for Individual Counseling
Jeff reported the high consumption of alcohol, feelings of sadness, extreme fatigue, loss
of interest in everyday activities, suicidal ideation, and a plan to carry out his suicidal thoughts.
Jeff reports a history of domestic violence with his ex-wife, which led to jail time, all of which is
a result of the excessive consumption of alcohol. Jeff also expressed active suicidal ideation and
has a plan in place on how he will act on his thoughts. With these, Jeff is considered high risk,
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although he does not have any thoughts of harming other people, but he is considered to be at
risk to himself; therefore, an inpatient treatment would be recommended.
The use of a Solution-Focused Brief Therapy could be helpful in the treatment of Alcohol
Use Disorder. According to the findings from González, et. al (2019), “solution-focused brief
Therapy (SFBT) is effective for treating patients with AUDs, and level one alcohol users with
comorbid depressive symptoms.” In addition to these findings, González, et. al (2019) posit that
there is potential for growth relating to treating AUD in primary care settings.
Utilizing a Solution-Focused Brief Therapy may seem challenging in Jeff’s case because
the fear of losing his job drives his compliance. Jeff reports that he was recommended to seek
help to avoid losing his job. Another recommendation would be the use of Cognitive Behavioral
Therapy (CBT). CBT is a technique proven to be effective in treating alcoholism and mental
disorders such as depression and anxiety that have comorbidity with SUD. Sannibale et al.
(2013) also posited that the use of the Cognitive Behavioral Therapy technique was effective in
managing alcohol use, negative moods, traumatic events, high-risk situations, coping with
cravings/urges, etc. Jeff would benefit from using Cognitive Behavioral Therapy.
Specific Considerations
Several factors influence the decision-making process for obtaining a diagnostic
impression and treatment; therefore, it is crucial to ensure that the selected treatment plan
encompasses a comprehensive plan that addresses all diagnoses, as seen in Jeff’s case. As
recommended by Treichler et al (2021), “treatment planning processes are a fundamental
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component of evidence-based practice in mental health for people with serious mental illness
(SMI), who often present with complex concerns and require an interdisciplinary treatment
team.” This is crucial to avoid the possibility of selecting a treatment plan that only addresses
one part of the diagnosis; instead, it is pertinent that selected treatment plans should address
all parts of the diagnosis.
The appropriate treatment approach considered to be most effective in addressing Jeff’s
case would be to address the use of alcohol. In Jeff’s case, it could be challenging for him to
maintain focus due to his high level of alcohol consumption. The alcohol use needs to be
worked with first in order to create a calmer, more open environment for Jeff to learn and grow.
Brewer & Hulvershorn (2017) found that patients who have internalizing and externalizing
disorders are prone to the use of substances, non-responsive to treatment, and have a greater
relapse rate.
The next step in the treatment plan would be to address Jeff’s suicidal ideation, which is
causing him to be a high-risk patient. Major Depressive Disorder and Alcohol Use Disorder could
be influencing factors of Jeff’s suicidal ideations; therefore, to address the depression and
suicidal thoughts, the counselor will work closely with Jeff to identify the importance of
reducing the amount of alcohol consumed daily, with the ultimate goal of getting Jeff to become
sober.
References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders.
American psychiatric association.
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Brewer, S., Godley, M. D., & Hulvershorn, L. A. (2017). Treating mental health and substance use
disorders in adolescents: what is on the menu?. Current psychiatry reports, 19(1), 5.
González Suitt, K., Geraldo, P., Estay, M., & Franklin, C. (2019). Solution-focused brief therapy for
individuals with alcohol use disorders in Chile. Research on Social Work Practice, 29(1),
19-35.
Humeniuk, R., & Ali, R. (2006). Validation of the Alcohol, Smoking and Substance Involvement
Screening Test (ASSIST) and pilot brief intervention: a technical report of phase II findings
of the WHO ASSIST Project. In Validation of the alcohol, smoking and substance
involvement screening test (ASSIST) and pilot brief intervention: a technical report of
phase II findings of the WHO ASSIST Project.
Sannibale, C., Teesson, M., Creamer, M., Sitharthan, T., Bryant, R. A., Sutherland, K., ... & Peek‐
O'Leary, M. (2013). Randomized controlled trial of cognitive behaviour therapy for
comorbid post traumatic stress disorder and alcohol use disorders.‐ Addiction, 108(8),
1397-1410.
Treichler, E. B., Evans, E. A., & Spaulding, W. D. (2021). Ideal and real treatment planning
processes for people with serious mental illness in public mental health care.
Psychological Services, 18(1), 93.
Verhoog, S., Dopmeijer, J. M., de Jonge, J. M., van der Heijde, C. M., Vonk, P., Bovens, R.
H., ... & Kuipers, M. A. (2020). The use of the alcohol use disorders identification test–
Consumption as an indicator of hazardous alcohol use among university students.
European addiction research, 26(1), 1-9.
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