Case Study: Assessment of Mood and Anxiety Disorders

Jim R. enters the substance abuse treatment center after detoxification at the hospital. He was admitted following a drinking and driving incident in which he hit the side of a building, fortunately injuring no one. The counselor immediately sees that Jim R. is depressed and somewhat anxious. He talks about how he has screwed up, will probably lose his license, and will then not be able to work. He says he has tried repeatedly to stop drinking and cannot succeed; his life is hopeless.
Jim R. is not thinking of suicide, but he has lost a great deal of weight recently, has difficulty concentrating, feels worthless, moves suddenly in an agitated way (he shifts his position in the chair continually), and admits to difficulty sleeping. The counselor senses that the client may be depressed and notes the indications of depression in the record. To obtain further collaboration, the counselor immediately uses the BDI-II and finds that Jim R. scores 15. A score of 15 represents a moderate level of depression, but the treatment program's protocol for the use of the BDI-II by counselors calls for weekly monitoring of moderately scoring clients with repeat administrations of the BDI-II. In the next session, the counselor notes signs of increased depression and reevaluates the symptoms. He finds that Jim R. now scores 40 on the BDI-II. According to the established protocol, he now refers him to a psychiatrist, suggesting that Jim R. may be in need of medication and a differential diagnosis.
The psychiatrist does a longitudinal assessment in which she explores Jim R.'s drinking and establishes a diagnosis of alcohol abuse disorder. The psychiatrist also explores when Jim remembers being depressed and gauges the severity and persistence of these depressions. Finding a pattern of persistent depression with anxious features, such as excessive worry, that precedes Jim R.'s drinking, she prescribes an antidepressant with a calming effect. She tells Jim R. the pills should help him feel less worried and sleep better even though the pills are neither tranquilizers nor sleeping pills, and she stresses the importance of taking them regularly. Noting that Jim R. is a college graduate, she prescribes a workbook on depression (David Burns, The Feeling Good Handbook) to help him learn about the disease. The psychiatrist informs the substance abuse treatment counselor of her action and asks the counselor to continue monitoring the client's depression. She also refers Jim R. for cognitive-behavioral sessions with a mental health clinician to help him overcome his negative thinking and regain his sense of worth.
On Jim R.'s next visit, the substance abuse treatment counselor checks Jim R.'s pill box and finds that many of the pills have not been taken. He uses motivational therapy techniques to encourage Jim R. to take the pills regularly. He also reinforces the work of the mental health counselor, pointing out that the “stinking thinking” discussed in AA as a bad rationale for drinking is similar to the thought patterns that drive his depression. Gradually, Jim R. is able to manage his disorder through medication and improved thought patterns.

From: Appendix D: Specific Mental Disorders: Additional Guidance for the Counselor

Cover of Substance Abuse Treatment for Persons With Co-Occurring Disorders
Substance Abuse Treatment for Persons With Co-Occurring Disorders.
Treatment Improvement Protocol (TIP) Series, No. 42.
Center for Substance Abuse Treatment.

NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.