CASE STUDY JEFF 1
Case Study Jeff
Cara Soto
School of Behavioral Science in Mental Health Counseling, Liberty University
CASE STUDY JEFF 2
Key Issues
Biological
oHangover
oFatigue
oHeadaches
oFamily history of drinking,
oIntense craving (all he can think about) for alcohol after 10 hours without having
a drink.
oNo appetite (when depressed)
Psychological
oHeavy drinking problem
o4-5 bouts of major depression (lasted 7-8 months each time)
oSuicidal ideation
oLow level of sadness all the time
Social
oStrained relationship with ex-wife
oThreat of termination from job
oDrinks with friends and family
Spiritual
oCurrently has no interest in the integration of any spiritual matters.
Assessment
The first assessment that needs to be done with Jeff is the 4-item Suicidal Behaviors
Questionnaire-Revised. Because Jeff has not only thought about suicide but already has a plan in
CASE STUDY JEFF 3
place it is urgent that he gets the help he needs to prevent him from committing suicide. This 4-
item test is chosen because it is fast and won't take a lot of his time. This test is found to be
psychometrically sound. The findings of Aloba et. al (2017) found that the measures between the
HADS-Anxiety and Depression subscales, and the GHQ-12 has a positive correlation that is
significant. The Cronbach’s alpha for the SBQ-R items is 0.80.
Diagnostic Impressions
Jeff has a double diagnosis of Alcohol Use Disorder 303.90 F10.20 and Severe and Major
Depressive Disorder in full remission 296.36 (F33.42).
DSM
Letter
&
Numbe
r
DSM Criteria
DSM Diagnosis (in order of DSM criteria)
Alcohol Use Disorder
Client Report
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:
client exhibits more than two
of the following criteria
A1 Alcohol is often taken in larger amounts or over a
longer period than was intended.
currently is drinking more on
weekdays then intended
A2 There is a persistent desire or unsuccessful efforts
to cut down or control alcohol use.
Never thought about drinking
less
A3 A great deal of time is spent in activities necessary
to obtain alcohol, use alcohol, or recover from its
effects.
Over sleeping, getting drinks
before going to dinner with
co-workers. drinks all
weekend and days off work.
A4 Craving, or a strong desire or urge to use alcohol. strong desire to drink after
10hr on the job with no
alcohol.
A5 Recurrent alcohol use resulting in a failure to fulfill
major role obligations at work, school, or home.
domestic violence due to
drinking. Job probation due
to excessive drinking. divorce
due to drinking.
A6 Continued alcohol use despite having persistent or
recurrent social or interpersonal problems caused or
exacerbated by the effects of alcohol.
continues to drink even if job
is on the line. ex-wife won’t
let him see children if
drinking continues
A7 Important social, occupational, or recreational
activities are given up or reduced because of
cannot see his children due to
drinking. job is on the line
CASE STUDY JEFF 4
alcohol use. due to being late because of
hang-overs
A8 Recurrent alcohol use in situations in which it is
physically hazardous.
Driving while intoxicated
A9 Alcohol use is continued despite knowledge of
having a persistent or recurrent physical or
psychological problem that is likely to have been
caused or exacerbated by alcohol.
Hangovers are consistent.
fatigue. sadness, headaches
A10 Tolerance, as defined by either of the following: increased tolerance
a A need for markedly increased amounts of alcohol
to achieve intoxication or desired effect
he has increased drinking
over the last 18 months
from4-5 beers to 6-8 to feel
buzzed
b A markedly diminished effect with continued use of
the same amount of alcohol.
has to drink more alcohol to
get buzzed then he did 18
months ago
A11 Withdrawal, as manifested by either of the
following:
Yes
a The characteristic withdrawal syndrome for alcohol
(refer to Criteria A and B of the criteria set for
alcohol withdrawal, pp. 499–500).
b Alcohol (or a closely related substance, such as a
benzodiazepine) is taken to relieve or avoid
withdrawal symptoms.
After 10 hours without a
drink, he notices he can't
think of anything else but
having a drink
(American Psychiatric Association, 2013)
DSM
Letter
&
Numbe
r
DSM Criteria
DSM Diagnosis (in order of DSM criteria)
Major Depressive Disorder
Client Report
A Five (or more) of the following symptoms have
been present during the same 2-week period and
represent a change from previous functioning; at
least one of the symptoms is either (1) depressed
mood or (2) loss of interest or pleasure.
Note: Do not include symptoms that are clearly
attributable to another medical condition
Jeff has five or more
symptoms that have lasted
more then 2-weeks. has
experienced both depressed
mood and loss of interest or
pleasure.
A1 Depressed mood most of the day, nearly every day,
as indicated by either subjective report (e.g., feels
sad, empty, hopeless) or observation made by others
(e.g., appears tearful).
Depressed every day. noticed
by family and friends
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A2 Markedly diminished interest or pleasure in all, or
almost all, activities most of the day, nearly every
day (as indicated by either subjective account or
observation).
lost all interest in activities
he normally enjoyed. feeling
hopeless
A3 Significant weight loss when not dieting or weight
gain (e.g., a change of more than 5% of body weight
in a month) or decrease or increase in appetite
nearly every day.
lost all appetite. lost
significant amount of weight
(25-30lbs) in 8 months
A4 Insomnia or hypersomnia nearly every day. Disturbed sleep
A5 Psychomotor agitation or retardation nearly every
day (observable by others, not merely subjective
feelings of restlessness or being slowed down).
feelings of irritability
A6 Fatigue or loss of energy nearly every day. wake up fatigued almost
every morning
A7 Feelings of worthlessness or excessive or
inappropriate guilt (which may be delusional) nearly
every day (not merely self-reproach or guilt about
being sick).
