COUC 546

JEFF CASE STUDY

Jeff is a 33-year-old divorced Caucasian male who came in for an assessment and treatment to keep his job. “If I do not do what you tell me to do, then they are going to fire me… just because I drink a little and miss work sometimes.” Jeff lives alone in an apartment he has rented for the past 3 years. He stated he is not sure why his work is making such a big deal about his habits. “I don’t drink or do drugs at work. I do not steal, hit people or get into fights. All I do is come in late at times and a couple times my boss has said I smelled like alcohol. If I am on my own time, I don’t think it is my boss’s business what I do. But I need this job. It is the best job I have ever had.”

Jeff stated that he has been at his current job for 5 years. He stated that until this job, he had done lower paying jobs like roofing and painting. He currently works for the state as part of the construction crew that builds bridges and other state-run infrastructure. Jeff stated that currently he works 2 hours from his home. He stated that he will be on site for about 10 to 12 days and then will return home for 4 to 5 days. While on site a hotel room is provided. Jeff reported “My supervisor has told me several times that I am very good at my job and that they would hate to lose me.” Jeff’s supervisor reported that Jeff is a valued employee but if his alcohol consumption continues in this manner, they will not be able to employ him any longer. Jeff is randomly drug tested, including blood alcohol tests while on site. In the last 18 months, Jeff has had four violations for his blood alcohol content being above the maximum allowed on site. Each violation results in a three-day suspension without pay. Two of these violations occurred in the past month. The fourth positive resulted in the supervisor suspending Jeff for five days without pay and requiring he receive a mental health assessment and follow through on any treatment requirements.

Jeff reported that he currently drinks daily with the amount depending on if he is working or if he's off site. He stated that when he's working, he will drink 4-8 beers after work. He reported that he does not drink hard liquor on workdays. When he is off, he will consume 6 – 8 beers a day and will also have “a few shots of whiskey, bourbon, vodka, or whatever is in there.” Jeff stated that in the last 18 months he's noticed that it takes more alcohol for him to get buzzed, which is his goal on workdays. Jeff stated he tries not to get drunk on workdays but saves that for his time off. Jeff stated “about a year and a half ago I could get buzzed off 4 to 5 beers. Now I can drink 5 to 7 beers and not feel much of anything.” Jeff stated that on his days off he will spend time with his friends in the evening and will often get intoxicated with them. “It's pretty rare that I'm not out with my buddies drinking during my time off. But that's what you do, you spend time with your friends doing what friends do.” Jeff stated that it takes more liquor for him to get drunk, about 4-6 shots more than 18 months ago. Jeff reported that when on site he really misses being able to do shots with his friends. He stated that if he works more than 10 hours “I really start wanting a beer and will struggle to think of much else.” This results in him leaving the site and immediately going to his hotel room to have a few beers before joining his coworkers for dinner.

Jeff stated that in the last 18 months he has noticed that he takes much longer to recover from a night of drinking. He stated when he was younger, he could drink all night and then get up and go to work in the morning with no problem. Now, he struggles to get out of bed and make it to work on time. This has resulted in him being late to his site at least one day a week for the past year. Jeff reported he's been written up numerous times for being late at work. “I guess because I am so good at my job, they have not fired me yet.” Jeff's boss reported that after the two positive blood alcohol screenings, the head supervisor decided that if in the next 30 days, Jeff is late one more time or tests positive for alcohol, he will be fired. “I really like my job. I get paid well and it’s the first time I am good at something. I knew the big boss was going to put me on this tight leash… honestly, I am surprised he did not do it sooner. He has been threatening to suspend me for over six months for being late all the time.” Jeff stated that even though he knew he could lose his job due to being late because of a hangover, he never really considered not drinking after work. Jeff reported that on his days off he will often arrive home after 2:00 AM. He stated that he will often sleep until 2:00 PM and wake up with a headache and feeling hungover. He will normally wait until 5:00 PM to have this first drink and then will drink until 2:00 AM. “The hangovers seem to be new… since the divorce.”

Jeff reported that he and his ex-wife separated three years ago, and the divorce was finalized two years ago. He stated that his ex-wife blames his drinking for the divorce. Jeff reported that even though his drinking resulted in three separate acts of domestic violence, he still doesn't see how alcohol was the main reason for his wife leaving and taking their two young children. Jeff reported that when he was married, he did not drink as much as he does now. He stated that he would primarily drink on weekends and would only get drunk two to three times per month. During the last two years of their marriage, Jeff stated that he did hit his wife on three separate occasions. Two of them were single acts of striking his wife during a heated argument. He stated that on both occasions he had been drinking and was intoxicated. During the final incident Jeff hit his wife multiple times while intoxicated. Due to the extent of her injuries, his ex-wife went to the emergency room and the police were notified by the ER doctor. Jeff stated that if the police had not gotten involved, he doesn't think his ex-wife would have left. He ended up being charged with an assault and battery and spent 15 days in jail. Jeff reported that while he was in jail, his ex-wife packed up all of her and the children's belongings and moved in with her parents. She filed for divorce shortly after and the divorce was finalized a year later. Jeff stated that he and his ex-wife have a very tense relationship and struggle to get along when they communicate about the children. Due to this conflict, Jeff shared he chooses not to see his kids often. He sees them primarily on major holidays like Christmas and their birthdays. Jeff stated that he wants to have a better relationship with his children but doesn't see how that will happen due to the anger his ex-wife has for him. She has recently threatened to get all visitation stopped if she finds out he has been drinking with the children in his care. During his children's last overnight visit, Jeff admitted he had “one too many” and was visibly hungover when his ex-wife picked up the children from his residence. Jeff reported that his ex-wife is getting remarried soon.

