A client reports that he is feeling down and withdrawn lately.

Reply to at least one peer   and e  ensure your research advances    the knowledge of the discussion. In your reply,     address    at least one     point made by your peer for     each of the three requirements     in the initial post above.      After one formal reply in APA style, subsequent replies may be informal and casual in discussion. Observance of     discussion board etiquette and netiquette     is expected.     Each reply must incorporate at least 2 scholarly citation(s) in current APA format for graduate student format. Any sources cited must have been published within the last five years. Acceptable sources include discussion sources, the textbook, peer-reviewed scholarly sources, and the Bible.

Required Resource

Inaba, D. S., & Cohen, W. E. (2014). Uppers, downers, all arounders: Physical and mental effects of psychoactive drugs (8th ed.). Medford, OR: CNS Productions, Inc. ISBN: 9780926544390.

Case Scenario    

A client reports that he is feeling down and withdrawn lately. You notice that his movement and affect are slow and restricted. He is aware that he has become more isolated and doesn’t find much satisfaction in his work anymore. At one time he enjoyed his work and took pride in his skill as a cabinetmaker, but lately he is having trouble completing the jobs he has and doesn’t have the energy to go after new jobs.    

He tells you it is harder to get out of bed in the morning and he often doesn’t return calls from friends or customers. He says this has been going on for the last four months and he feels completely stuck.    

He has become isolated from friends and ruminates over how he messed up past relationships. He says he drinks alcohol most nights – usually a few beers or wine with dinner. Occasionally, he has a few shots of brandy before going to bed. When you encourage him to be more specific about his alcohol intake, (e.g. how much wine and how many beers and when), he becomes irritated and dismisses your questions insisting that he doesn’t believe he has problem with alcohol.    

Response to Brent Alcohol Case Scenario

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        In assessing the client, more information concerning his drinking habits would be required to determine whether he has an alcohol use disorder (AUD). The DSM-V lists 11 criteria for AUDs of which at least two need to have been present within the last 12 months (American Psychiatric Association, 2013, pp. 490-491). Some follow-up questions concerning the client’s alcohol use would be required to determine if the client meets the criteria for an AUD.

        The National Institute on Alcohol Abuse and Alcoholism (NIAAA) defines moderate use as up to two drinks a day for men or 14 drinks in a week (Inaba & Cohen, 2014, p. 5.12). At this level of consumption the behavior is considered low-risk for developing health problems, abuse, or alcoholism (Inaba & Cohen, 2014, p. 5.12). While the client avoids specific questions about amounts and frequency of alcohol consumption, “a few” would imply more than two and when coupled with his occasional nightcaps, it is safe to assume that he is consuming more than two drinks a day and 14 in a week indicating heavy use. Based on this knowledge, the client’s alcohol use would meet the criteria for abuse which is defined as “continued use despite negative consequences” (Inaba & Cohen, 2014, p. 5.11).

        Since “most people who use drugs also drink alcohol, and most alcohol abusers use other drugs” it is impossible to rule out polydrug use (Inaba & Cohen, 2014, p. 5.27). Marijuana has a relaxation effect similar to alcohol (Inaba & Cohen, 2014, p. 5.27) and depressants such as barbiturates and benzodiazepines also decrease brain function (Clinton & Scalise, 2013, pp. 89-91). It would be important to rule out other psychoactive drug use in assessing this client.

        It would also be important to rule out major depressive disorder as a possible co-occurring disorder due to the client’s depressed mood, diminished interest in activities, sleep issues, psychomotor retardation, fatigue, and rumination over past failures (American Psychiatric Association, 2013, pp. 160-161). The client admits to general lethargy and decreased job satisfaction over the past four months. This could be the result of the alcohol which disturbs sleep cycles and can “decrease daytime alertness and impair performance” (Inaba & Cohen, 2014, p. 5.13) or the depression as stated above. It would be important to determine whether it is serotonin depletion caused by the chronic alcohol use (Inaba & Cohen, 2014, p. 5.14), other drug use,  or an underlying mental health condition that is causing these symptoms.

        The first step for a counselor would be to move the client from the precontemplation stage where he does not consider his alcohol use a problem to the contemplation stage where he begins to think about change (SAMSHA, 2005, p. 12). Currently the client is in denial that his behaviors are causing negative consequences in his life. Discussing further how his symptoms may be related to his alcohol use would be a good start. Next, I would refer him to his primary care physician to be diagnosed for possible depression and would encourage him to discuss his alcohol use candidly. Since I am a pastoral counselor and not a clinical counselor I do not diagnose and would have to refer out. If after further investigation the client is diagnosed with an AUD, I would refer him to an in-patient or outpatient substance abuse treatment facility and/or a support group such as Alcoholics Anonymous depending on the severity.

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). American Psychiatric Association.   

Clinton, T., & Scalise, E. (2013). The quick reference guide to addictions and recovery counseling. Baker Books. 

Inaba, D. S., & Cohen, W. E. (2014). Uppers, downers, all arounders: Physical and mental effects of psychoactive drugs (8th ed.). CNS Productions, Inc. 

SAMSHA (2005). Types of groups commonly used in substance abuse treatment. In Substance abuse treatment: Group therapy (pp. 9-36). (Treatment Improvement Protocol (TIP) Series, No. 41). Center for Substance Abuse Treatment. https://www.ncbi.nlm.nih.gov/books/NBK64214

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