CASE STUDY JEFF 2
Client Concerns
Symptoms or
information data
reported that is
important and
why
Biological
factors
Physical
symptoms,
neurological,
past present
impact
Past and present
Psychological
Ideas thoughts
feelings beliefs
values about
self, others the
world
Past and present
Social/cultural
Family systems
Relationships
with others
Cultural
elements
Past, present
Spiritual
Past present
Hangovers Heavy drinker Rough
relationship with
ex-wife
No interest in
integrating any
kind of
spirituality into
his life or mental
health sessions.
Fatigue Several long-
lasting episodes
of depression
Threat of losing
job
Headaches Suicidal ideation Drinks quiet a
bit with family
and friends
Cravings Consistent
sadness
Assessment
CASE STUDY JEFF 3
An assessment that I would like to use would be the Suicidal Behaviors Questionnaire,
this questionnaire can be quick and efficient when used. Sometimes clients can struggle to want
to do the questionnaires that are provided by clinician because they can be long or just repetitive.
This questionnaire is short and sweet and to the point. This test has been found to be a sound test
to use in the field of psychology. It is important that we address the suicidal thoughts
immediately as Jeff has already thought out a plan as to how he would do it, so it is not just a
thought of maybe committing suicide, but a plan is there that he could put into action, that we
want to prevent. I would also want to assess his depression and alcohol use, it appears as though
they are working hand in hand, when assessing the depression I would want to use the Patient
Health Questionnaire (PHQ) which is also a short self-reporting questionnaire for depression.
Diagnostic Impression
It would appear that Jeff as multiple diagnosis that need to be addressed. Of these include
Alcohol Use Disorder (F10.20) as well as Major Depressive Disorder in remission (F33.42)
Signs and Symptoms
DSM-5 Diagnostic Criteria: Alcohol Use
Disorder (F10.20)
Client’s Signs/Reported Symptoms:
Criterion A: Problematic pattern of alcohol
use causing significant impairment of distress
by at least two of the following and occurring
within a 12-month period:
1. Alcohol is often used in greater
amounts and longer period of times
than intended.
2. Persistent desire or unsuccessful effort
to lessen or gain control of the use of
alcohol.
3. Majority of time is spent in activities
Jeff has reported the following in which
aligns with alcohol use disorder:
Currently drinking more on weekends
than what is intended.
Has no desire to drink less.
Over sleeps, getting drinks prior to
dinner with co-workers, drinks all
weekend and days off.
Strong desire to drink after ten hours
on the job with no alcohol
consumption
CASE STUDY JEFF 4
necessary to obtain alcohol, use
alcohol or recover from alcohol use.
4. Craving or strong desire to use
alcohol.
5. Recurrent alcohol use resulting in a
failure to fulfill major roles in life.
6. Continued use of alcohol despite
having persistent problems in social
settings.
7. Important social, occupational or
recreational activities are given up or
reduced because of alcohol usage.
8. Recurrent alcohol use in situations that
are physically hazardous
9. Alcohol use is continued despite
knowledge of persistent or recurrent
physical or psychological problems
that alcohol exacerbated.
10. Tolerance, as defined by either of the
following:
a. Need for markedly increased
amounts of alcohol to achieve
desired level of intoxication.
b. Markedly diminished effect
with continued use of the same
amount of alcohol.
11. Withdrawal, as manifested by:
a. The characteristics of
withdrawal syndrome for
alcohol
b. Alcohol is taken to relieve to
avoid withdrawal symptoms.
domestic violence due to drinking.
On probation due to drinking in
excess.
Divorce due to drinking.
Continues to drink, even with job
being at stake.
Unable to see children in drinking
continues.
Driving while intoxicated
Hangovers are consistent, as well as
fatigue, sadness and headaches.
Increased alcohol tolerance.
Increased drinking over the last 18
months from 4-5 beers to 6-8 just to
get a buzzed feeling.
Nagging thoughts of alcohol after a
period of only 10 hours without it.
DSM-5 Diagnostic Criteria: Major
Depressive Disorder (F33.42)
Criterion A: Five or more of the following
symptoms have been present during the same
2-week period and represent a change from
the previous functioning:
1. Depressed mood most of the day,
nearly every day
2. Markedly diminished interest or
pleasure in all, or almost all,
activities most of the day, nearly
every day.
Jeff has reported the following which align
with Major Depressive Disorder:
Depressed daily to the point friends
and family have noticed.
Loss in interest in activities that he
normally would enjoy.
Loss in appetite.
Significant weight loss.
Distrubed sleep
Feeling irritable.
CASE STUDY JEFF 5
3. Significant weight loss when not
dieting or weight gain or decrease or
increase in appetite nearly every day.
4. Insomnia or hypersomnia nearly
every day.
5. Psychomotor agitation or retardation
nearly every day (can be noticed by
others.)
