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JEFF’S CASE STUDY
Case Study Assignment: Jeff
Mónica A. Lynn
Department of Counselor Education and Family Studies, Liberty University
Author Note
Mónica A. Lynn
Department of Counselor Education and Family Studies, Liberty University
I have no conflict of interest to disclose.
Correspondence concerning this article should be addressed to Mónica A. Lynn
Email: malynn1@liberty.edu
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JEFF’S CASE STUDY
Client’s Concerns
Symptoms Behaviors Stressors
Sadness lasting +6 moths Late to work Risk of getting fired
Fatigue Blood alcohol tests
suspensions & violations
Divorce
Alcohol intake increase Daily/Non-stop drinking Brother’s lost communication
No desire of cutting down
alcohol
Arrested for intoxication Difficulty on spending time
with his children
Lack of interest in activities Physical & verbal aggression Family history of use of
alcohol
Suicidal ideation Arrested for assault & battery Family history of depression
Depression history
Assessment
One of the great assessment tools that can be used to clarify the client’s diagnosis is the
Alcohol Use Disorders Identification Test, or better known as the AUDIT. This assessment is
well-known for detecting on participating clients the risky and harmful drinking patterns that
they may be having. According to the National Institute on Drug Abuse, this 10-item screening
tool, developed by the World Health Organization, normally assess, not only the alcohol
consumption, but also the drinking behaviors and the alcohol-related problems the individual
may be presenting. Therefore, the AUDIT screening tool will be a great fit to assess and clarify
Jeff’s diagnosis.
Diagnostic Impression
Alcohol Use Disorder, Severe (F10.20)
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JEFF’S CASE STUDY
Signs and Symptoms
DSM-5-TR Diagnostic Criteria: Alcohol Use
Disorder, Severe (F10.20)
Client’s Signs/Reported Symptoms:
Criterion A: A problematic pattern of alcohol
use leading to clinically significant
impairment or distress, as manifested by at
least two of the following, occurring within a
12-month period:
Taking it in larger amounts or over a
longer period than was intended.
Unsuccessful efforts to cut down or
control alcohol use.
Great deal of time is spent in activities
to obtain and use alcohol or recover
from its effects.
Craving or desire to use alcohol.
Recurrent alcohol use resulting in
failure to fulfill major role obligations.
Continued alcohol use despite having
persistent problems by effects of
alcohol.
Important social, occupational or
recreational activities are given up
because of alcohol use.
Recurrent alcohol use in physically
hazardous activities.
Alcohol use is continued despite
knowledge of having a persistent
physical or psychological problem that
is likely to have been caused by
alcohol.
Tolerance defined by a need for
markedly increased amounts of
alcohol to achieve intoxication or
desired effect.
Withdrawal manifested by withdrawal
syndrome or using alcohol to relieve
withdrawal symptoms.
Client reported having a history of
alcohol use that has been increasing
over time.
Client reported attending the
Alcoholics Anonymous and outpatient
treatment but dropped out of it.
Client reported spending time drinking
when is not on site working and then
recovering from its effects.
Client reported wanting to being
buzzed off of work to drink and get
drunk.
Client reported being suspended
between 3-5 days without pay for
violations for his blood-alcohol test.
Client reported the continuation of
alcohol intake despite his divorce and
separation from his children.
Client reported being and wanting to
be around his friends drinking and
doing shots.
If client continues drinking, it can be
dangerous for his job.
Client reported having suicidal
ideation/thoughts along with a plan,
feeling hopeless, sadness, loss of
appetite, among others. Nonetheless,
client reported continues using
alcohol.
Client reported an increase of alcohol
use to reach intoxication.
Client reported severe withdrawal
symptoms and difficulty to recover
from it.
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JEFF’S CASE STUDY
Other DSM-5-TR Conditions Considered
An alternative DSM-5-TR conditions that I consider for client was the Major Depressive
Disorder. The client reported symptoms of sadness, hopeless, loss of interest in certain activities
and even suicidal ideation. Nonetheless, because of Jeff’s constant use of alcohol, this other
diagnosis was ruled out completely.
