J‌‍‍‍‌‍‍‌‌‍‍‍‌‍‍‍‍‌‍‍erry believes he first become depressed when he was around

J‌‍‍‍‌‍‍‌‌‍‍‍‌‍‍‍‍‌‍‍erry believes he first become depressed when he was around 16 or 17. He remembers being a fairly good student in school and then slowly losing his motivation. His grades declined and he eventually dropped out of High School. He didn’t do much after dropping out, slept a lot, ate too much, and eventually his depression lifted. He remembers feeling like his old self. Rather than return to school, he enlisted in the Army. He had a weight problem and figured the Army could get him back in shape. He was posted to a war zone where he served 3 years. Because he was bright and competent, he earned promotions and got a desk job. But he continued to have moods shifts, he worried about his performance, and remembers being hypersensitive to any hint of criticism about his work. He was also a loner and didn’t feel comfortable in social situations. To compensate, he developed a heroin habit. “There was so much of it and it was so easy to come by”. He believed the heroin helped keep his mood stable and made him less sensitive to feeling “less than adequate”. After his tour was up, he was sent back to the states. After returning home, Jerry continued his heroin use for many years before recognizing or accepting that he had a drug problem. He checked into a VA program and was placed on methadone and began attending NA meetings. Things went well for the next 10 years. He got a job with a small publishing company and worked his way up to general manager. He also got married and had two children. His life was stable and he was fairly happy with himself. When the VA program closed down due to funding cuts h‌‍‍‍‌‍‍‌‌‍‍‍‌‍‍‍‍‌‍‍e was tapered off his methadone. To his credit, he has managed to stay clean and continues going to his NA meetings. But, it has been rough. His withdrawal symptoms were terrible for the first couple of months. Others in his NA meetings were getting better but he seemed to be getting worse. He became more despondent. Everyone told him “it will get better, just stay clean and sober and take one day at a time”. Despite their support he felt he was being criticized for not working his recovery program. His mood continued to darken and he withdrew from his family and the few friends he had. It was harder and harder to show up at work, his arms and legs felt like lead weights and he began gaining weight again. Chocolate was his comfort food and would he usually go straight to bed when he got home from work. Occasionally he would enjoy some good moments – getting a big job done on time, words of praise from his boss, seeing his children enjoying the holidays. His mood would brighten but never for very long. For the first time in years he felt “like a real loser”. He considered “going out” and scoring some heroin. He even thought about “taking one big shot of heroin to just get it over with”. He reports these thoughts have been recent and he is really hoping you can help him. • What are the major clinical concerns presented by this case study? • Is any other information needed to accurately assess the client’s presentation to better direct clinical interventions? • What resources are available to better assess this client’s symptoms? • Prioritize the clinical intervent‌‍‍‍‌‍‍‌‌‍‍‍‌‍‍‍‍‌‍‍ions that need to occur with this client.