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CASE STUDY ASSIGNMENT: JEFF
Case Study Assignment: Jeff
Breanna C. Seal
School of Behavioral Sciences, Liberty University
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CASE STUDY ASSIGNMENT: JEFF
Case Study Assignment: Jeff
Jeff is a 33-year-old Caucasian male who has been required by his job to seek a mental
health assessment due to his blood alcohol content being above the maximum allowed for his
job. He has had four violations in the last 18 months and his fifth resulted in five day suspension
without pay. He also struggled with a depressive episode after his wife left, which lasted for
about 8 months. He stated that he has been dealing with sadness since he was 15 years old,
however his depressive episodes have happened four or five times before and they have lasted
seven to eight months at a time. He has agreed to participate in services to keep his current job.
Key Issues
Biological
Jeff’s drinking is occurring daily and the amount in which he drinks depends on if he is
working or not. He usually consumes 4-8 beers when he is working, after work. When he is not
working he will have 6-8 beers and a few shots of whatever liquor is available to him. Jeff has
noticed that in the last 18 months it has taking more alcohol for him to get a buzz. He previously
was able to get buzzed off of four to five beers, now if he drinks five to seven he does not feel a
thing. It also has taken more liquor for him to get drunk, about 4-6 more that he usually needed.
If he is working one of his longer shifts of more than 10 hours he will start to crave a beer and
that will be an impending thought until he can get one. On his days off he will get home after
2:00am sleep until 2:00pm, wake up with a headache feeling hungover and have his first drink
around 5:00pm. Jeff also has family history of drinking, his dad drank daily and his two brothers
drank similar to his dad and him.
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CASE STUDY ASSIGNMENT: JEFF
Jeff also stated that he felt sad daily after his wife left. He lost all pleasure in his normal
activities and had a feeling of hopelessness. He also had an inconsistent sleep schedule and
fatigue regardless of the amount of sleep he had. He also had several incidents of suicidal
ideations and came up with a plan but never went through. He suffered from a loss of appetite
losing around 25 to 30 pounds during his depressive episodes. Jeff also isolates himself from his
family during his sad episode and also has an irritable mood.
Psychological
Jeff has had difficulty with always feeling sad since he was 15 years old. The differences
in his sad episodes now are more apparent. His periods of sadness have happen about four to five
times lasting 7-8 months. During these times he would have trouble sleeping, loss of appetite,
fatigue and suicidal ideations. Jeff states that he had a plan, but has never done anything to
actually hurt himself.
Social
One of Jeff’s biggest stressors is the possibility of losing his job if he does not seek
treatment. He likes to socially drink with his coworkers. He also has a strained relationship with
his wife due to his drinking, which puts him at risk for not being able to see his children Jeff also
mentioned that drinking was something that he and his family did when they got together.
Spiritual
Jeff’s mother’s parents were Baptist and he would attend church with them when his was
younger however he has not attended or been inside a church since the passing of his
grandmother. He has no interest in discussion anything spiritual at this time.
Assessment
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CASE STUDY ASSIGNMENT: JEFF
One appropriate assessment that can be used to clarify the diagnosis of Jeff is the Alcohol
Use Disorders Identification Test (AUDIT). It is a 10 item questionnaire that can be presented in
interview form and a self-report version to help identify hazardous drinking. It has been shown to
accurately report the measure of risk across age, sex and cultures (Fujii et al., 2016). This
assessment is being chosen over the others because it is brief and easy to administer. Another
appropriate assessment to provide for Jeff’s sad episodes is the Patient Health Questionnaire –
( which is an easy and brief 9 item self-report assessment that looks at the levels of depression
based on the 9 key symptoms (Zuithoff et al., 2010). It has also be shown to identify if major
depressive disorder (MDD) is present. The overall score can also be used to identity the severity
of depression (Zuithoff et al., 2010).