6. Fatigue or loss of energy nearly
daily
7. Feelings of worthlessness or
excessive or inappropriate guilt
nearly daily
8. Diminished ability to think or
concentrate or indecisiveness almost
daily.
9. Recurrent thoughts of death,
recurrent suicidal ideation with or
without a plan.
Wakes feeling fatigued more often
than not.
Planned on how to end his life with
the divorce.
Criterion B: Symptoms causing clinically
significant distress or impairment in all walks
of life.
Pulls away from family and friends
Struggles to finish a day of work
Criterion C: Episode is not attributable to the
physiological effects of a substance or other
medical conditon
Criterion D: Occurrence of the major
depressive episode is not better explained by
schizoaffective disorder, schizophrenia,
schizophreniform disorder, delusional
disorder, or other specified and unspecified
schizophrenia spectrum and other psychotic
disorders.
Not explained byn other psychotic
disorders.
Criterion E: There as never been a manic
episode or hypomanic episode.
No manic episodes
(American Psychiatric Association Publishing, 2022)
CASE STUDY JEFF 6
Other DSM-5 Conditions to Consider
Some other DSM-5 Conditions that I would like to consider would be Persistent
Depression Disorder and Substance/Medication-Induced Depressive Disorder. What pulls me
away from Persistent Depression Disorder is that the symptoms are not continuously present for
one year, instead they come and go. As for what caused me not to use Substance/Medical-
Induced Depressive Disorder is I am not fully convinced that the depressive symptoms are
caused by the alcohol consumption, though we know that it certainly does not help the
depression.
Developmental Theories and/or Systemic Factors
Some issues that need to be considered when dealing with Jeff and his mental health
needs is that alcohol use disorder is more prevalent in men than it is in women. Alcohol use
disorder is also a disease that can run in the family (American Psychiatric Association
Publishing, 2022). From what Jeff has already stated he started drinking with the men in his
family at the ripe young age of seven years old and it has just continued ever since. Because the
men in his life drank almost daily the availability of alcohol also increased and he was exposed
more and more to the drinking men of the family. From the sounds of it only one “man” made it
out of the family without having to drink all the time, Jeff’s brother.
Multicultural and/or Social Justice Considerations
Jeff does not appear to have any multicultural issues or social justice issues that we need
to take into consideration. He was raised in a Baptist church with Baptist traditions; however he
has stated that he is not interested in incorporating any religion into his mental health sessions.
CASE STUDY JEFF 7
Treatment Recommendations
Key Issues for Treatment
Suicidal Ideation
Alcohol Use
Depression
Recommendations for Individual Counseling
I believe that Jeff may be challenging to work with in the mental health setting as he
states that he is only seeking out mental health help due to his employer forcing the issue, and
that he does not think that he has a problem. With that I would suggest that finding a way in and
making a connection with Jeff would be essential. It is important to not blur the line of
counselor/client into friends, but also make sure he knows that he is in a safe place free from
judgement. As a Christian counselor it would be very important that he knows I know it is not
my place to judge but rather than help him through this rough time. Assisting Jeff in coming up
with a realistic plan to keep his job would be a good start to goal setting. The two treatment
recommendations that I would have for Jeff would be using Cognitive Behavioral Therapy
(CBT) as well as Motivational Enhancement Therapy (MET). CBT can be beneficial for both
the depression and the alcohol use issues that need to be addressed. Because Jeff does not think
that he has an alcohol problem it could be useful to use MET to help him recognize and
acknowledge his alcohol use disorder.
CASE STUDY JEFF 8
Special Considerations
Jeff – Case Study 3: How do multiple diagnoses affect the decision-making process for
diagnostic impressions and treatment planning? How do you decide what disorder you might
address first, or do you address both simultaneously? How does a substance use disorder affect
the process of diagnostic impressions and the order you make treatment recommendations?
When dealing with a client with multiple diagnoses it will be important for the clinician
to prioritize what needs to be addressed in what order. For Jeff the most immediate issue would
be his suicidal ideation and then we would work from there once we can confirm that he is safe
and away from that self-harm. Because of the diagnosis with Jeff and the alcohol use disorder
any other diagnosis following that can be challenging, especially the major depressive disorder
or any disorder that has to do with depression, as we know alcohol is a depressant and can
simply make it worse. So, for Jeff it would be important to address the alcohol issue as soon as
possible. Sometimes fixing the substance abuse issue can fix the other diagnosis.
CASE STUDY JEFF 9
References:
American Psychiatric Association Publishing. (2022). In Diagnostic and statistical manual of
mental disorders fifth edition text revision: DSM-5-TR (5th ed.).
Kring, A. M., & Johnson, S. L. (2022). Abnormal psychology: The science and treatment of
psychological disorders (15th ed.). Wiley.
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