Alcohol, Depression, and Suicide The names and details of this case study have been changed to maintain anonymity.

Cheryl, a 43-year-old manager of a telecommunications company, struggled with bouts of alcoholism and depression. She originally called, seeking help for marital problems. During the assessment session, Cheryl reported her struggles with alcohol and drugs. She admitted that she was probably addicted to cocaine. She was convinced that she could no longer use cocaine. She still struggled to control her drinking. Cheryl had been through one inpatient treatment program and sporadically attended AA, but was able to sustain only short periods of abstinence. Her job was extremely stressful, demanding more of her time and energy. She frequently lost her temper with people she worked with. The counselor listened to her "gripes" about her husband and their marital problems but astutely brought the conversation back to Cheryl's alcohol abuse.

In the third session, Cheryl acknowledged the need to strengthen her efforts to seek recovery from alcohol. She began attending AA and was encouraged to obtain an AA sponsor and attend counseling sessions once a week, yet, as time went on, she got distracted from committing to AA and chose a sponsor whom she rarely interacted with. Despite the counselor's efforts to get her to develop a stronger recovery program, she resisted. In future sessions, Cheryl began to talk about overwhelming feelings of depression and suicidal thoughts. She was referred to a psychiatrist for evaluation and was put on antidepressant medication. At the same time, the counselor and Cheryl wrote a contract that she would not attempt suicide and, if she felt suicidal, she would call the counselor or the suicide helpline.

Several months into treatment, Cheryl's depression was stabilizing and she was attending AA meetings more regularly, but she still had not established an active relationship with a sponsor or others in the program. The counselor suggested a woman's recovery therapy group. Cheryl agreed and attended the therapy group each week. At this time, her marriage was headed for a divorce, and her job was getting worse. She eventually moved out of her house and rented an apartment. During this time, she lapsed back to using alcohol and was more depressed. The counselor and group encouraged her to get more active in AA and to continue with her medication. Unfortunately, Cheryl did the opposite. She stopped taking her medication, rarely went to AA, and immersed herself in her work. She spent excessive hours working overtime and eventually dropped out of group counseling, stating that her schedule and finances made it impossible to attend. Despite efforts by her counselor to have her continue in group at a reduced fee, Cheryl decided against it. She continued, only briefly, with her individual counseling. Despite the counselor's best efforts to point out the need for counseling and renewed recovery efforts, Cheryl did not follow through. She began to miss counseling appointments. The counselor pointed out her pattern of "isolating" and continued to try to reengage her into counseling and recovery. Despite the counselor's best efforts, Cheryl went to counseling less frequently and eventually stopped going.

Nine months later, the counselor received news that Cheryl had killed herself. The combination of alcoholism, depression, marital problems, stress at work, and Cheryl's inability to seek connection with others had led to her suicide.

Discussion Questions Describe the role "pride" and "shame" can play in not seeking help.

As a counselor, what boundaries would you set to deal with a client with suicidal ideation? Would you set up a contingency contract?

List some questions you might ask a client whom you suspect may be suicidal.

What does "silence is the enemy of recovery" mean?

What signs might make you aware of the potential for suicide?

Have you ever considered suicide? What is your view on suicide?

What conditions increase a person's vulnerability to suicide?