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Jeff – Alcohol, Divorce, & Professional Limbo
Client Concerns
Symptoms Behaviors Stressors
Sadness Punctuality Divorce
Craves alcohol Alcohol Consumption Work Violations
fatigue Higher tolerance Strained sibling relationship
Weight loss Hazardous work-related
situations
Relationship with ex-wife
Loss of appetite Visitation w/Kids
Denial of problem
Assessment
The client's behavior patterns are questionable and affect every aspect of his health. A
valid assessment related to the client's condition would be the alcohol use disorders identification
test, otherwise known as AUDIT. Medical professionals utilize this assessment as a means of
identifying when a patient's alcohol use has become harmful (Higgins & Babor, 2018). In
addition to this assessment, the interview schedule, which screens for mood and anxiety
disorders, would be offered. The client's alcohol use leads to a greater degree of depressive
symptoms and behaviors. This instrument is reliable when evaluating depression and PTSD. A
separating factor with this tool is that it is designed to engage persons dealing with alcohol use,
misuse, and depression-like symptoms (Hasin et al., 2015).
Diagnostic Impressions
The client presents with severe alcohol use disorder code F10.20 and a secondary
diagnosis of major depressive disorder, recurrent episodes code F33.2.
Signs and Symptoms
DSM-5-TR Severe Alcohol Use Disorder
(F10.20)
Client’s signs/reported symptoms:
Criterion A – Problematic pattern of alcohol A.1 The client stated that in the last 18
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use manifested by at least two of the
following:
months, he has noticed that it takes more
alcohol for him to get buzzed, which is his
goal.
A.3 Jeff stated that on his days off, he will
spend time with his friends in the evening,
and they will often get intoxicated
A.4 He stated that if he works more than 10
hours, "I start wanting a beer and will struggle
to think of much else
A.5 struggles to get out of bed and work on
time. This has resulted in him being late to his
site at least one day a week for the past year.
Jeff reported he has been written up numerous
times for being late at work
A.6 The client got divorced due to drinking,
does not see children, and engaged in
domestic disputes while intoxicated.
A.8 The client has received two DUIs and one
domestic battery.
A.9 The client is reluctant to acknowledge
misuse of alcohol
A.10 The client needs 4 – 6 shots more to
achieve a buzz
DSM-5-TR Secondary: Major depressive,
recurrent severe (F33.2)
Client’s signs/reported symptoms:
Criteria A: Five (or more) of the following
symptoms have been present during the same
2-week period and represent a change from
previous functioning; at least one of the
symptoms is either (1) depressed mood or (2)
loss of interest or pleasure
The client reports feelings of sadness most of
the day after the divorce, significant weight
loss, decreased appetite, fatigue loss, losing
all interest in activities that he usually enjoys,
and feeling hopeless about his life in general .
Criteria B: The symptoms cause clinically
significant distress or impairment in social,
occupational, or other important areas of
functioning.
The client states that he struggles to get out of
bed and make it to work on time. He stated,
"When I have a sad episode, I pull away from
my family, whom I am close to.
Criteria C: The episode is not attributable to
physiological effects of a substance or another
medical condition
The client has no medical history
Criteria D: Not caused by schizophrenia or
other psychotic disorder
The client reports no hallucinations or
delusions.
Criteria E: No manic episode
Other DSM-5-TR Conditions Considered
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Various other DSM 5 conditions were considered—first adjustment disorder with
depressed mood. Given the fact that the client is recently divorced, this diagnosis was
considered; however, criteria that the client met within major depressive fell short in this
disorder. Additionally, Persistent depressive disorder was ruled out due to the symptoms not
lasting two years. Furthermore, a case could be made for bipolar disorder, particularly bipolar II;
however, the client reported no manic episodes.
Developmental Theories and Systemic Factors
Albert Bandura described human behavior as learned observationally through modeling.
Therefore, according to social learning theories, a person’s tendency to imitate or observe others
influences how they evolve (Newman & Newman, 2015). The client noted his family history of
alcohol use, beginning with his father. The client admitted to having his first drink at seven years
old, which was provided by his father. Under the right conditions, children will model various
behaviors from parents, siblings, and peers (Newman & Newman, 2015). The client reported that
his immediate family, apart from one brother, engages in high usage of alcohol. The family
system has a misdirected belief system about alcohol consumption, which has led to the client's
personal and professional life being affected.
Multicultural and Social Justice Considerations
Kring and Johnson (2022) found that alcohol use disorder's heritability is between .40 to
.60. This reflects the idea that family history can play a role in one's alcohol consumption later in
life. There are two identities I want to focus on for this client, the first being family history. The
client's father drank daily and was the person to offer the client his first alcoholic beverage at a
young age. The past three years of the client's life reflect how that history has impacted his lived
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experience. Alcohol use has led to multiple DUIs, incidents of domestic battery against his ex-
wife, relationship strain, and job reprimands.
