Jeff Case Study 2
Jeff Case Study
Overview
Jeff is a 33 year old divorced white man. He’s seeking an assessment for his job to determine if
he should keep his job.
Client Concerns
Symptoms Behaviors Stressors
Intoxication Failing blood test Loong work hours
Tolerance increased 7 beer minimum depression
Unable to concentrate Wants beer after long shifts Long work days
Hangovers Late to work Separation/divorce
Tense relationships Avoiding kids, DV Accountability
Bad decision making Arrested twice Life
Sadness No interest in activities Wife leaving
No appetite Losing 20 lbs during sad
times
Work/life balance
Assessment
An effective assessment for Alcohol Use Disorder (AUD) is the Severity of Alcohol
Dependence Questionnaire (SADQ) to gauge the severity of alcohol-related issues. This
assessment often has questions related to frequency and quantity of alcohol consumption, as well
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as the impact on one's physical and mental health. Developed by Stockwell et al., this
questionnaire comprises 20 items that cover various aspects of alcohol dependence, including
physical and psychological symptoms, as well as the impact on daily life. Respondents rate each
item based on their experiences over the past month, and scores are totaled to determine the
overall severity of dependence.
Diagnostic Impression
The primary diagnostic impression based upon the DSM-5-TR is Alcohol Use Disorder,
Severe, F10.20.
Signs and Symptoms
DSM-5-TR Diagnostic Criteria: Alcohol Use
Disorder, Severe, Code F10.20
Client’s Signs/Reported Symptoms:
Criterion 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 (6 or more for severe)
Client
1. Alcohol is often taken in larger
amounts or over a longer period than
was intended.
4-8 beer after work
Off days 6-8 and liquor
2. There is a persistent desire or
unsuccessful efforts to cut down or
Quit AA
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control alcohol use.
3. Craving, or a strong desire or urge to
use alcohol.
Working more than 10 hours he,”really wants
a beer”
4. Recurrent alcohol use resulting in a
failure to fulfill major role obligations
at work, school, or home.
Late one day a week for the past year due to
hangovers
5. Continued alcohol use despite having
persistent or recurrent social or
interpersonal problems caused or
exacerbated by the effects of alcohol.
When married, drinking led to DV
6. Important social, occupational, or
recreational activities are given up or
reduced because of alcohol use.
Time with kids reduced because he had “one
to many”
Arrested twice because of alcohol
7. Recurrent alcohol use in situations in
which it is physically hazardous.
4 BAC violations on construction worksite
8. Alcohol use is continued despite
knowledge of having a persistent or
Drinking until hungover and late for work
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recurrent physical or psychological
problem that is likely to have been
caused or exacerbated by alcohol.
9. Tolerance 4-5 beers used to cause a buzz, now 7
minimum
Other DSM-5-TR Conditions Considered
The client reported episodes of sadness throughout life. After his wife left, he reported
losing interest in things he loved. Feeling hopeless about life in general and having trouble
sleeping. Although he created a suicide plan, but he had no intention to hurt himself, also loss of
appetite. I ruled out MDD because some, if not most of the symptoms can be the physiological
effects of alcohol. With Jeff reluctant to quit there is no way to determine if the sadness
symptoms are comorbid or stand-alone.
Developmental Theories and/or Systemic Factors
The strain on familial relationships due to alcohol consumption and associated patterns is
a recognized factor in the development of Alcohol Use Disorder (AUD). Colder et al. delves into
how family dynamics, including strained relationships with siblings, can contribute to alcohol-
related issues. The study suggests that familial conflicts, particularly those stemming from one's
alcohol use and adherence to family patterns, may act as stressors that contribute to the
escalation of alcohol-related problems.H
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The impact of parental alcohol consumption, particularly when one's father drinks daily,
has been studied in relation to the risk of developing Alcohol Use Disorder (AUD).H The study
emphasizes the influence of the familial environment on an individual's vulnerability to AUD,
suggesting that growing up with a daily-drinking father may significantly heighten the risk of
developing problematic alcohol use patterns later in life.H(Abbey, 2011)
While there is a correlation between early initiation of alcohol consumption and an
increased risk of developing Alcohol Use Disorder (AUD) later in life, it's essential to note that
causation is a complex interplay of genetic, environmental, and social factors. A study by
Hingson et al, 2016, underscores that early exposure to alcohol during formative years may
impact brain development and increase susceptibility to problematic drinking behaviors in
adulthood. Jeff has also stated that he drinks often with friends, on weekends, and this nonstop
drinking has cost him his marriage, freedom, and now threatening his employment.
