CASE STUDY: JEFF 1
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CASE STUDY: JEFF
Jeff’s Case Study
First Last
School of Behavioral Sciences, Liberty University
Author Note
First Last
I have no known conflict of interest to disclose
Correspondence concerning this article should be addressed to David Evans
Email:
Jeff’s Case
Jeff is a 33-year-old Caucasian male who has agreed to being assessed to keep his job as a construction worker, which he has held for 5 years. Jeff has been suspended from work multiple times because of his tardiness and showing up to work smelling like alcohol. Jeff’s parents have been married for 45 years. He is the fourth of three brothers and two sisters. There is a familial theme of heavy alcohol drinking with his father, two brothers, and two brothers-in-law. Jeff has a strained relationship with his third brother as a result of his excessive drinking. Jeff is a divorced father of two. Other than alcohol consumption, Jeff reported some marijuana use. Jeff has no reported medical history, but described his mom as being sad. Jeff has been incarcerated on three separate occasions: once for physical abuse to his wife, and the others for two individual DUI infractions.
Clients Concerns
| Symptoms |
Behaviors |
Stressors |
| Sadness |
Domestic violence toward his wife |
Potential of losing the job he loves |
| Alcohol withdrawals |
Missing work |
Divorce/tense relationship with ex-wife |
| Headache due to excessive drinking |
Being late to work |
Possibility of losing visitation with his children |
| Depression |
Drinks alcohol to achieve intoxication |
Arrests |
| Loss of interests doing activities |
Hungover at work |
Strained relationships with family and friends |
| Excessive sleeping |
Driving while intoxicated |
|
| Fatigue |
Marijuana use |
|
| Suicide Ideation |
Isolation |
|
| Loss of appetite |
|
|
| Irritability |
|
|
Assessment
It appears that Jeff’s excessive alcohol consumption is a large contributor to poor decision-making habits. It seems that not being able to control his impulse to drink has affected his interpersonal relationships, job performance and conduct. Administering the US Alcohol Use Disorder Identification Test (USAUDIT), recognized as the most recognized screening instrument, may confirm whether he suffers from alcohol use disorder (Higgins, et al., 2018). Another assessment consideration is the Hamilton Rating Scale for Depression (HRSD). Identified as the “gold standard,” using this assessment will likely generate a clearer picture of Jeff’s depressive symptoms (Worboys, 2013).
Diagnostic Impressions
The diagnostic impression associated with Jeff’s symptoms are most congruent with Alcohol Use Disorder. The ICD-10 code for this is F10.20. A secondary disorder has been considered for Jeff. Major Depressive Disorder, ICD-10F33.2.
Signs and symptoms
The symptomology that Jeff expresses are explained by the DSM-5-TR as Alcohol Use Disorder and Major Depressive Disorder. The criterion for these diagnoses is listed in the table below.
| DSM-5-TR Diagnostic Criteria: Alcohol Use Disorder/ ICD-10F10.20 |
Jeff’s Signs/Reported Symptoms: |
| A: An unfavorable cycle of alcohol consumption leading to significant misjudgment and is seen in at least two of the following ways within a 12-month period.
1. Larger amounts of alcohol are consumed over a greater time than anticipated.
2. Activities are centered around alcohol consumption efforts.
3. Appetite for alcohol grows.
4. Alcohol consumption is not reduced regardless of interruption of interpersonal relationships.
5. Alcohol use continues regardless of physical hazards.
6. Intoxication level requires larger alcohol consumption levels (APA, 2022). |
Jeff reported that he now drinks up to eight beers and multiple shots during drinking sessions, which is greater than earlier consumption levels. He also stated that getting buzzed has required more alcohol consumption within the past 18 months. Jeff shared that most of his activities with friend include alcohol consumption. Alcohol is even a common theme during family functions. Jeff reported that now he cannot work a 10-hour shift without having overwhelming thoughts to drink. Jeff’s marriage and relationship with one of his brothers has diminished as a result of excessive drinking. Jeff has received three DUI violations. Jeff is now taking four-six more shots now than he did 18 months ago due to an increased tolerance level.
|
| DSM-5-TR Diagnostic Criteria:
Major Depressive Disorder/ ICD-10-F33.2 |
Jeff’s Signs/Reported Symptoms: |
| A: At least five of the following symptoms must be present simultaneously for 2 consecutive weeks and present a shift from previous functioning; At least one symptom is either depressed mood or loss of desire or enjoyment.
