CASE STUDY ASSIGNMENT 2
Case Study Assignment: Jeff
Introduction
Jeff is a 33-year-old Caucasian male who has been suffering from a severe alcohol use
disorder that affects his career and relationships. He went for counseling against his wish but was
forced by his employer because of his drinking behavior. Jeff is a single man and has been
divorced recently, which he blamed his drinking as one of the causes. However, he continues
working for a state construction team, suggesting some functional capacity. His efficiency and
productivity have been affected by his habits, including lateness and issues relating to
alcoholism. Jeff’s employer has raised an issue about his drinking habits and the effects it has on
his work. Additionally, Jeff’s social aspects, such as friends and family, are tied to alcohol, which
distorts his impression of alcohol. He acknowledged drinking daily, with heavier drinking when
offsite, suggesting a degree of dependence. He has developed an increased tolerance to alcohol,
where more is needed to obtain the desired results, indicating increasing physical dependency.
The cultural construction of Jeff’s interactions emphasizes the social acceptability of his
drinking. It puts him in a dangerous position as he risks losing his job if his trend persists. The
Diagnostic and Statistical Manual of Mental Disorders (DSM) acts as a guide for appropriate
diagnoses and treatment of mental disorders through pragmatic information (American
Psychiatric Association, 2013). The essay aims to analyze Jeff’s case, focusing on the DSM-5-
TR diagnostic criteria. It will also develop a management plan to cater to his needs and
conditions requiring management.
CASE STUDY ASSIGNMENT 3
Client Concerns
Symptoms Behaviors Stressors
Increased tolerance to alcohol daily heavy drinking Divorce Due to Alcohol Job
Insecurities
Symptoms of hangover The history of alcohol-related
domestic violence
Threat of Losing a Job
Emotional distress (depressive
episodes)
Consistent alcohol-related
tardiness at work
Social isolation from family and
friends.
Assessment
Alcohol Use Disorders Identification Test (AUDIT) is employed in evaluating Jeff. It is
widely used to identify people with alcohol abuse problems all over the world. AUDIT is a
screening instrument used for the harmful use of alcohol (Neufeld et al., 2021). Created by the
World Health Organization, the AUDIT enables assessing the different harshness of alcohol
issues. It includes ten questions, each of which addresses various facets of the use of alcohol and
its effects. The answers are rated on a scale concerning the degree of alcohol use disorder.
AUDIT is preferred because it is brief, easy to use, and has scores that healthcare team members
can understand. It enables the identification of risky drinking habits before the beginning of fatal
forms of the disease. Research has also established that the specific tool is reliable across
populations. It gives a precise level of alcohol intake, which is so vital in the diagnosis process.
The AUDIT has a broad scope because it considers the consumption level, dependency
symptoms, and the consequences. It is more strategic to use the AUDIT instead of other tools,
such as the Beck Depression Inventory, as it is explicitly designed to address alcohol-related
concerns. It is important to note that although the Beck Depression Inventory helps identify
CASE STUDY ASSIGNMENT 4
depression, it does not focus on alcohol use. Additionally, the fact that AUDIT is alcohol-focused
is important for Jeff’s case because his issues are mainly related to alcohol.
Diagnostic Impressions
Applying the DSM-5-TR criteria to Jeff’s case, his main diagnosis is Alcohol Use
Disorder, severe. The DSM’s diagnosis is further backed by several criteria that suggest
substantial problematic alcohol use that results clinical dysfunction or significant levels of stress.
The ICD-10 code that is related to Alcohol Use Disorder, Severe is F10. 20. Secondly, one
should not forget the presence of secondary diseases. Jeff’s previous experience of depressive
episodes, especially when he was separated and divorced, highlights the presence of a potential
Major Depressive Disorder (MDD). The ICD-10 code that correlates with Major Depressive
Disorder, Recurrent, Moderate is F33. 1.
Signs and Symptoms
DSM-5-TR Criteria:
Alcohol Use Disorder (ICD-10: F10.20)
Client’s Signs/Reported Symptoms:
Criterion A1: Alcohol is often taken in large
amounts for an extended period
Jeff drinks a lot, even on weekdays and off days.
Criterion A2: Persistent desire for alcohol use. Jeff tries to reduce drinking but without success.
Criterion A3: Strong urge to use alcohol. Jeff has much desire to drink, especially after
work.
Criterion A4: Persistent alcohol causing
absenteeism and poor performance.
Jeff often gets to work late and has been
suspended many times due to alcohol use.
Criterion A5: Continued use of alcohol even after Jeff’s alcohol use led to his divorce and is causing
CASE STUDY ASSIGNMENT 5
having social or interpersonal problems caused by
alcohol effects.
conflicts with his previous wife.
Criterion A6: Important personal activities and
relationships are affected or reduced because of
alcohol use.
Jeff spends little time with family and friends and
neglects his relationship with his children.
(Lecture Notes, 2024).
Criterion A7: Repeated alcohol use in physically
risky situations.
Jeff has driven while drunk and has had violations
in the workplace due to alcohol.
Criterion A8: Alcohol use is sustained even with
the knowledge of having caused insistent physical
or psychological problems.
