Dual Diagnosis – Major Depression with Alcohol Abuse

Case Study: Dual Diagnosis – Major Depression with Alcohol Abuse

Client Profile

Name: Sarah Thompson
Age: 29
Gender: Female
Occupation: Marketing Coordinator
Marital Status: Single
Living Situation: Lives alone in a small apartment in an urban area

Presenting Problem

Sarah Thompson, a 29-year-old marketing coordinator, presents to the agency with complaints of persistent sadness, lack of interest in activities she once enjoyed, and increased alcohol consumption. Over the past year, she has experienced significant life stressors, including the recent loss of her job and a breakup with her long-term boyfriend. Sarah reports that she often feels overwhelmed by feelings of worthlessness and hopelessness, which have exacerbated her drinking habits.

Background Information

Sarah grew up in a middle-class family and was the youngest of three siblings. Her childhood was largely stable, but she experienced some emotional neglect from her parents, who were often preoccupied with their careers. Throughout her teenage years, Sarah struggled with feelings of inadequacy and began to seek comfort in alcohol during social gatherings. Despite these challenges, she was able to complete her bachelor’s degree in marketing and secure a job shortly after graduation.

Over the years, Sarah has faced several life events that have contributed to her mental health struggles. The death of her father from cancer two years ago was particularly traumatic for her and marked the beginning of her depressive symptoms. Following her father’s death, she began to drink more frequently as a means of coping. Initially, drinking was limited to weekends, but it gradually escalated to daily consumption.

Symptoms

During her intake assessment at the agency, Sarah reports several symptoms consistent with major depression and alcohol use disorder:

1. Depressive Symptoms:

– Persistent low mood most of the day, nearly every day
– Anhedonia: diminished interest in activities such as reading, socializing with friends, and engaging in hobbies
– Fatigue and low energy levels
– Feelings of worthlessness and excessive guilt related to personal failures

2. Alcohol Abuse Symptoms:

– Increasing tolerance: needing to consume more alcohol to achieve the desired effects
– Withdrawal symptoms when not drinking, including irritability and anxiety
– Failed attempts to cut down on drinking despite recognizing its negative consequences on her life
– Drinking alone or in secret to cope with emotional pain

Assessment

Upon further assessment using the DSM-5 criteria for both Major Depressive Disorder and Alcohol Use Disorder:

– Major Depressive Disorder (MDD): Sarah meets the criteria for a major depressive episode, characterized by five or more depressive symptoms lasting for at least two weeks.
– Alcohol Use Disorder (AUD): Sarah meets the criteria for AUD, as indicated by her pattern of problematic alcohol use leading to significant impairment or distress over the past year.

Treatment Plan

Based on Sarah’s dual diagnosis, a comprehensive treatment plan will be developed focusing on both her mental health and substance use:

1. Psychotherapy:

– Cognitive Behavioral Therapy (CBT) will be initiated to help Sarah address negative thought patterns related to her depression and develop healthier coping strategies.
– Motivational interviewing techniques will be employed to explore her ambivalence about alcohol use and enhance her motivation for change.

2. Support Groups:

– Referral to Alcoholics Anonymous (AA) meetings will be recommended to provide peer support and accountability in her recovery journey.

3. Medical Evaluation:

– A referral to a psychiatrist will be made for potential medication management to address depressive symptoms and assess any need for medications that may assist in reducing cravings for alcohol.

4. Lifestyle Changes:

– Encourage engagement in physical activities such as yoga or jogging to improve mood and reduce stress.
– Development of a structured daily routine to promote stability and encourage healthy habits.

5. Family Involvement:

– Facilitate family therapy sessions to address underlying familial issues and improve support systems.

Conclusion

Sarah’s case illustrates the complex interplay between major depression and alcohol abuse. By addressing both conditions simultaneously through an integrative approach, there is potential for significant improvement in her overall well-being. The goal is to empower Sarah with tools to manage her depression while fostering healthier coping mechanisms that do not rely on alcohol.