Developmental Theories and/or Systemic Factors
Based on the client’s reported story, it seems that there are multiple factors that may be
influencing the behaviors that Jeff is currently displaying. One of these factors can be the history
of alcohol in the family. Jeff mentioned that his father is an alcoholic and used to drink at home.
Therefore, it made Jeff to also drink, even at a young age as he described it. Also, Jeff mentioned
the history of depression from his mother. Client mentioned that mother was always sad and in a
depressed mood due to her marriage and her environment. This did not lead to healthy coping
skills. Therefore, this was not helpful for Jeff either. Likewise, the client reported that he
divorced from his wife and got separated from their children. He tried to work and get better,
however as soon as he knew his wife was not going to return, he stopped the treatment and kept
on drinking alcohol. Studies have shown that environmental factors such as home environment
and adversity are contributors and can significantly predict alcohol in young adulthood
(Kandaswamy et al., 2021).
Besides the presented factors, the psychosocial developmental theory from Erik Erikson
can also be introduced in this. Jeff is a 33-year-old Caucasian male that is currently and can be
placed at the intimacy vs isolation stage of this theory. This stage of the theory focuses on
seeking, establishing and maintaining relationships with key people that they can trust. The
failure at this stage would be the individual led to isolation (Maree, 2021). Despite Jeff was
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JEFF’S CASE STUDY
married to his wife, due to his alcohol use, they got separated and divorced leading to disrupt a
relationship of trust he established that could lead him to isolation.
Multicultural and/or Social Justice Considerations
As stated at initial of the assessment, Jeff is a 33-year -old Caucasian male, and within his
mentality he thinks that he doesn’t need help or treatment for his drinking problem and is “not
sure why his job is making such a big deal”. His father struggled with alcohol and never decided
to get help. Therefore, Jeff thinking and stating that he doesn’t think he has a problem, or that he
needs help, is a duplicate behavior from his father. It’s been shown in multiple studies that men
less often seek for mental health help since they position themselves based on hegemonic
masculinity showing toughness, fearlessness and emotional endurance in society (Masemola et
al., 2022).
Treatment Recommendations
Key Issues for Treatment
Alcohol Increase Intake
Unsuccessful desire to cut down alcohol
Suicidal Ideation/Thoughts
Recommendations for Individual Counseling
As Jeff’s counselor, I would strongly recommend the Motivational Interviewing
technique. This from is typically known and used to address addiction and substance use
disorder, like alcoholism, that involves provoking the client’s reasoning and motivations to
change to get to a particular goal. Multiple studies have shown, not only the efficacy of the MI
technique, but also the reduction of illegal activity and reduced alcohol and drug use in
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JEFF’S CASE STUDY
individuals that go under this treatment (Pederson et al., 2021). Jeff can benefit from this
therapeutic technique by finding a motivation to reduce his alcohol intake.
Likewise, an alternative recommendation I would suggest as a counselor it would be the
Cognitive Behavioral Therapy (CBT) as well. This type of therapy can help Jeff in identifying
those feelings and situations that lead to heavy drinking. Magill et al. (2019) demonstrated in
their meta-analysis the efficacy of this type of therapy for alcohol or other drugs use disorders.
The CBT might help Jeff in teaching him healthy coping skills and how to change the thoughts
that lead wanting to drink alcohol, and also with the suicidal ideation and thoughts.
Specific Considerations
Medication Considerations
According to Jeff’s story and diagnosis, his alcohol drinking behavior is severe.
Therefore, I would recommend him for a medication evaluation to also support with his
treatment. If medication is prescribed, it can help Jeff with the Alcohol Use disorder. Despite
studies shown that use of medication is associated with greater severity of the disorder, and it’s
rarely prescribed, it is highly suggested that the use of prescribed medications and therapy
services go along together for better efficacy (Han et al., 2021). Some of the medication the
clients can get prescribed are naltrexone and acamprosate. The naltrexone will help to block
those receptors of feeling good after drinking, while the acamprosate will help the individual to
avoid alcohol after quitting the drinking pattern/behavior (Mong et al., 2021).
Unique Client Considerations
The factor of multiple diagnosis can actually affect the decision-making process for
diagnostic impression and treatment planning since every assessed client is completely different.
