PS531 Unit 6 Depression and Alcohol Paper Example

Is It Depression or Is It the Wine?: A PS531 Unit 6 Paper on Assessing and Treating Depression in a Client Who Drinks Heavily

[Student Name]

Purdue University Global

PS531: Co-Occurring Disorders and Treatments

Unit 6 Depression and Alcohol Paper

[Instructor Name]

[Date]

The client, her family, the agency and every detail of the case are composite and illustrative; the sources cited are real.

The Client

Renee is 41, divorced and drives a school bus for the Escanaba district, mornings and afternoons, with a long empty stretch in the middle of the day. She has two children in middle school. Over the past two years, since her divorce, a bottle of red has become her usual evening, with a second on Fridays. She came to our agency after her primary care doctor screened her for depression at a checkup. Her score on the PHQ-9 was 21, in the severe range: she reported low mood most days, poor sleep, loss of interest, fatigue, guilt about her children and difficulty concentrating. She denied any thoughts of suicide. Her doctor suggested starting an antidepressant that week and referred her to us for counseling.

The Diagnostic Question

The DSM-5-TR distinguishes an independent depressive disorder from a substance-induced depressive disorder (American Psychiatric Association, 2022). A substance-induced depression is one the drinking or its aftermath produces, and it tends to ease within roughly four weeks of the last drink. Independent depression began before the substance use, persists well after a period of abstinence or is out of proportion to the amount used. SAMHSA's protocol advises clinicians to take a careful timeline, asking which came first and whether depression was present during earlier periods without heavy use (Substance Abuse and Mental Health Services Administration, 2020).

Renee's timeline is mixed. She had one episode of depression at 26, after her first child was born, when she was not drinking. The current symptoms began around the time of her divorce, which is also when her drinking increased. Heavy alcohol use can cause or deepen every symptom on her PHQ-9.

Renee's score of 21 is real distress, but until she has stopped drinking for a few weeks, nobody can say how much of it belongs to depression and how much to the wine.

What the Evidence Says About Antidepressants

Nunes and Levin (2004) reviewed 14 placebo-controlled trials, with 848 patients, of antidepressants in people with a current depressive disorder and a current alcohol or drug use disorder. Antidepressants showed a modest benefit for depression overall. The effect was larger in studies that diagnosed depression after at least a week of abstinence, which suggests that some depression diagnosed during active use reflects substance effects that would lift anyway. When depression improved, substance use tended to decrease, but antidepressants alone did not treat the substance use disorder; patients still needed treatment aimed directly at their use.

Weighing Whether to Wait

These findings support a short period of observation for Renee. If she can reduce or stop drinking, a reassessment after two to four weeks will show whether depression persists. Waiting is not appropriate for everyone. If Renee had thoughts of suicide, could not function at work or had a clear history of depression without alcohol, starting treatment immediately would be more reasonable. Her earlier episode at 26 raises the chance that this is an independent depression, which argues against waiting too long.

I discussed this with Renee and, with her permission, with her doctor. The doctor agreed to a plan: Renee would work on stopping drinking with our support, her depression would be reassessed in three weeks and an antidepressant would be started then if symptoms remained severe, or sooner if they worsened or she developed any thoughts of self-harm.

The Plan

Renee chose to stop drinking rather than cut back. Our agency's physician assessed her for withdrawal risk, which was low, and offered naltrexone to reduce cravings. Renee started it.

Counseling began right away, combining behavioral activation for depression with relapse prevention for alcohol. The two overlap: both target her empty midday hours between bus routes and her evenings after the children are in bed, which are her highest-risk times for drinking and her lowest points for mood. She scheduled a midday walk with a fellow driver and an evening phone call with her sister in Gladstone.

Safety was reviewed at every visit. Renee agreed to call the crisis line or her counselor if she had any thoughts of suicide, and her doctor was informed of the plan.

Three Weeks Later

After twenty days without alcohol, Renee's PHQ-9 had dropped from 21 to 13. Her sleep had improved and she was enjoying her children's basketball games again. She still felt low most mornings, carried guilt about the divorce and had trouble concentrating. The pattern fits a mix: part of her depression lifted with abstinence, but a moderate depression remains, consistent with her earlier episode. Her doctor started an antidepressant, and counseling continues.

Coordinating With Her Doctor

Renee's case also shows why integrated care requires communication across settings. Her primary care doctor was ready to prescribe on the first day, our agency wanted to observe for a few weeks and Renee was caught between two reasonable views. A phone call with her doctor, made with Renee's written consent, settled the plan in ten minutes: a defined wait, clear criteria for starting medication sooner and a shared date for reassessment. Without that call, Renee might have started an antidepressant that would have been credited with improvements that were really due to stopping drinking, or she might have waited too long with a depression that needed treatment.

Her Work and Her Safety

Renee drives children twice a day. Her employer has a drug and alcohol testing program for drivers, and she had never been impaired at work, but a full bottle at night can still register on a breath test when her first route starts at 6:40. Part of her plan, which she proposed herself, was to stop drinking entirely during the school year, not only to cut back. That decision protected her job and the children on her bus.

Limits

Nunes and Levin's meta-analysis included trials of varying quality and several substances, and its findings may not apply exactly to alcohol. The three-week reassessment gives a partial answer; some substance-induced symptoms take longer to clear.

Conclusion

Renee's case shows why timing matters in treating depression with heavy drinking. The DSM-5-TR and SAMHSA's protocol direct clinicians to separate substance-induced from independent depression through a timeline and a period of abstinence. Nunes and Levin's meta-analysis supports a modest role for antidepressants, larger when depression is diagnosed after abstinence, and confirms that the alcohol use needs its own treatment.

References

American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.). https://doi.org/10.1176/appi.books.9780890425787

Nunes, E. V., & Levin, F. R. (2004). Treatment of depression in patients with alcohol or other drug dependence: A meta-analysis. JAMA, 291(15), 1887-1896. https://doi.org/10.1001/jama.291.15.1887

Substance Abuse and Mental Health Services Administration. (2020). Substance use disorder treatment for persons with co-occurring disorders (Treatment Improvement Protocol Series, No. 42; SAMHSA Publication No. PEP20-02-01-004).