Diagnostic Impressions
Based on the symptoms that have been described by Jeff and the criteria listed in the
Diagnostic and Statistical Manual of Mental Disorders (DSM -5), Jeff meets the criteria for
Alcohol Use Disorder F10.20 and Major Depressive Disorder F33.41 in partial remission
because he has been one month without a sad episode (American Psychiatric Association (APA),
2013).
Signs and Symptoms
Comparison of Client’s Symptoms to the DSM-5 Symptoms
DSM-5 Symptoms of Alcohol use disorder Client Symptoms
Alcohol consumed in large amounts over
long period
Drinks more on the weekend then
intends to
Persistent desire or unsuccessful effort to cut
down on control alcohol use
Does not think he needs cut back on
drinking
More time is spent in activities necessary to
obtain alcohol, use alcohol or recover from
effects
Over sleeps often,
will drink more during weekdays and
while off of work
will get alcohol before going out with
friends
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CASE STUDY ASSIGNMENT: JEFF
Craving or strong desire or urge to use
alcohol
when working 10hr shifts really want
a beer and be the only thing he can
think about
Recurrent alcohol use resulting in a failure to
fulfill major role obligations at work, school
or home
will show up to work late
use alcohol while watching children
Continued
alcohol use
despite
having
persistent
or
recurrent
social or
interperson
al problems
caused or
exacerbate
d by the
risk of job termination
if he continues to drink will not be
able to see his children
does not have contact with brother
unless stop drinking
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CASE STUDY ASSIGNMENT: JEFF
effects of
alcohol.
Continued
alcohol use
despite
having
persistent
or
recurrent
social or
interperson
al problems
caused or
exacerbate
d by the
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CASE STUDY ASSIGNMENT: JEFF
effects of
alcohol.
Continued alcohol use despite having
persistent or recurrent social or interpersonal
problems caused or exacerbated by alcohol
Recurrent alcohol use in situations in which it
is physically hazardous
Driving multiple time while
intoxicated
Alcohol use is continued despite knowledge
of having persistent or recurrent physical or
psychological problems that have been likely
cause by alcohol
Recurrent headaches
hangovers
Need for markedly increased amount of
alcohol to achieve intoxication
increase to 6-8 and a shot to feel
something
Alcohol is taken to relieve or avoid
withdrawal symptoms
when craving all he can think about is
having a drink and will relieve himself
before going out with friends
DSM-5 Symptoms of Major Depressive Disorder Client Symptoms
Depressed mood most of the day, nearly every day Feeling of being sad all the time
Noticed by coworkers
Diminished interest or pleasure in all or almost all
activities most of the day nearly every day
No interest in activities he
normally enjoyed feeling
hopeless
Significant weight loss when not dieting or weight
gain
Loss of appetite
Losing 25 to 30 pounds
Insomnia or hypersomnia nearly everyday Disturbance in sleep
Psychomotor agitation or retardation nearly
everyday
Irritable mood
Fatigued or loss of energy nearly every day Very fatigued no matter how
much sleep
Recurrent thoughts of death or suicidal ideation Though about killing himself
and came up with a plan
Symptoms cause clinically significant distress or
impairment in social occupational or other important
areas of functioning
Draws away from family
Struggle to finish full day of
work
Spend less time with coworkers
Other DSM Conditions Considered
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CASE STUDY ASSIGNMENT: JEFF
One of the secondary disorders that was considered was persistent depressive disorder,
however Jeff’s sad episodes were not present continuously for 2 years. Another secondary
disorder to consider is substance/medication-induced depressive disorder F10.24 . Jeff states that
he feels sad all the time not only when he consumes alcohol.
Considerations of Theories and Factors
Alcohol use disorder can vary by education, gender and race. However, it has historically
been seen more prevalent in men according to (Kring & Johnson, 2021). Alcohol use disorder
run in families (APA, 2013) and Jeff’s dad drank daily too. It is three to four times higher in
close relatives with individuals who have alcohol use disorder. Environmental factors also play a
role in alcohol use disorder. Jeff was introduced to his first alcoholic beverage at 7 years old and
it was seen as what men do. Also, his availability to alcohol increased being that his father drank
daily. Also when Jeff was younger he was with a lot of peers who drank as well.