1. Depressed mood everyday for most of the day from a self-evaluative perspective or objectively observed by others.
2. Significant unintentional weight fluctuation.
3. Daily fatigue
4. Feeling insignificant.
5. Obsessive thoughts of the end (APA, 2022). |
Jeff’s AA counselor confronted him about his depressed appearance. Additionally, shortly after being separated from his spouse, Jeff reported feeling down daily and losing a desire to participate in usual activities. He also felt fatigued regardless of how much sleep he was getting. Jeff had several thoughts of committing suicide. Jeff shared that he has had a loss of appetite and lost 25-30 pounds |
| B: Symptoms have a significantly adverse impact on personal/professional relations (APA, 2022).
|
Jeff’s excessive drinking has affected his marriage. There have been three different instances of domestic violence between he and his wife. All three incidents involved him being intoxicated. Additionally, Jeff is no longer close to his favorite brother because of his alcohol abuse. Jeff’s job is also at risk of being terminated due his lack of responsibility with alcohol consumption. |
Other DSM-5-TR Conditions Considered
An alternative consideration for Jeff’s diagnosis was persistent depressive disorder. Jeff has reported feeling depressed most of his life from age 15 years old. However, the criterion associated with this diagnosis includes depressed mood most of the time for at least 2 years. There is no indication in the scenario that suggests this level of detail (more days than not) and must be further explored to confirm.
Developmental Theories and/or Systemic Factors
There is a developmental component to his feeling of depression. Jeff reported first feeling depressed around age 15 which is not much long after he potentially started puberty. This detail supports the criteria of when the DSM-5-TR suggests depressive symptoms may likely begin (APA, 2022). Also, men are more likely to participate in abnormal coping behaviors associated with depression. Alcohol is among the list of proclivities to remedy the maladapting behaviors produced out of feelings of sadness (APA, 2022). Lastly, Jeff testified that his mother has always had a melancholy disposition which makes him developmentally more susceptible.
Multicultural and/or Social Justice Considerations
There are some multicultural factors that should be highlighted when considering Jeff’s case. Jeff reported that he remembered having his first drink at age seven. He has a familial theme that supports heavy alcohol consumption. The attitude is “that is just what men do.” His father introduced him to beer; two of his brothers drink heavily, as well as the spouses of his two sisters. Jeff shared that drinking alcohol is usually what he and his buddies did when spending time together, so it appears that Jeff is inoculated into a culture where excessive alcohol consumption is normal behavior.
Treatment Recommendations
Key Issues for Treatment
· Major depressive disorder seems to be the pressing issue. Assisting Jeff with reconstructing his thoughts may lead him to making better decisions about his alcohol consumption as well as affirm him overall (i.e., self-worth, interpersonal relationships, and professional duties).
· Jeff job performance duties have been significantly impacted by his clinically impaired distress. Self-sufficiency is a fundamental part of caring for oneself. Being able to maintain job stability is essential and can only be achieve by Jeff changing his behavior.
· Jeff has acted out in violence against his wife. This destructive behavior must be addressed and remedied through effective problem-solving techniques.
Recommendations for Individual Counseling
According to the key issues I believe are most pressing for Jeff, I would implement cognitive behavior therapy (CBT). This treatment option is designed to help Jeff reconstruct his approach to the relational issues within his interpersonal relationships (Burns et al., 2020). This modality will also aid Jeff in how he responds to the warnings presented by his boss. Another interjection for Jeff’s treatment is interpersonal therapy (IPT). The interpersonal relationship Jeff has with his ex-wife is toxic. Aside from the physical abuse, Jeff has testified that due to the contention between them, he is only seeing his children maybe twice per year. This is a stressor contributing to Jeff’s depressive symptoms and overall mental health. According to Tavoli et al. (2020), IPT has produced favorable outcomes in depressive situations. The belief is that the stressors, behaviors, and symptoms are all contributors to Jeff’s poor decision-making habits (APA, 2022).
Specific Considerations
My perspective on the presenting issues and associated symptoms, behaviors, and stressors, is trying to find the source from where these challenges come. Excessive drinking, violence, poor work ethics, and feelings of sadness all stem from something potentially underlying. Jeff reported feeling sad as a teenager. I believe that those unaddressed feelings may have developed into something greater. Therefore, I believe that starting with learning more about Jeff’s background will equip me with the types of resources and interventions necessary to walk with Jeff toward wellness.
References
American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders: DSM-5 TR (5th ed. Text Revision). American Psychiatric Press, Inc.
Burns, J. W., Van Dyke, B. P., Newman, A. K., Morais, C. A., & Thorn, B. E. (2020). Cognitive behavioral therapy (CBT) and pain education for people with chronic pain: Tests of treatment mechanisms. Journal of Consulting and Clinical Psychology, 88(11), 1008.
John C. Higgins-Biddle & Thomas F. Babor (2018) A review of the Alcohol Use Disorders Identification Test (AUDIT), AUDIT-C, and USAUDIT for screening in the United States: Past issues and future directions, The American Journal of Drug and Alcohol Abuse, 44:6, 578-586, DOI: 10.1080/00952990.2018.1456545
Tavoli, A., Allahyari, A. A., Azadfallah, P., Fathi Ashtiani, A., & Melyani, M. (2020). The Comparison of Group Interpersonal Therapy (IPT) and Group Cognitive Behavioral Therapy (CBT) Effectiveness in Reducing Depression Symptoms of Patient with Social Anxiety Disorder. Clinical Psychology and Personality, 14(2), 115-124.
Worboys, M. (2013). The hamilton rating scale for depression: The making of a “gold standard” and the unmaking of a chronic illness, 1960–1980. Chronic Illness, 9(3), 202-219. https://doi.org/10.1177/1742395312467658
