Case Study: Jeff 1
Case Study: Jeff
School of Behavioral Sciences, Liberty University
COUC 546
June 8. 2025
Client Concerns
Symptoms Behaviors Stressors
Alcohol addiction Heavy drinking, past DWI,
drinking while on the job, and
excessive drinking when not
working.
Alcohol is present from an
early age
Sad/Depressive episodes Loss of appetite, pull away
from family and friends,
unable to finish a full work
shift
Dealt with this since he was
fifteen, but issues of divorce
and lack of seeing his children
contributed
Prominent hangovers Excessive drinking,
consuming higher amounts of
alcohol, both beer and liquor
Divorce and a general desire
to drink constantly
Suicidal Ideations Thinks about doing it, has
also created a plan
Shortly after his wife left, but
has had past ideations.
Case Study: Jeff 2
Fatigue Lack of sleep from suicidal
ideations that occur during the
time he’s having sad episodes
Stress of divorce, arriving late
to work due to a lack of sleep
Assessment
The assessment that can best assess the symptoms, behaviors, and stressors that Jeff is
currently experiencing is the Alcohol Use Disorders Identification Test (AUDIT). The AUDIT
screens for unhealthy alcohol use, which is defined as risky or can be considered an alcohol use
disorder. The AUDIT consists of a 10-item questionnaire, each question can be scored between
zero and four points, with the possibility of a total score between zero and forty (Mansfield et al.,
2019). A score ranging from one through seven indicates low-risk consumption, while scores
eight through fourteen suggest dangerous or harmful alcohol consumption; any score fifteen or
higher indicates the probability of having alcohol dependence (Mansfield et al., 2019). It is a
widely used screening instrument that is and continues to be used all over the world and in
different languages.
Diagnostic Impression
Jeff’s consistent symptoms throughout his life, and more recently, the last three years
have been full of bigger symptoms, behaviors, and stressors that meet the criteria for the primary
diagnosis of a severe Alcohol Use Disorder, corresponding ICD-10 code F10.20. A secondary
diagnosis for Jeff would be Substance/Medication-Induced Depressive Disorder, severe use
disorder, corresponding ICD-10 code F10.24. Jeff meets multiple criteria for both diagnoses.
Signs and Symptoms
DSM-5-TR Diagnostic Criteria: Alcohol Use
Disorder, F10.20
Client’s Signs/Reported Symptoms:
Case Study: Jeff 3
Criterion A: A problematic pattern of alcohol
use that causes impairment and consists of at
least two of the following symptoms,
behaviors, and stressors within a 12-month
period
A1) Alcohol consumption has been present in
this client’s life for decades, but has increased
the level of consumption since his separation.
A2) Jeff displays a constant desire and urge to
drink, impacting his work and relationship
with his children
A3) Jeff spends the majority of his time out
with friends, drinking in the afternoons after
work, and on the weekends. More frequent
and intense hangovers as well in the last
eighteen months
A4) Jeff expressed yearning for alcohol at
work, to the extent that if he works over ten
hours, his urges take over and he goes to his
hotel to drink immediately after
A5) Recurrent alcohol use that has affected his
marriage, his work, and his personal life
A6) Client has verbalized no intention of
minimizing drinking except to keep their job.
Over the years, the client has been arrested
and charged for multiple offences, been
suspended and written up at their job-site, and
his personal relationship with his ex-wife
A7) Client prefers to go out and drink or stay
home and drink over doing much of anything
else
A8) Drinking on the job is a breach of safety
protocols at his job site
A9) Client has dealt with depressive episodes
since fifteen years old, and alcohol
consumption has been present since the age of
seven. The client is aware but unwilling to
stop or reduce intake
A10) The client has confirmed that it takes a
Case Study: Jeff 4
much bigger alcohol intake to feel a buzz
DSM-5-TR Diagnostic Criteria:
Substance/Medication-Induced Depressive
Disorder, F10.24
Client’s Signs/Reported Symptoms:
Criterion A: Prominent or persistent mood
disturbance that is a depressed mood or
diminished interest in activities.
The client presents depressed mood and a loss
of interest in activities
Criterion B: There is a history of the substance
causing symptoms in criterion A to develop
upon using the substance, and it produces the
symptoms as well
The client is aware that alcohol is a
depressant, but still uses it heavily,
contributing to the formation of symptoms.