Furthermore, this leads to economic class and racial identity. The client is a 33-year-old
Caucasian male who, as evidenced by self–reporting, is privileged. He has multiple DUIs and
violence against women, and he still has a job that a management team is helping him maintain,
even to a fault. In all reality, Jeff should be in jail, prison, and dead.
Treatment Recommendations
Key Issues for Treatment
Acknowledgement that drinking is an issue and reluctance to give up chemical
dependency.
Excessive alcohol consumption.
Feelings of sadness in life.
Recommendations for Individual Counseling
Umhau (2019) found that alcohol use sufferers put themselves at greater risk of death by
denying early signs of the disorder. Therefore, cognitive behavioral therapy would be
recommended for the client to modify irrational thoughts related to his thoughts and behavior.
Once progressed, this should help the client cope with cravings and relapses. The delivery of
CBT would be coupled with motivational interviewing so reflective listening can be utilized.
Motivational interviewing will help the therapist distinguish between the patient's current
behaviors and personal goals (Jhanjee, 2014).
In this case, an in-patient rehabilitation program would be highly recommended to detox
Jeff for mental and medical clarity. Most rehab programs lasting 30 – 60 days are associated with
successful outcomes. Essentially, the longer a person engages in treatment, the more behavioral
change will occur (Jhanjee, 2014). However, the price of attending an in-patient treatment
program deters people from engaging. So other interventions like alcohol anonymous and group
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talk are encouraged. However, alcohol anonymous has a high dropout rate as it is a "self-help"
program (Kring & Johnson, 2022, p.300).
Medication considerations
Medication will firmly be incorporated due to the intensity of the alcohol use and major
depressive symptoms. As medications focus on cravings and symptoms and not the actual root of
the condition, the effects of medication-assisted treatment could provide relief for other
treatments to take effect holistically. Naltrexone has shown excellent outcomes in reducing
cravings when combined with other treatments and gabapentin (Anton et al., 2020).
Specific Considerations
Multiple diagnoses can be challenging to pinpoint and understand which is more
important. In this case, alcohol consumption is at a level that can be deadly. Additionally,
alcohol is a natural depressant, and this adds to the already established stressors within the
client's life. In deciding which disorder to address first, a clinician should ask which is causing
the most damage or impairment in the immediate context. In some cases, the diagnoses can be
addressed simultaneously; however, in this case, alcohol use has to be remediated quickly.
Lastly, substance use disorder impacts diagnostic impressions because the side effects of drugs
can be like symptoms related to mental health. As the song by Jimmy Cliff goes, "I can see now
the rain is gone." One must clear the rain to see sunshine. Jeff must accept the reality that he is
chemically dependent, withdraw from use, and build skills to assist in behaviorally and
cognitively managing his stressors differently.
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References
American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders
(5th ed.). https://doi/book/10.1176/appi.books.9780890425787
Anton, R. F., Latham, P., Voronin, K., Book, S., Hoffman, M., Prisciandaro, J., & Bristol, E.
(2020). Efficacy of gabapentin for the treatment of alcohol use disorder in patients with
alcohol withdrawal symptoms: A randomized clinical trial. JAMA Internal Medicine,
180(5), 728–736. https://doi.org/10.1001/jamainternmed.2020.0249
Hasin, D.S., Shmulewitz, D., Stohl, M., Greenstein, E., Aivadyan, C., Morita, K., Saha, T.,
Aharonovich, E., Jung, J., Zhang, H., Nunes, E.V., & Grant, B.F. (2015). Procedural
validity of the AUDADIS-5 depression, anxiety, and posttraumatic stress disorder
modules: Substance abusers and others in the general population. Drug and alcohol
dependence, 152, 246-256. https://doi.org/10.1016/j.drugalcdep.2015.03.027
Higgins-Biddle, J. C., & Babor, T. F. (2018). A review of the Alcohol Use Disorders
Identification Test (AUDIT), AUDIT-C, and USAUDIT for screening in the United
States: Past issues and future directions. The American journal of drug and alcohol
abuse, 44(6), 578–586. https://doi.org/10.1080/00952990.2018.1456545
Jhanjee S. (2014). Evidence-based psychosocial interventions in substance use. Indian Journal
of Psychological Medicine, 36(2), 112–118. doi:10.4103/0253-7176.130960
Kring, A. M., & Johnson, S. L. (2022). Abnormal psychology: The science and treatment of
psychological disorders (15th ed., DSM-5-TR Update). John Wiley & Sons.
Newman, B. M., & Newman, P. R. (2015).LTheories of human development. Taylor & Francis
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