Multicultural or Social Justice Consideration
Although Jeff does not practice his Baptist traditions from when his was younger it is
important to remember what actually is important to him. He stated that his job was very
important to him so incorporating practices that will help Jeff keep his job will be crucial. It is
also important to remember that Jeff has had several encounters with the law, by understanding
his world view it could help alleviate any uneasiness and maneuver through any triggers that he
may have.
Treatment Recommendations
Key Issues
Suicidal Ideation
Alcohol Use
Depression
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CASE STUDY ASSIGNMENT: JEFF
Ensuring that Jeff feels like he is in a safe space will be crucial to the therapeutic
relationship. He can become defensive when he is talked to about his alcohol usage. Making sure
to include his own thoughts and feelings while suggesting more appropriate solutions could ease
his uneasiness toward his struggles. Also it is important to keep in mind the upbringing of Jeff,
he has his own perception of what men do. A gently reminder that it is okay to discuss his
feelings when he is ready and offer options for how he would like to disclose.
Recommendations of Individual Counseling
Treatment for Jeff would include Cognitive Behavioral Therapy (CBT) for alcohol use
disorder. CBT is used to reduce the effects of alcohol by identifying situations that led to alcohol
use and offering coping mechanisms to manage them (Caselli et al., 2018). Other skills that are
used are being able to participate in other activities that don’t include the use of alcohol and
removing motivational and cognitive barriers to change (Caselli et al., 2018). CBT could also be
use to target Jeff’s depressive episodes by challenging his thoughts and beliefs to cope with his
problems. Mindfulnessbased cognitive therapy (MBCT) could be an option as well. It
development is used to help individuals by preventing the recurrence of depression long term
(Zhang et al., 2018). This allows for more awareness of negative thoughts during a period of
relapse. This skills can be practice through meditation and mindfulness skills helping the
individual improve the unwanted feelings.
Specific Consideration
Because there is multiple diagnosis the clinician should address the problem that poses
the most risk to the client. In this case, Jeff’s suicidal ideation needs to be monitored and a plan
needs to be put in place so he will not participate in any self-harm. Because Jeff has been one
month without a sad episode his alcohol use should be addressed next because it poses the risk of
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CASE STUDY ASSIGNMENT: JEFF
termination from his job as well as other important areas of his life. With these sessions that Jeff
is participating in those skills can play part in helping with his MDD. Alcohol use disorder is also
comorbid with other disorders such as bipolar disorders, schizophrenia and other depressive
disorder so providing an accurate diagnosis could be complicated because there could be the
possibility that his alcohol intake is causing his sadness.
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CASE STUDY ASSIGNMENT: JEFF
Reference
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental
disorders (5th ed.).
Caselli, G., Martino, F., Spada, M & Wells, A. (2018) Metacognitive therapy for alcohol use
aisorder: A systematic case series. https://doi.org/10.3389/fpsyg.2018.02619
Fujii, H., Nishimoto, N., Yamaguchi, S., Kurai, O., Miyano, M., Ueda, W., Obs, H., Aoki, T.,
Kawada, N & Okawa,K. (2016). 379, 1-8.
Kring, A. M., & Johnson, S. L. (2021). Abnormal psychology: The science and treatment of
psychological disorders (15th ed.). John Wiley & Sons,
Zhang, Z., Zhang, L., Zhang, G., Jin, J & Zheng, Z. (2018) The effect of CBT and its
modifications for relapse prevention in major depressive disorder: a systematic review
and meta-analysis. 50(18).https://doi.org/10.1186/s12888-018-1610-5
Zuithoff, N.P., Vergouwe, Y., King, M, Nazareth,I., Wezep, M., Moons, K., & Geerlings,M.
(2010) The Patient Health Questionnaire-9 for detection of major depressive disorder in
primary care: consequences of current thresholds in a crossectional study. 98
https://doi.org/10.1186/1471-2296-11-98