Criterion C: The disturbance is not better
explained by another depressive disorder that
is not substance-induced
The client’s depressive symptoms are directly
tied to the consumption of alcohol
Criterion D: The disturbance isn’t happening
during an episode of delirium
The client did not present any symptoms of
delirium
Criterion E: The disturbance causes distress in
other areas of functioning, such as
occupational and social
The client’s symptoms are causing issues such
as arriving late to work, losing weight, and
distancing from family and friends
Other DSM-5-TR Conditions Considered
Based on the depressive symptoms that Jeff is having, another diagnosis was considered.
The Major Depressive Disorder, recurrent episode, severe, corresponding ICD-10 code F33.2 fits
a lot of the symptoms that Jeff is displaying. However, despite meeting criteria A and B, criterion
C states that he episode is not attributed to the effects of a substance, ruling out the diagnosis.
Developmental Theories and/or Systemic Factors
Despite Jeff’s misuse of alcohol, which has contributed to multiple arrests, a strained
relationship with family and his ex-wife, and the possibility of losing his job, it is important to
reflect on the systemic factors that have built who Jeff is today and how that has contributed to
Case Study: Jeff 5
his alcohol use disorder. Elam et al. (2020) state that there is a higher probability that children
who have parents with alcohol use disorder, in this case, Jeff’s father, have a higher chance of
alcohol consumption themselves when compared to children who don’t have parents with alcohol
use disorder. The social-learning theory further backs this by the modeling mechanisms that the
parent provides to the child (Elam et al., 2020). When exposure to parental alcohol use occurs, it
provides behaviors that are deemed normal and are likely to be modeled. This often reflects in
early adolescence, but for Jeff it began at the young age of seven years old, which led to early
initiation to alcohol, in return causing heavier alcohol use in his later adolescent stage up until
now an adult (Elam et al., 2020).
Multicultural and/or Social Justice Considerations
Based on Jeff’s statements about his upbringing and family dynamics, it is important to
consider his family background and history since it contributes to his diagnosis. Jeff reports that
he has a long history of alcohol use. At the short age of seven, Jeff had his first drink with his
father and older siblings, stating that “‘it's just what you do as a man’”, which insinuates that the
use of alcohol was considered normal within his household and boasted as a positive thing. As he
got into his early and late adolescence, he began to spend time with other peers who consumed
alcohol heavily, and soon found himself partying from Friday through Sunday. After completing
high school and obtaining a job as a painter, his job was inconsistent, and when he was off, he
would drink with friends. After two years, he became a roofer and drank almost every weekend,
and at times would arrive at work intoxicated or smelling of alcohol. This never seemed to be an
issue, which fortified Jeff to normalize alcohol consumption even more. Garrido et al. (2017)
discuss the impact of adverse childhood experiences such as neglect, exposure to domestic
violence, and parental substance abuse, and how these correlate with health-risk behaviors.
Adults who have had multiple adverse childhood experiences are more than likely to smoke,
Case Study: Jeff 6
abuse alcohol, use illicit drugs, and engage in risky sexual behavior (Garrido et al., 2017). Jeff’s
early introduction to alcohol use has led him to the misuse of alcohol and to deal with
sad/depressive episodes for the last decades of his life, eventually impacting his work,
relationship with his wife and child, and a strained relationship with his mother and siblings.
Treatment Considerations
Key Issues for Treatment
●Suicidal Ideation
●Alcohol misuse
●Depression
Recommendations for Individual Counseling
The first recommended treatment for Jeff’s alcohol use disorder is motivational
enhancement therapy. According to Flanagan et al. (2018), the motivation enhancement therapy
is a form of intervention that is designed to further enhance an internal motivation that pushes
individuals with alcohol use disorder to desire change and engagement in the changing process.
Jeff expresses little to no motivation or desire to reduce the intake of alcohol or to stop drinking
at all, even if it has contributed to multiple arrests for DWI, domestic violence, depressive
episodes, and the possibility of being fired. Using the motivation enhancement therapy allows for
the use of collaborative, empathetic, and non-confrontational techniques that help individuals
increase awareness of negative consequences, reduce alcohol intake, quit, and incite more
motivation to prioritize their physical health (Flanagan et al., 2018).
The Centers for Disease Control and Prevention, as of 2021, states that the rate of suicide
in men is four times higher than that of women (Harmer et al., 2024). Jeff’s depressive episodes
have escalated more and more as the alcohol consumption has also increased. Symptoms have
gotten so severe that Jeff has formulated a plan to act on his suicidal ideation, but states that he
Case Study: Jeff 7
hasn’t hurt or acted on it before. Building a crisis response plan creates a guide to help
individuals who are actively having suicidal ideations or a history of suicide attempts (Harmer et
al., 2024). By identifying the risk, evaluating the triggers, providing coping strategies, a support
network, and crisis services such as inpatient care if the client is a danger to themselves or others
(Harmer et al., 2024).
