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JEFF
Case Study Assignment: Jeff
Sydney Clayton
School of Behavioral Sciences, Liberty University
Author Note
Sydney Clayton.
I have no known conflict of interest to disclose.
Correspondence concerning this article should be addressed to Sydney Clayton.
Email: [email protected]
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JEFF
Case Study: Jeff
Symptoms Behaviors Stressors
Major sadness and
depression
Excessive drinking Possibility of losing job
Headaches Aggressive behavior towards ex
wife
Divorce from ex wife
Fatigue Constantly late to work No relationship with family (ex
and kids)
No appetite Receiving two DUIs --
Feeling hopeless Suspended for failing a blood
alcohol test
--
Suicidal thoughts Desire for alcohol after about
10 hrs without a drink
--
Client Concerns
Assessment
In this specific situation, it would be best to use the Alcohol Use Disorder Identification
Test (AUDIT) to assess Jeff. Created by the World Health Organization (WHO), this assessment
includes 10 questions and is known for being user-friendly for both counselors and clients. By
evaluating Jeff's alcohol use and drinking habits, the AUDIT will offer valuable information and
a better understanding of his patterns of alcohol consumption (Hingson et al., 2017).
Diagnostic Impression
Jeff has a diagnosis of Severe Alcohol Use Disorder 303.90 (F10.21) in addition to Major
Depressive Disorder 296.36 (F33.42) as found in the APA Code (American Psychiatric
Association, 2013).
Signs and Symptoms
DSM Letter/Number DSM-5-TR Diagnostic Criteria:
Alcohol Use Disorder F10.21
Client Reported
Symptoms:
A Over the course of a year, a
concerning pattern of alcohol use
The client meets three or
more criteria
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JEFF
develops, leading to significant
impairment or distress that is
clinically relevant. As indicated by
the presence of at least two of the
following:
A1 The consumption of alcohol often
surpasses the intended quantity or
length of time.
Currently, the person is
drinking more alcohol on
weekdays than intended.
A2 There exists a continual longing or
ineffective attempts to reduce or
manage alcohol consumption.
Never considered drinking
less.
A3 Much time is dedicated to engaging
in tasks required to acquire alcohol,
consume alcohol, or recuperate from
its consequences.
Oversleeping, pre-dinner
drinks with co-workers, and
a weekend of drinking and
time off from work.
A4 The strong desire or overwhelming
urge to drink alcohol.
Intense beverage craving
after 10-hour work shift
without alcohol.
A5 Repeated consumption of alcohol
leading to an inability to meet
responsibilities at work, school, or
personal life.
Alcohol abuse causing
domestic violence, job loss,
and marital separation.
A6 The ongoing use of alcohol
exacerbates and prolongs social or
interpersonal problems that arise
from its consumption.
Despite the job loss risk, the
person persists in drinking
alcohol, leading their ex-
wife to threaten child
visitation revocation.
A7 Drinking alcohol can cause people
to neglect or reduce their
involvement in important social,
work, or leisure activities.
The person's heavy drinking
is keeping him from being
with his children and risking
his job with frequent
tardiness from hangovers.
A8 Consistent alcohol consumption in
situations that present a physical
danger.
DUIs endanger lives on the
road.
A9 Even though they know that alcohol
is likely contributing to their
ongoing physical or psychological
issues, individuals persist in
consuming it.
Hangovers are characterized
by fatigue, melancholy, and
throbbing headaches.
A10 Tolerance can be defined in one of
the following ways:
Deepened empathy.
a It is clear that a larger amount of
alcohol is needed to achieve
intoxication or the desired effect.
In the past 18 months, his
alcohol consumption has
increased from 4-5 beers to
6-8 beers to get drunk.
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JEFF
b Despite consistently consuming the
same quantity, the prolonged
consumption of alcohol results in a
noticeable decrease in its
effectiveness.
The person now needs to
drink more alcohol to get
drunk than they did a year
and a half ago.
A11 The presence of any of the
following manifestations can
indicate withdrawal:
Yes
a Withdrawal syndrome is associated
with alcohol is characterized by
specific symptoms outlined in
Criteria A and B of the criteria set
for alcohol withdrawal.
Withdrawal
b Alcohol (or a related substance like
a benzodiazepine) is used to relieve
or prevent the occurrence of
withdrawal symptoms.
Once he goes without
drinking any liquids for 10
hours, he becomes acutely
conscious that his mind is
solely focused on satisfying
his thirst.
(American Psychiatric Association, 2013)
DSM Letter/Number DSM-5-TR Diagnostic Criteria:
Major Depressive Disorder F33.42
Client Reported
Symptoms:
A In a 14-day period, at least 5
symptoms, including persistent
sadness or decreased interest, must
be observed, indicating a change
from the person's usual functioning.
Jeff is currently
experiencing 5 or more
symptoms for over 2 weeks,
including persistent sadness
and lack of interest in
activities.
A1 An individual often feels sad,
empty, or hopeless most days, as
reported by themselves or observed
by others.
Experiencing daily
melancholy, the
despondency is evident to
all.
A2 Loss of interest or pleasure in daily
activities, persisting most of the day,
nearly every day.
He no longer enjoys the
activities he used to love,
feeling deeply hopeless.
A3 Rapid weight changes without
dieting or changes in appetite.
The person lost 25-30
pounds in 8 months due to a
total loss of appetite.
A5 Others can observe if someone is
moving too quickly or too slowly on
a daily basis.
Feeling easily annoyed.
A6 Daily fatigue or lack of energy. I wake up tired most
mornings.
