Adolescent & Addiction Essay
Below are two case studies: one for an adolescent and one for an adult. For this written assignment, apply the Diagnostic and Statistical Manual on Mental Disorders 5 (DSM5) criteria to each case study using the following guidelines:
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– Identify all the signs/symptoms each individual demonstrates, which diagnostic criteria he/she appears to meet, and what severity specifiers might apply to each individual. Provide examples from the case studies to support your conclusions. (Remember, each individual is using multiple substances.)
– Include in your response – How effectively or not does the DSM 5 criteria apply to each case example? Provide a rationale to support your perspective Adolescent & Addiction Essay.
– Discuss why the ages of each person an important factor when considering a diagnosis or diagnostic criteria.
– What additional questions would you like more information about before arriving at a conclusion? While there may be no definitive or “clear cut” answers, some responses may be more appropriate than others.
You are expected to develop a coherent response of at least 2-3 pages (12 point font), maximum of 4 narrative pages, excluding a cover page and references. Remember to cite and reference all of your readings and any other source you believe will be helpful in writing the paper. You should explain all the technical terms and cite the course texts. APA formatting is required.
Case Study #1: Gloria.
Gloria is a 16-year-old female. She smokes marijuana once to twice per week, and drinks alcohol at least one to two weekends a month. She has no current health problems. Recently she began dating a man several years older than her and they have been using cocaine together once or twice a month. She plans to graduate from high school next year and attend a local community college; her goal is to work as an Administrative Assistant in an Attorney’s office, and eventually become a paralegal.
Gloria lives with her parents and her younger brother Albert, age 12. Although. Gloria has always gotten along with her parents, they found marijuana in her room twice which resulted in heated arguments. They are also beginning to suspect she has been using other drugs when she returns home late at night from being with her boyfriend, whose age they are unaware of. When they confronted her with their suspicions, more arguments resulted. They have threatened to send her to counseling if this continues, but haven’t followed through with their threats. She wishes they would mind their own business. She has never been in trouble, does not believe her drug use causes problems as she goes to school and has sound academic performance. She does her chores at home. She realizes her marijuana and alcohol use has increased from her initial use, but doesn’t really see this as a problem (and infrequent cocaine use is not a concern) because it hasn’t interfered with her school performance.
Case Study #2: James.
James. is an unemployed 28-year-old Caucasian male. He is 5′ and weighs 229 lbs. He has been drinking heavily for the last three years. Recently he began using cocaine a few times a week and has been doing so for 2 months; his drinking has escalated over the last 7 months. He states he doesn’t feel the effects of alcohol until he has had at least 6 drinks. He has no withdrawal symptoms, however, he has experienced blackouts on a few occasions. He has had some contact with AA (Alcoholics Anonymous), and has gone to three NA (Narcotics Anonymous) meetings with a friend but does not find them helpful. He wonders if his cocaine use is a problem and if it is his alcohol use that causes him to have extreme mood swings. He has had problems with his girlfriend. He stopped drinking completely 2 years ago because of the problems with his girlfriend and noticed changes after he stopped; however, he began drinking again on weekends with friends. He tries to limit his drinking to weekends but he has returned to daily drinking and now includes the use of cocaine.
He currently lives with his girlfriend Janne. She is “fed up” with his drinking and cocaine use, and gave him an ultimatum “to do something” or move out. He has high blood pressure for which he’s been prescribed medication. His doctor has told him to cut down on his drinking or stop all together. His doctor is unaware of his cocaine use. James also smokes 1 1/2 packs of cigarettes a day. He has no significant psychiatric symptoms other than his mood swings, although he becomes very angry and hostile when using cocaine and alcohol together. This has added to his problems with his girlfriend.
Abstract: Not required.
Substance Use Disorder: Diagnostic Challenges Presented by the DSM-5 as Illustrated by Two Case Studies
Introduction
The phenomenon of substance use is often associated with the use of a single substance. Indeed majority of users abuse a single substance. However, increasing numbers of patients and clients are being seen with multiple substance usage. And therein lays the diagnostic quagmire. In the immediate last edition (fourth) of the Diagnostic and Statistical Manual of Mental Disorders or DSM-4, a diagnostic entity known as Polysubstance Dependence existed. It referred to the use of multiple substances (three or more) with no particular preference to any of them (Alta Mira, 2019; Connor et al., 2014). This diagnosis has however been eliminated from the latest manual, the fifth edition. This is after years of observation and treatment of these conditions. As a result, the current diagnostic criteria in the DSM-5 are grouped under the all-encompassing diagnostic classification of Substance Use Disorders. In this and according to the DSM-5, the diagnosis is made by specifying the particular substance being used and its severity. This severity is ranked from mild to severe (Alta Mira, 2019; Connor et al., 2014). It is however imperative to note that Polysubstance dependency is not the same as multiple substance use disorder, since in the later there are independent multiple substance use disorders that are co-occurring (Alta Mira, 2019; Connor et al., 2014). This paper discusses two case studies involving multiple substance use disorders in a 16 year-old girl and a 28 year-old man. This is done in the context of the current DSM-5 Adolescent & Addiction Essay.