Jeff understands that alcohol might contribute to
his depression but continues to drink.
Criterion A9: Tolerance Jeff has developed a tolerance, demanding more
alcohol to achieve the same effect.
Criterion A10: Withdrawal Jeff experiences hangovers and drinks to avoid
withdrawal symptoms.
DSM-5-TR Criteria
Major Depressive Disorder (ICD-10: F33.1)
Client’s Signs/Reported Symptoms
Criterion A1: Mostly Depressed mood
Depressed mood nearly daily as indicated by
subjective reports including hopelessness and
observation from others like appearing tearful
(American Psychiatric Association, 2013)
Jeff reports having sad feelings, especially
following his divorce.
Criterion A2: Lack of interest in many activities. Jeff has lost interest in his activities, such as
spending quality family time.
CASE STUDY ASSIGNMENT 6
Criterion A3: Decrease or increase appetite nearly
daily, leading to weight loss.
Jeff experiences weight loss periodically.
Criterion A4: Insomnia or hypersomnia nearly
daily.
Jeff struggles to fall asleep. He feels tired regardless
of the amount of sleep.
Criterion A5: Feelings of guilt and worthlessness. Jeff shows hopelessness and low self-esteem,
especially when talking about his divorce.
Criterion A6: Indecisiveness Jeff struggles to concentrate at work, resulting in
less productivity.
Criterion A7: Recurrent death and suicidal
thoughts.
Jeff has had recurrent suicidal thoughts and has
developed plans but has not enacted the plans.
Other DSM-5-TR Conditions Considered
For Jeff, some other considerable diagnosis include:
Several other DSM-5-TR conditions were considered because of the reported symptoms
and behavior patterns of Jeff.
Generalized Anxiety Disorder (GAD) was considered but excluded because the criteria of
excessive, persistent worrying were not present. Jeff does not show elevated levels of
anxiety that would impair his functioning in everyday life.
Bipolar disorder was considered but ruled out as there is no manifestation of mania or
hypomania in Jeff.
Post-Traumatic Stress Disorder (PTSD) was also considered due to Jeff’s past traumatic
experience. Still, Jeff does not have PTSD criteria like intrusive memories or
hypervigilance.
CASE STUDY ASSIGNMENT 7
The diagnosis of Persistent Depressive Disorder (Dysthymia) was considered because
Jeff had been continuously sad for the past two years. However, his symptoms are not
continuous.
The symptoms are more in line with Major Depressive Disorder (MDD). MDD is one of
the most globally known severe and common psychiatric disorder (Li et al., 2021).
The diagnosis of adjustment disorder was anticipated but did not capture the entirety of
Jeff’s problematic drinking or depressive episodes. Thus, the two primary diagnoses are
still Alcohol Use Disorder and Major Depressive Disorder.
Developmental Theories and Systemic Factors
Multiple systemic and environmental factors influence Jeff’s development and behavior.
Erikson’s stages of psychosocial development provide a helpful framework for analysis. Jeff
appears to be in the "Generativity vs. Stagnation" stage, typically occurring in middle adulthood.
The middle adulthood stage is where an individual manages the balance between life excitement
and boredom (Zuhdi & Syauqillah, 2020). The stage focuses on contributing to society and
supporting the next generation. Jeff’s inability to fulfil his potential in the stage contributes to his
feelings of stagnation. His family system also plays a significant role in his current functioning.
Jeff’s family normalized heavy alcohol consumption, influencing his attitudes towards drinking.
His father's daily drinking habits likely modeled the behavior Jeff adopted. The absence of
conflict resolution skills within his family has impacted Jeff’s interpersonal relationships. Jeff’s
drinking patterns increased after his divorce, suggesting a coping mechanism for emotional
distress. The lack of a supportive family environment exacerbates his dependency on alcohol.
Jeff's professional environment also influences his conduct on a significant scale.
Working in a field where drinking is culturally accepted reinforces his alcohol use. His job stress
CASE STUDY ASSIGNMENT 8
and the threat of termination contribute to his drinking habits as a coping strategy. Jeff’s limited
social support system further hinders his ability to address his addiction. His friends engage in
similar drinking behaviors, spreading a cycle of alcohol use. The loss of his marital relationship
intensifies Jeff's feelings of sadness and isolation. The absence of a stable, nurturing relationship
contributes to his psychological distress. Jeff's chronic involvement with the legal systems
related to his alcohol abuse further burdens him. It is on top of the systemic and environmental
factors that all shape Jeff's development and actual behavior.
Multicultural and Social Justice Considerations
Jeff's alcohol use disorder should also be considered from multicultural and social justice
perspectives. Jeff belongs to the working class. Hence, his economic class is likely to contribute
most in determining what type of resources he will access and the kind of treatment he will get.
The inability to afford good care and management may arise from the lack of financial security.