A7 Persistent feelings of inadequacy or
overwhelming guilt on a daily basis,
Feeling daily guilt
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JEFF
possibly delusional.
A8 Daily cognitive challenges or focus
issues, self-reported or observed by
others.
Challenged to complete
daily tasks
A9 Recurring thoughts of mortality,
self-harm without a plan, or actual
self-harm.
Planned to end his life.
B The symptoms cause significant
distress or impairment in important
areas of life.
Separates from loved ones,
faces work challenges.
C The episode is not caused by any
substance or medical condition.
D The depressive episode is not
caused by any schizophrenia-related
disorders.
Not explained by other
psychotic disorders.
E No manic or hypomanic episodes
have occurred, unless caused by
substance use or another medical
condition.
More research is required to
establish if manic episodes
preceded or resulted from
substance abuse.
(American Psychiatric Association, 2013)
Differential Diagnosis
Additional factors to consider for exclusion are Persistent Depressive Disorder, if the
symptoms have not persisted for a continuous one-year duration, and Substance/Medication-
Induced Depressive Disorder, if the depressive symptoms cannot be linked to alcohol use. The
client has reported experiencing periods of sadness regardless of alcohol consumption. It is
noteworthy that the client has been consuming alcohol more frequently over the past two years
and has not experienced a major depressive episode.
Jeff's addiction is a result of a combination of genetic predisposition and environmental
influences. The textbook states that genetic and shared environmental factors contribute to
alcohol use (Glaesmer et al., 2018). Jeff began drinking at a young age with his father and other
family members, as it was a common practice within his family. Furthermore, his work
environment and social circle have also contributed to the normalization of drinking behavior.
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JEFF
Treatment
Key Issues
Suicidal thoughts
Use of alcohol
Depression
Jeff's suicidal thoughts seem to arise only during periods of depression. To prevent any
further inclination towards self-harm, it is crucial for the counselor to delve deeper into this
issue. Additionally, the counselor should address Jeff's alcohol consumption. It is important to
establish a connection with Jeff without passing judgment, as he tends to become defensive when
confronted about his drinking habits. Collaborating with Jeff to help him maintain his job is
essential, as it will provide him with a sense of purpose and reduce his resistance to making
positive changes.
Jeff is in denial about his issues, which has led to work-related problems and the
breakdown of his marriage due to physical abuse. It is crucial for therapy sessions to focus on
helping Jeff realize what he is missing out on in life. Research by Spithoff & Kahan (2015)
highlights the importance of a strong relationship between the counselor and the client for
effective change. They also emphasize the need to address barriers, avoid triggers, and establish
a support network. Motivational Enhancement Therapy has shown success in helping individuals
with alcohol dependency acknowledge their problems (Hershow et al., 2021). Additionally,
Cognitive Behavioral Therapy and MET have been beneficial for clients dealing with alcohol
dependency and depression (Curtiss et. al 2021).
Specific Considerations
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The top priority should be addressing the most pressing issue, which is Jeff's dual
diagnosis and suicidal thoughts. It is essential to ensure his safety and prevent any potential self-
harm. Following that, it may be beneficial to focus on Jeff's alcohol problem to help him
maintain his job. Setting goals, providing education on his health, and offering various options
could be an effective approach. Implementing cognitive-behavioral therapy (CBT) and
motivational enhancement therapy (MET) after a few sessions may help Jeff become more self-
aware and assist with his depression. Accurately diagnosing Jeff can be challenging due to the
potential connection between depression and alcohol use. It is possible that his sadness is linked
to drinking, or that alcohol worsens his depressive symptoms. In a case study by Gamble (2013),
a combination of solution-focused brief therapy and fluoxetine prescription for an alcohol-
dependent and depressed client led to a significant decrease in depression levels after 4 months
of treatment, with the client able to abstain from alcohol.
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References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders
(DSM-5). American Psychiatric Publishing.
Curtiss, J. E., Wallace, B., Fisher, L. B., Nyer, M., Jain, F., Cusin, C., & Pedrelli, P. (2021).
Change processes in cognitive behavioral therapy and motivational interviewing for
depression and heavy alcohol use: A network approach.FJournal of affective disorders
reports. https://doi.org/10.1016/j.jadr.2020.100040
Gamble SA, Talbot NL, Cashman-Brown SM, et al. (2013). A Pilot Study of Interpersonal
Psychotherapy for Alcohol-Dependent Women with Co-Occurring Major Depression.
Sage Journals. doi:10.1080/08897077.2012.746950
Glaesmer, H., Kapusta, N. D., Teismann, T., Wagner, B., Hallensleben, N., Spangenberg, L., &
Forkmann, T. (2018). [Psychometric Properties of the German Version of the Suicide
Behaviors Questionnaire Revised (SBQ-R)].FPsychotherapie, Psychosomatik,
medizinische Psychologie. https://doi.org/10.1055/s-0043-118335
Hershow, R. B., Reyes, H. L. M. N., Ha, T. V., Chander, G., Mai, N. V. T., Sripaipan, T., Dowdy,
D. W., Latkin, C., Hutton, H. E., Pettifor, A., Maman, S., Frangakis, C., & Go, V. F.
(2021). Evaluating the effects of two alcohol reduction counseling interventions on
intimate partner violence perpetration: secondary analysis of a three-arm randomized
controlled trial among Vietnamese men with HIV.FAddiction (Abingdon, England).
https://doi.org/10.1111/add.15496
Hingson, R., Zha, W., & Smyth, D. (2017). Magnitude and Trends in Heavy Episodic Drinking,
Alcohol-Impaired Driving, and Alcohol-Related Mortality and Overdose Hospitalizations
