CASE STUDY JEFF
Case Study Jeff
David J Popick
Liberty University
Author Note
I have no known conflict of interest to disclose.
Correspondence concerning this article should be addressed to David J
Popick Email: DJPopick@liberty.edu
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CASE STUDY JEFF
Client Concerns
Symptoms
Sadness
Inflated Sense of Self
Mood Swings (Manic),
Feeling ‘high’
Auditory Hallucinations
Lack of Enjoyment in
Normal Activities
Feeling Worthless/Hopeless
Fatigue/Lethargic Feelings
Suicidal thoughts/depressed
mood
Behaviors
No appetite, feeling
lethargic, difficulty
concentrating
Sleeping, no
appetite, suicidal
ideations
Writing novel for 10 hrs. a
Working on novel and
screenplay for over 10 hrs. a
day. Believing she is the
greatest author ever.
Hysterical/Crying
Uncontrollably.
Crying uncontrollably quite
often.
Lack of sleep or sleeping
12-13 hours a day
Researching painless
Suicides methods. Figuring a
plan but not a set date.
2
Stressors
Strained relationships
with family. Better
relations with mother
and stepfather than
father and stepmother.
Mood changes, grades,
strained relationships
Fear of not finishing
graduate program, fear
that
family and friends would
be better off if she were
dead
Fear that family and
friends would be better
off if she were dead.
Concerned her professors
Would not be able to
help her.
Mood swings, lack of
sleep
Writing her novel, lack of
sleep
How her depressed mood
is impacting her
friendships
Fear of not finishing
graduate program.
CASE STUDY JEFF
Criterion E- Needs increased amounts of
Alcohol (APA, 2022).
Criterion for MDD F33.1
Criterion F: Depressed over 2-week span
day, completing
housework, socializing.
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He admitted he needs more alcohol now than
18 months ago to feel even buzzed. He has
increased his consumption so he can feel
buzzed on work nights and even more on days
off.
Client’s Signs/Reported Symptoms:
Feels symptoms for 7–8-month spans. Has
Assessment
The AUDIT test which is 97% effective, quick to administer, and easy to use (Moussas et
al 2009). I think this test will confirm what the test shows. This test covers dependance,
consumption and alcohol related harm. Since Jeff seems honest about family history and use of
alcohol, it will confirm his statements and help with his treatment plan. Jeff seems to revolve
around the use of alcohol, and it seems to control him.
Diagnostic Impression/Signs and Symptoms
DSM-5 TR Diagnostic Criteria: Alcohol Client’s Signs/Reported Symptoms:
Use Disorder F10.20
with Major Depressive Disorder F33.1 (APA,
2022).
Criterion A- Alcohol taken in larger amounts5-7 beers to feel buzzed and 4-6 shots more
(APA, 2022).than 18 months ago
Criterion B- Unsuccessful effort to cut downAttended AA and counseling but quit after 4
use (APA, 2022).months when his marriage fell apart.
Criterion C- Failure to fulfill work obligationsShowing up late to work at least once a week
and still being impaired by alcohol when
(APA, 2022).arriving at work.
Criterion D- Recurrent physical problemHitting his wife several times and being
arrested for domestic violence and recurring
exacerbated by alcoholhangovers in the morning after drinking.
Sleeping long periods after arriving home
(APA, 2022).late.
CASE STUDY JEFF
(APA, 2022).
Criterion G: Diminished pleasure/interest in
all or almost all activity
Criterion H: Significant weight loss (MDD)
Criterion I: Fatigue (APA, 2022).
Criterion J: Suicidal thoughts
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felt sad most of his adult life.
Does not want to socialize with his coworkers
after work.
Has lost at times 25-30 pounds
Sleeping over twelve hours some days and
still tired.
Has thoughts of suicide and even planned it.
Other DSM-5-TR Conditions Considered
Jeff reported symptoms of adjustment disorder with mixed disturbance of emotions and
conduct, DSM 5-TR 309.9 F43.25, due to the stress of his divorce. He also stated he would
drink at prior jobs before his current job. Jeff also reported these symptoms started earlier in his
life, before the divorce, so the disorder was no longer considered due to the above factors.