Considering Jeff’s history with the misuse of alcohol and ongoing depressive episodes,
medication management is recommended for the client. Upon seeing a qualified nurse
practitioner who does medication management or a psychiatrist, an antidepressant may be given
to eventually lift a client's mood and increase the motivation that is lacking when in an episode
(InformedHealth, 2024). Upon taking antidepressants, it can take days or weeks to feel a
difference. When on antidepressants, it is important to see a doctor regularly to monitor any
issues or concerns, as well as the progress that the medication is having, and also to create the
ability to make adjustments to the medication to better fit the needs of the client
(InformedHealth, 2024).
Specific Considerations
Jeff initially comes in for an assessment about his substance/alcohol use disorder, but as
more information is provided, it becomes evident that there is a co-occurring mental disorder.
When diagnosing and creating treatment plans, it is important to screen for any potential mental
disorders along with a substance use disorder, specifically the safety risk that is related to
intoxication or the withdrawal of a substance (Treatment Improvement Protocol, 2020).
Considering that Jeff’s depression is closely tied to his misuse of alcohol because alcohol is
considered a depressant, it would be important to simultaneously work on treating both diagnoses
since they go hand in hand. A concerning symptom that Jeff is dealing with is suicidal ideation,
shifting the diagnosis to be more severe, the treatment planning is more vigorous and crisis-based
Case Study: Jeff 8
rather than regular treatment planning. It is of great importance to work with Jeff to help him
through his suicidal ideations and then formulate a treatment plan that works with his
alcohol intake and the symptoms that come with it.
References
American Psychiatric Association. (2022). Diagnostic and Statistical Manual of Mental
Disorders: DSM-5 TR (5th ed. Text Revision). American Psychiatric Press, Inc.
Elam, K. K., Sternberg, A., Waddell, J. T., Blake, A. J., & Chassin, L. (2020). Mother and Father
Prescription Opioid Misuse, Alcohol Use Disorder, and Parent Knowledge in Pathways to
Adolescent Alcohol Use. Journal of Youth and Adolescence, 49(8), 1663-1673.
https://doi.org/10.1007/s10964-020-01266-2
Flanagan, J. C., Jones, J. L., Jarnecke, A. M., & Back, S. E. (2018). Behavioral Treatments for
Alcohol Use Disorder and Post-Traumatic Stress Disorder. Alcohol research: current
reviews, 39(2), 181–192.
Garrido, E. F., Weiler, L. M., & Taussig, H. N. (2018). Adverse Childhood Experiences and
Health-Risk Behaviors in Vulnerable Early Adolescents. The Journal of early adolescence,
38(5), 661–680. https://doi.org/10.1177/0272431616687671 Harmer B, Lee S, Rizvi A, et
al. Suicidal Ideation. [Updated 2024 Apr 20]. In: StatPearls [Internet]. Treasure Island
(FL): StatPearls Publishing; 2025 Jan-. Available from:
https://www.ncbi.nlm.nih.gov/books/NBK565877/
InformedHealth.org [Internet]. Cologne, Germany: Institute for Quality and Efficiency in Health
Care (IQWiG); 2006-. Depression: Learn More – How is depression treated? [Updated
2024 Apr 15]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK279282/
Liberty University. Jeff Case Study. [Case Study Assignment: Jeff]. School of Behavioral
Sciences, Liberty University, Canvas. https://canvas.liberty.edu/
Case Study: Jeff 9
Mansfield, K., Crellin, E., Denholm, R., Quint, J. K., Smeeth, L., Cook, S., & Herrett, E. (2019).
Completeness and validity of alcohol recording in general practice within the UK: a cross-
sectional study. BMJ Open, 9(11)https://doi.org/10.1136/bmjopen-2019-031537 Substance Use
Disorder Treatment for People With Co-Occurring Disorders: Updated 2020
[Internet]. Rockville (MD): Substance Abuse and Mental Health Services Administration
(US); 2020. (Treatment Improvement Protocol (TIP) Series, No. 42.) Chapter
3—Screening and Assessment of Co-Occurring Disorders. Available from:
https://www.ncbi.nlm.nih.gov/books/NBK571017/