Jeff has been arrested two other times. He was arrested for driving while intoxicated in his mid-20s and again in his early 30s. Both arrests resulted in misdemeanor charges and two overnights in jail. Jeff reported no other legal interactions, no significant medical history, no history of medication and no other drug use. “I did smoke pot in high school and when I was painting… but I grew out of that stuff.”

Jeff reported that after his wife left, he started attending Alcoholics Anonymous and outpatient treatment “because she said she wasn’t coming back otherwise.” He participated in four months of outpatient treatment. He stated that when their relationship continued to deteriorate and it became apparent his wife was not going to return, he dropped out of AA. He remained in treatment for a short time after but ended up terminating when the counselors suggested he was an alcoholic and appeared to be depressed. Jeff stated that he didn't need someone telling him there was something wrong with him. About 2 months after his wife left, Jeff had an extended period where he felt very sad daily. He reported losing all interest in activities that he normally enjoyed and feeling hopeless about his life in general. He stated that he struggled to sleep during those months. He reported being extremely fatigued no matter how much he slept and had several incidents of thinking about killing himself. Jeff stated “I have thought about killing myself multiple times. And after my wife left, I came up with a pretty good plan. But I've never done anything to actually hurt myself.” Jeff stated, “One of the strangest things that happens to me during these times is that I lose my appetite completely. As you can see, I'm a pretty big guy, and I will lose about 25 to 30 pounds during my sad times. Just because food doesn't look good. I just don't feel like eating.” Jeff reported that these symptoms continued for 8 months. “I think I've had problems with feeling sad for most of my adult life… at least since I was 15 years old. But that's just who I am, I kind of feel sad all the time.” Jeff stated that there was a clear difference between his normal state of “sadness” and the “sad episode” after the separation. He stated “When I have a sad episode, I pull away from my family who I'm very close to. I also struggle to finish a full day of work and spend less time with my coworkers after work.” Jeff stated that his boss has noted the difference in his mood and work performance during his “sad episodes.” He has not been threatened with being fired but did miss a promotion due to decreased work performance. His co-workers and family have all commented on how different Jeff is during these episodes and the strain his sadness puts on all his relationships. Jeff reported that he has had “3 or 4” other incidents like this, where he feels increased sadness and all the other symptoms mentioned above for 7 to 8 months at a time. Jeff stated that over time the other symptoms like not enjoying his life, fatigue, sleeping problems, low appetite and irritability will diminish, while a low-level sadness remains. Jeff reported he has never had any psychotic or manic-like symptoms.

“One of the things that really ticked me off at the counselor I saw last time was that he suggested my drinking contributed to me feeling sad all the time. And I think he's full of it!” As Jeff continued to talk about these “sad episodes,” he stated twice that he had read alcohol is a depressant and can increase things like depression. He reluctantly stated that it would make sense a depressant would make an individual feel depressed, but he had no intentions of decreasing or discontinuing drinking. “Even if the drinking's making me feel a little bit sad, those episodes come and go. So why should I give up drinking.” Jeff reported that he has not had “a full sad episode” in about three months.

Jeff is the 4th of six children. He has three older brothers and two younger sisters. His parents have been married for 45 years and have regular contact with Jeff. Jeff has contact with all but one of his brothers and both of his sisters. Jeff reported that his father has drank daily as long as he could remember and his mother “has always been a sad kind of woman.” Jeff reported that his two brothers that he has contact with drink in a similar manner as he and his dad do, and his sisters are married to men who also drink daily. Jeff reported his one brother who no longer has contact with the family does not drink and told the family he would not have contact with them if they continued to drink the way they did. Jeff reported “I feel a little bad about that, because honestly he was my favorite brother. But what are you gonna do? He doesn't want to be around us when we're drinking and that's what we do as a family.” Jeff reported that he met and married his wife when he was in his early 20s. He stated that he has no intentions dating or getting remarried at this time.

Jeff reported that he has a long history of alcohol use. “I think I had my first drink when I was around 7 years old. It was in the garage with my Dad and older brothers. It's just what you did as a man.” Jeff reported that he did not really enjoy the taste of beer when he was younger, but halfway through high school he began spending a lot of time with peers who drank heavily on weekends. He stated that during his junior and senior year he would “party” on Fridays, Saturdays, and Sundays. Partying always included a large amount of alcohol. After Jeff graduated high school he began working as a contract painter with a friend of his. This job was not consistent and on his days off he would “hang out with my friends and drink a good portion of the day.” After two years of inconsistent work, he left the painting business and began working as a roofer. This work was much more consistent as he worked for a larger company. He reported that he did not work weekends and would spend most of his weekends drinking with his friends. If there was a rainy day, he would get together with his friends in the early afternoon and they would drink until late in the evening. He stated this was very common among his coworkers and he never had a problem when he would show up to work smelling of alcohol. “As long as I did my job, didn't fall off the roof, and didn't nail anyone's foot to the roof, nobody complained about anything.” Jeff stated it was not unusual for multiple members of the roofing team to be intoxicated from the night before. He stated there were several times he went to work intoxicated but never had any negative consequences due to the behavior.

Jeff reported that his mother's parents were Baptist and he would go to church with them on occasion when he was young. He reported that his family did not attend church and he has not been inside of a church since his grandmother's funeral. Jeff stated that he is not interested in talking about any type of spiritual matters at this time. He stated that he would be willing to attend counseling but only to save his job.

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