A8 Diminished ability to think or concentrate, or
indecisiveness, nearly every day (either by
subjective account or as observed by others).
A9 Recurrent thoughts of death (not just fear of dying),
recurrent suicidal ideation without a specific plan, or
a suicide attempt or a specific plan for committing
suicide.
planned how to end his life
B The symptoms cause clinically significant distress
or impairment in social, occupational, or other
important areas of functioning.
pulls away from family and
friends. has a hard time
finishing a day of work
C The episode is not attributable to the physiological
effects of a substance or another medical condition.
D The 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 by other
psychotic disorder.
E There has never been a manic episode or a
hypomanic episode.
Note: This exclusion does not apply if all of the
manic-like or hypomanic-like episodes are
substance-induced or are attributable to the
physiological effects of another medical condition.
No manic episodes also
further research into if this is
substance abuse induced or
occurred before substance
abuse started
(American Psychiatric Association, 2013)
CASE STUDY JEFF 6
Differential Diagnosis
Other disorders that need to be ruled out are:
Persistent Depressive Disorder- symptoms have not been continuously present for 1-year.
Substance/Medication-Induced Depressive Disorder- onset of depressive symptoms is not
caused by alcohol consumption. Client stated that he has "sad times" regardless of consumption.
Has been consuming more frequently the past two years and has not had a major depressive
episode.
Bipolar I- No manic episodes
Bipolar II- No manic episodes
Another contributing factor in Jeff's addiction is genetics and environment. As stated in
our textbook genetic and shared environmental aspects encourage the use of alcohol (Kring,
2018). Jeff had drinks with his father and other relatives at 7 years old. It was socially expected
that this is what a man does, and what families do together. Jeff previous work environment and
friends have also contributed to the normalcy of drinking.
Treatment
Key Issues
oSuicidal Ideation
oAlcohol Use
oDepression
Jeff seems to experience suicidal ideation only when in a depressive state. However, this
needs to be explored by the counselor to prevent any more steps towards suicide. Next, the
counselor must address Jeff's alcohol usage. Make a connection with Jeff and don't judge, he
becomes defensive when told he drinks to much. The counselor must work with Jeff in keeping
his job, this will give Jeff something to work towards and lessen the resistance to want to change.
CASE STUDY JEFF 7
Jeff has a strong denial that he has a problem. He denies that it causes work related issues and
can’t see why his wife left him, even after physical abuse. Sessions must include helping Jeff see
what he is missing out on in life. Spithoff & Kahan (2015) have found that a strong relationship
with the counselor is helpful for change. They also state that barriers should be explored, triggers
avoided and a support network to be set up. Motivational Enhancement Therapy has been found
to be a success at helping those with alcohol dependency acknowledge their problems (Murphy
et. al 2018). Cognitive Behavioral Therapy and MET have also been helpful to clients with
alcohol dependency and depression (Riper et. al 2014).
Specific Considerations
With a dual diagnosis and suicidal ideation. the most pressing should first be addressed.
Make sure he is safe and there is no potential for self-harm. Next, with Jeff working on the
drinking problem to keep his job could be the best approach. Setting goals for him, educating
him about his body and giving him options seems to be a good fit for him. After a few sessions
CBT and MET can be used to help him become more acknowledging and help with the
depression (Riper et. al 2014). Because depression can be linked to alcohol usage it can be
difficult to properly diagnosis Jeff. It could be that the sadness is from drinking. Or maybe the
sadness has always been an issue and alcohol exasperate the depressive mood. In a case study by
Spilsbury (2012), she found that solution-focused brief therapy and a prescription of fluoxetine
for her client, who was alcohol dependent and depressed, resulted in depression levels dropping
to normal after 4 months of treatment and client was able to abstine from alcohol.
CASE STUDY JEFF 9
References
Aloba, O., Ojeleye, O., & Aloba, T. (2017). The psychometric characteristics of the 4-item
suicidal behaviors questionnaire-revised (SBQ-R) as a screening tool in a non-clinical
sample of nigerian university students. Asian Journal of Psychiatry, 26, 46-51.
https://doi.org/10.1016/j.ajp.2017.01.017
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders
(DSM-5). American Psychiatric Publishing.
Kring, A., Johnson, S. (2018). Abnormal Psychology. Wiley.
Murphy, C. M., Ting, L. A., Jordan, L. C., Musser, P. H., Winters, J. J., Poole, G. M., & Pitts, S.
C. (2018). A randomized clinical trial of motivational enhancement therapy for alcohol
problems in partner violent men. Journal of Substance Abuse Treatment, 89, 11-19.
https://doi.org/10.1016/j.jsat.2018.03.004
Riper, H., Andersson, G., Hunter, S. B., de Wit, J., Berking, M., & Cuijpers, P. (2014). Treatment
of comorbid alcohol use disorders and depression with cognitive-behavioural therapy and
motivational interviewing: A meta-analysis. (3), 394- Addiction (Abingdon, England), 109
406. https://doi.org/10.1111/add.12441
Spilsbury, G. (2012). Solution-focused brief therapy for depression and alcohol dependence: A
case study. Clinical Case Studies, 11(4), 263-275.
https://doi.org/10.1177/1534650112450506
Spithoff, S., & Kahan, M. (2015). Primary care management of alcohol use disorder and at-risk
drinking: Part 2: Counsel, prescribe, connect. Canadian Family Physician, 61(6), 515-
521.