Multicultural and/or Social Justice Considerations
Engaging in regular alcohol consumption during adolescence, particularly on weekends,
has been associated with various developmental challenges. The impact of adolescent binge
drinking on brain development indicates that alcohol exposure during adolescence can lead to
persistent changes in brain structure and function, affecting neurotransmitter gene expression,
behavior, and neurochemistry in adulthood. These findings suggest that regular alcohol
consumption during the teenage years may contribute to developmental challenges, potentially
affecting cognitive and emotional functions later in life. (Lees et al., 2020) It stresses the
importance of addressing and preventing alcohol misuse during adolescence to support healthy
development.
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Treatment Recommendations
Key Issues for Treatment
Alcohol Consumption
Depression
Recommendations for Individual Counseling
The treatment of Alcohol Use Disorder (AUD) is multifaceted, encompassing various
therapeutic modalities. Since AA has been unsuccessful, I would refer Jeff to a psychiatrist for
medical treatment. I would also use Cognitive-Behavioral Therapy (CBT), it plays a pivotal role
in addressing maladaptive thought patterns and behaviors associated with AUD (Sockalingam et
al., 2011). Holistic approaches incorporating mindfulness can complement traditional
interventions, addressing both the physical and psychological aspects of AUD (NIAAA, 2021).
Overall, a personalized and comprehensive approach is essential to effectively address the
complexities of AUD and promote sustained recovery.
In this instance I would highly advocate for family therapy. Family therapy plays a
crucial role in the comprehensive treatment of Alcohol Use Disorder (AUD), especially for a
client with a family history of alcohol-related issues. In the context of a client facing AUD with
parents and siblings who also engage in drinking, family therapy can offer a valuable space to
explore the familial dynamics contributing to the client's struggles. The involvement of family
members in therapy, as discussed in the article by Filges et al, allows for a holistic examination
of the environment surrounding the client. Through therapeutic interventions, family therapy
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aims to improve communication, set healthy boundaries, and address enabling behaviors,
fostering a supportive atmosphere for the client's recovery journey. This collaborative approach
acknowledges the interconnectedness of family dynamics in the development and treatment of
AUD.
Specific Considerations
Multiple diagnoses significantly impact the decision-making process for diagnostic
impressions and treatment planning, particularly when a client presents with both Alcohol Use
Disorder (AUD) and Major Depressive Disorder (MDD). Grant et al. (2016) emphasizes that
individuals with comorbid AUD and MDD often exhibit more severe symptoms, necessitating
integrated interventions that address both conditions simultaneously. The treatment plan must be
tailored to the unique challenges associated with dual diagnoses, considering the bidirectional
relationship between alcohol use and depressive symptoms. Integrated approaches, incorporating
psychotherapeutic interventions and pharmacotherapy, have proven effective in addressing the
complexities of co-occurring AUD and MDD (Ray et al., 2014). Thus, a holistic and
individualized approach is paramount in diagnostic and treatment decision-making for clients
facing multiple diagnoses.
Alcohol and substance use disorders introduce complexity to the process of diagnostic
impressions due to their varied presentations and significant impact on individuals' lives.