This transcends because one views the culture of heavy drinking in the family and close friends'
circles as the norm and accepts it. Such cultural factors may act as a barrier to care and promote
resistance to change. Another difficulty is the nature of Jeff’s workplace, which is saturated with
alcohol consumption. Solving the problems implies having culturally appropriate solutions
relevant to his environment. Treatment plans should also consider his socioeconomic status and
available social support systems. One should acknowledge potential bias stereotyping in
treatment, which is pertinent in counsellors' cases. Thus, equitable care means considering Jeff’s
cultural and social conditions. Introducing healthier social activities could also benefit Jeff in
terms of his recovery. It also means petitioning for better mental health coverage in health reform
policies. Alcohol-dependent people are majorly blamed for alcohol consumption in ways which
CASE STUDY ASSIGNMENT 9
are socially unacceptable (Douglass et al., 2023). Multicultural competence guarantees that
community interventions are sensitive and appropriate to the clients’ origins and experiences.
Treatment Recommendations
Key Issues for Treatment
Alcohol Dependence
Depressive Symptoms
Job-related Stress
Recommendations for Individual Counseling
CBT assists Jeff in changing his negative patterns of thinking about alcohol use. The
therapy helps the clients to identify and avoid triggers and to manage stress appropriately. It
allows Jeff to avoid alcohol and instead engage in more positive behavior and practices. MI helps
to address the uncertainty and increase Jeff’s desire to change problematic drinking. The client-
centered approach adheres to Jeff’s self-determination and discourages reliance on external
stimuli for behavior modification. Integrating CBT and MI targets behavioral and motivational
aspects of an alcohol use disorder, Jeff. Combining CBT and MI is associated with the
improvement of symptoms among people with depression and the ones affected by heavy
drinking (Curtiss et al., 2021). The therapies combined make up a complete intervention plan for
Jeff. It also guarantees the provision of a non-judgmental therapeutic setting to assist the patient.
Cultural and economic aspects should also be taken into account in Jeff's counseling. The broad
view guarantees that treatment is appropriate and applicable.
Medication Considerations
The importance of medication considerations would be crucial in Jeff’s treatment plan,
given his high levels of alcohol dependence. Self-medication can help in reducing cravings and
CASE STUDY ASSIGNMENT 10
withdrawal symptoms and are ideal for the diagnosis. Other medications, such as naltrexone, can
be prescribed to help reduce the craving for alcohol (Marin et al., 2023). It works by inhibiting
the ‘high’ that is associated with alcohol consumption. Acamprosate can be used and is used to
maintain abstinence. Acamprosate helps restore the standard brain chemistry that is altered due to
alcohol dependency. The two drugs should be used under a healthcare professional's direction. It
implies that the medications should be combined with other treatment procedures. Taking
medication along with therapy increases the likelihood of a successful outcome. Analysis should
be made by undergoing frequent follow-ups to modify medications when necessary. Medication
should be used in conjunction with psychotherapy and not as a stand-alone form of treatment.
Specific Considerations
Jeff’s case also involves multiple conditions that complicate the diagnostic and treatment
planning processes. Alcohol Use Disorder coexists with Jeff’s primary diagnosis of Depression,
and it has implications for treatment planning. Treating both disorders at once may be
challenging but necessary because both conditions require equal attention. Depression and
alcohol dependence worsen Jeff’s condition and his depression symptoms in particular. Less
drinking means better depressive episodes and mental health for Jeff. Substance use disorder
may intensify psychiatric symptoms, thus making diagnosis difficult. Alcohol dependence should
be treated with a focus on both conditions at the same time. Constant evaluations are necessary
to monitor Jeff’s improvements and modify treatments appropriately. Involving a
multidisciplinary team allows for complex management of Jeff’s case, covering different aspects
of his situation. Jeff’s decision to seek treatment is crucial and requires consistent encouragement
and follow-up to ensure he stays focused on the process.
CASE STUDY ASSIGNMENT 12
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. Journal of Affective Disorders
Reports, 3, 100040.
Douglass, C. H., Win, T. M., Goutzamanis, S., Lim, M. S., Block, K., Onsando, G., ... &
Horyniak, D. (2023). Stigma Associated with Alcohol and Other Drug Use Among People
from Migrant and Ethnic Minority Groups: Results from a Systematic Review of
Qualitative Studies. Journal of Immigrant and Minority Health, 25(6), 1402-1425.
Li, Z., Ruan, M., Chen, J., & Fang, Y. (2021). Major depressive disorder: advances in
neuroscience research and translational applications. Neuroscience bulletin, 37, 863-
880.
Marin, M. C. D., Pedro, M. O. P., Perrotte, G., Martins-da-Silva, A. S., Lassi, D. L., Blaas, I.
K., ... & Castaldelli-Maia, J. M. (2023). Pharmacological Treatment of Alcohol Cravings.
Brain Sciences, 13(8), 1206.
Neufeld, M., Bunova, A., Ferreira-Borges, C., Bryun, E., Fadeeva, E., Gil, A., ... & Rehm, J.
(2021). The Alcohol Use Disorders Identification Test (AUDIT) in the Russian language
systematic review of validation efforts and application challenges. Substance abuse
treatment, prevention, and policy, 16, 1-14.
Zuhdi, M. L., & Syauqillah, M. (2020). Analysis identity fusion and psychosocial development:
How the role of father, mother and son on radicalization within family. Journal of
Strategic and Global Studies, 2(2), 4.