It has been shown that when addressing, through treatment, dual diagnoses it will usually take
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JEFF’S CASE STUDY
more time and should be addressed appropriately for effectiveness and successful met planned
goals (Błachut et al., 2019). Every individual is different in all aspects, from environment to
lifestyle to background history, just as Jeff is. As a counselor, it’s important to develop an
adequate treatment plan which will address efficiently the dual diagnoses that client is
presenting. The main issues or most important symptoms described should be identified and
addressed since they are a priority. In Jeff’s case, he expressed in a certain moment during the
assessment feeling hopeless, sadness, lack or no interest in usual activities, suicidal ideation,
among others. Although all these issues are common for a depressive disorder, his main issue and
reason for him to access to receive therapy services was for his alcohol usage and drinking.
Consequently, the common symptoms from the depressive disorder that Jeff described were
rooted in his use of alcohol. Therefore, addressing the alcohol use issue is more important to treat
first in order for the rest of the symptoms be reduced.
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JEFF’S CASE STUDY
References
American Psychiatric Association. (2022).KDiagnostic and statistical manual of mental
disorders: DSM-5-TRK(5thKed.).K
Błachut,KM., Ścisło,KP., Jarząb,KM., Zając,KM., Piegza,KM., Badura-Brzoza,KK., & Gorczyca,KP.
(2019). Impact of dual diagnosis in patients with schizophrenia and affective disorders
during hospital treatment on the course of illness and outcomes of treatment – a
preliminary report.KPsychiatria Polska,K53(6), 1237-
1250.Khttps://doi.org/10.12740/pp/onlinefirst/103352
Han,KB., Jones,KC.KM., Einstein,KE.KB., Powell,KP.KA., & Compton,KW.KM. (2021). Use of
medications for alcohol use disorder in the US.KJAMA Psychiatry,K78(8),
922.Khttps://doi.org/10.1001/jamapsychiatry.2021.1271
Kandaswamy,KR., Allegrini,KA., Nancarrow,KA.KF., Cave,KS.KN., Plomin,KR., & Von Stumm,KS.
(2021). Predicting alcohol use from genome-wide polygenic scores, environmental
factors, and their interactions in young adulthood.KPsychosomatic Medicine,K84(2), 244-
250.Khttps://doi.org/10.1097/psy.0000000000001005
Magill,KM., Ray,KL., Kiluk,KB., Hoadley,KA., Bernstein,KM., Tonigan,KJ.KS., & Carroll,KK. (2019).
A meta-analysis of cognitive-behavioral therapy for alcohol or other drug use disorders:
Treatment efficacy by contrast condition.KJournal of Consulting and Clinical
Psychology,K87(12), 1093-1105.Khttps://doi.org/10.1037/ccp0000447
Maree,KJ.KG. (2021). The psychosocial development theory of Erik Erikson: Critical
overview.KThe Influence of Theorists and Pioneers on Early Childhood Education, 119-
133.Khttps://doi.org/10.4324/9781003120216-11
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JEFF’S CASE STUDY
Masemola,KH.KC., Moodley,KS., & Shirinde,KJ. (2022). Perceptions and attitudes of Black men in
a rural district of South Africa towards depression and its treatment.KSAFP | South
African Family Practice,K64(1).Khttps://doi.org/10.21203/rs.3.rs-1473644/v1
Mong,KJ., Ahamad,KK., & Bach,KP. (2021). Anticraving medication for moderate to severe
alcohol use disorder.KCanadian Medical Association Journal,K193(19), E695-
E695.Khttps://doi.org/10.1503/cmaj.200895
National Institute on Drug Abuse. (n.d.).KAUDIT. NIDA.NIH.GOV | National Institute on Drug
Abuse (NIDA).Khttps://nida.nih.gov/sites/default/files/files/AUDIT.pdf
Pederson,KS.KD., Curley,KE.KJ., & Collins,KC.KJ. (2021). A systematic review of motivational
interviewing to address substance use with justice-involved adults.KSubstance Use &
Misuse,K56(5), 639-649.Khttps://doi.org/10.1080/10826084.2021.1887247