According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5),
substance use disorders are diagnosed based on patterns of problematic use leading to clinically
significant impairment or distress (American Psychiatric Association, 2013). Symptoms
associated with these disorders, such as impaired control and social impairment, can overlap with
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those of other mental health conditions, posing challenges for accurate diagnosis. Additionally,
substance-induced conditions may mimic primary mental disorders, necessitating a careful
consideration of the relationship between substance use and psychiatric symptoms (Hasin et al.,
2013). Therefore, a comprehensive evaluation, including a thorough substance use history, is
imperative for forming accurate diagnostic impressions in individuals with alcohol and substance
use disorders.
References
Abbey, S. E., Abdelhamid, N., Blank, D., Hirschfield, G. M., Irvine, J., & Sockalingam, S.
(2011). Biological and psychosocial predictors of major depressive disorder outcome in a
tertiary care setting. Journal of Affective Disorders, 134*(1-3), 190-197.
American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders
(5th ed., text rev.). https://doi.org/10.1176/appi.books.9780890425787
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Colder, C. R., Shyhalla, K., Frndak, S., Read, J. P., Lengua, L. J., Hawk, L. W., & Wieczorek,
W. F. (2017). The prospective association between internalizing symptoms and
adolescent alcohol involvement and the moderating role of age and externalizing
symptoms. Alcoholism: Clinical and Experimental Research, 41(12), 2185–2196.
https://doi.org/10.1111/acer.13512
Filges, T., Knop, J., & Lemmer, G. (2015). Family-based approaches to treating adolescent
substance abuse: A systematic review. The Cochrane Database of Systematic Reviews,
2015(8), CD012016.
Grant, B. F., Goldstein, R. B., Smith, S. M., Jung, J., Zhang, H., Chou, S. P.& Hasin, D. S.
(2016). The Alcohol Use Disorder and Associated Disabilities Interview Schedule-5
(AUDADIS-5): Reliability of substance use and psychiatric disorder modules in a general
population sample. Drug and Alcohol Dependence, 168, 40-46.
Hasin, D. S., O'Brien, C. P., Auriacombe, M., Borges, G., Bucholz, K., Budney, A., & Grant, B.
F. (2013). DSM-5 criteria for substance use disorders: Recommendations and rationale.
The American Journal of Psychiatry, 170(8), 834-851.
Hingson, R., Zha, W., Simons-Morton, B., & White, A. (2016). Alcohol-Induced Blackouts as
Predictors of Other Drinking Related Harms Among Emerging Young
Adults.HAlcoholism, clinical and experimental research,H40(4), 776–784.
https://doi.org/10.1111/acer.13010
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Jonas, D. E., Amick, H. R., Feltner, C., Bobashev, G., Thomas, K., Wines, R., & Garbutt, J. C.
(2014). Pharmacotherapy for adults with alcohol use disorders in outpatient settings: A
systematic review and meta-analysis. JAMA, 311(18), 1889-1900.
Kim-Spoon, J., Farley, J. P., Holmes, C. J., Longo, G. S., & McCullough, M. E. (2016).
Processes linking parents' and adolescents' religiousness and adolescent substance use:
Monitoring and self-regulation. Journal of Youth and Adolescence, 45(2), 274–286
Lees, B., Meredith, L. R., Kirkland, A. E., Bryant, B. E., & Squeglia, L. M. (2020). Effect of
alcohol use on the adolescent brain and behavior. Pharmacology Biochemistry and
Behavior, 192, 172906. https://doi.org/10.1016/j.pbb.2020.172906
National Institute on Alcohol Abuse and Alcoholism (NIAAA). (2021). Treatment for Alcohol
Use Disorder. Retrieved from https://www.niaaa.nih.gov/publications/brochures-and-
fact-sheets/treatment-alcohol-use-disorder.
Ray, L. A., Bujarski, S., Shoptaw, S., Roche, D. J., Heinzerling, K., Miotto, K., & Mischel, W.
(2014). Development of the neurobehavioral alcohol response questionnaire. Journal of
Studies on Alcohol and Drugs, 58-67.