Developmental Theories and/or Systemic Factors
Jeff stated\ there are numerous risk factors identified that could have caused Jeff to
develop alcohol use disorder and major depressive disorder. Jeff’s told us his family history of
alcohol use and depression. Jeff explained several genetic and environmental influences that
could have contributed to his disorders. According to Edenberg and Foroud (2013), alcohol
abuse has a 45%-65% genetic factor. Jeff spoke of his first sip of alcohol when he was only
seven with his father and older brothers who were/are heavy drinkers. This social aspect could
compound his interactions with alcohol over the years. He also states that his brothers that he
communicates with are still heavy drinkers. Jeff also mentioned his mother was always sad,
which could be contributing to Jeff’s depressive symptoms and not wanting to seek help. He
stated his mother was never diagnosed with anything and has not sought help.
Multicultural and/or Social Justice Considerations
CASE STUDY JEFF5
Jeff is a white male who is ordered to counseling or risk losing his job. He claims this is
the best job he has ever had and listed some past jobs. The case study did not state what the
ethnicity of his bosses or coworkers are. Having a state job myself, I would assume he is in a
union and they are using progressive discipline. With this type of state job, I do not see race or
ethnicity being a factor, yet it could always be. If Jeff were not white, could he have been fired
sooner? I could speculate, but it would do no good. I also see that Jeff keeps friends that are
drinkers and with this subculture he may relapse and risj losing his job.
Treatment Recommendations
Key Issues for Treatment
* Alcohol use
* Depression
Recommendations for Individual Counseling
Jeff comes from a family of drinkers. When he was only seven years old, his family gave
him a beer and he has been drinking ever since. He often binge drinks and it s affecting his work
and already cost him his marriage. Kranzler and Soyka (2018) state that 50% of AUD is
hereditary and the other 50% is environment. Jeff in actuality has 100% immersion in alcohol
through friends and family. Kranzler and Soyka recommend prescription drugs and brief
counseling to aid in AUD. Their journal also specifies that Jeff’s symptom of depression can be
caused by AUD. I recommend Jeff tries AA and medication. I also would like to see him find a
different group of friends that are not drinkers.
As far as the type of therapy to help him with his AUD and depression, I recommend
CBT showed good results in reducing depressive symptoms in alcohol users (Grant et al (2021).
I think CBT is a great all-around therapy and this along with AA can help him with his alcohol
issues and then lessen his depression. I think he should also follow up with a medical doctor to
CASE STUDY JEFF6
assess the toll that alcohol use has possibly done to his body. There are four medications that
have minimal effect on AUD (Kranzler and Soyka (2018).
Specific Considerations
Jeff comes from a family of drinkers which I find concerning. He has close friends that
are drinkers as well. I also consider his and his family history of depression. I feel that his AUD
is the major causation for his depression. I would try and tackle his reasoning for drinking and
what his counseling long term goals are. I would ask him how important his job is versus
drinking. I also would monitor his depression and the suicidal ideation mentioned. I feel that if
he lost this job, his depression and drinking could escalate quickly. Jeff also stated he knows
alcohol is a depressant, yet he feels drinking is more important than his mental health. I would
also recommend he goes to an inpatient alcohol rehabilitation setting to help him with more
structure.
CASE STUDY JEFF7
References
American Psychiatric Association: Diagnostic and Statistical Manual of Mental
Disorders, (5th ed.) Text Revision. Washington, DC, APA 2022.
Edenberg, H., Foroud, T. Genetics and alcoholism. Nat Rev Gastroenterol Hepatol 10,
487–494 (2013). https://doi.org/10.1038/nrgastro.2013.86
Grant S, Azhar G, Han E, Booth M, Motala A, et al. (2021) Clinical interventions for
adults with comorbid alcohol use and depressive disorders: A systematic review and network
meta-analysis. PLOS Medicine 18(10): e1003822. https://doi.org/10.1371/journal.pmed.1003822
Kranzler HR, Soyka M. Diagnosis and Pharmacotherapy of Alcohol Use Disorder: A
Review. JAMA. 2018;320(8):815–824. doi:10.1001/jama.2018.11406 (2018)
Moussas, G., Dadouti, G., Douzenis, A. et al. The Alcohol Use Disorders Identification
Test (AUDIT): reliability and validity of the Greek version. Ann Gen Psychiatry 8, 11
(2009)