Signs and Symptoms, Met Diagnostic Criteria, and Severity Specifiers
The hallmark identifier of substance use disorders is that one continues to use the concerned substance despite the problems it may be causing him or her. And as indicated above, the severity of the disorder ranges from mild to moderate to severe. This may of course change with time either for the better or for worse; with mild having 2 or 3 symptoms, moderate having 4 to 5 symptoms, and severe having 6 or more symptoms (APA, 2013). The codes that are used for diagnosis class the substance abused, but the narration of the diagnosis includes the actual name of the substance (APA, 2013) Adolescent & Addiction Essay.
Gloria
Gloria is a 16 year-old school girl who is still living with her parents. She is using cannabis, alcohol, and cocaine. This is Multiple Substance Use with distinct co-occurring substance use disorders. The signs and symptoms she is demonstrating for her alcohol use are:
- Tolerance, since she has noted that she is using increasing amounts of alcohol as days go by;
- Craving. She has this burning desire to continue taking alcohol at all costs;
- She continues to use alcohol despite the risk of strained relations and social problems with her parents. This is evident from their reaction to finding cannabis in her room Adolescent & Addiction Essay.
From the DSM-5, the diagnostic criteria that these symptoms appear to meet are A. (1), (4), and (6) (APA, 2013). The severity specifier for this substance use by Gloria is therefore mild, as she is displaying a maximum of three symptoms. Her diagnosis in this respect as per the DSM-5 is therefore 305.00 (F10.10) Mild Alcohol Use Disorder. On the other hand, the symptoms she is displaying for cannabis use are tolerance, craving, and continued use in spite of the social problems that this brings between her and her parents. From the DSM-5, these symptoms meet diagnostic criteria A. (1), (3), and (6). The severity specifier here is still mild as only a maximum of three symptoms are displayed, giving a diagnosis of 305.20 (F12.10) Mild Cannabis Use Disorder. Gloria’s cocaine use did not meet any diagnostic criteria; hence she has not yet reached the stage of being diagnosed with its use. Adolescent & Addiction Essay.
James
James is a 28 year-old Caucasian man who is using alcohol, cocaine, and tobacco. This too is Multiple Substance Use with clear-cut co-occurring substance use disorders. His symptoms for alcohol use include tolerance (he does not start feeling the effect of the alcohol until after the sixth bottle), craving (he has attempted to limit his intake of alcohol to the weekends only without success), he has failed in his attempts to stop alcohol use (he ceased the habit two years ago but has resumed), he wastes a lot of time finding, ingesting, and recovering from alcohol, he continues to use alcohol despite having interpersonal problems and social issues with his girlfriend, and lastly; he continues to use alcohol in spite of knowing he has hypertension that may be worsened by alcohol. This symptom profile meets the diagnostic criteria A. (1), (2), (3), (4), (6) and (9) in the DSM-5 (APA, 2013). The severity specifier for this is severe because the symptoms are six; and the diagnosis is 303.90 (F10.20) Severe Alcohol Use Disorder.
James’ symptoms for cocaine use on the other hand are craving, tolerance, repeated use of cocaine such that he is unable to fulfil his socio-economic obligations (he is unemployed and is having a strained relationship with the girlfriend at home), he is neglecting important activities, having interpersonal problem with anger and hostility including towards his girlfriend, and wasting a lot of time finding, using, and recovering from cocaine. These symptoms fulfil the criteria A. (1), (3), (4), (5), (6), and (9) in the DSM-5 (APA, 2013). The severity specifier is severe, since six symptoms are involved (APA, 2013). Hence the diagnosis is 304.20 (F14.20) Severe Cocaine Use Disorder.
Lastly, the symptoms James has for tobacco use are tolerance, craving, spending a lot of time procuring and using the tobacco, and continuing the use of tobacco despite knowing that he has high blood pressure which is worsened by tobacco. These symptoms meet the DSM-5 diagnostic criteria of A. (1), (3), (4), and (9) for tobacco use disorder. The severity specifier in this case is moderate, since four symptoms are involved. The diagnosis is therefore 305.1 (F17.200) Moderate Tobacco Use Disorder.
How Effective or Not the DSM-5 Criteria Apply to Each Case Example
For both Gloria and James, the criteria of this latest manual indeed apply quite well to their presentations. It is then easy after identifying the symptoms and their number to then specify the severity and make the diagnosis. However, the complication in this kind of diagnosis illustrated by these two case examples is that this is a composite diagnosis with no singular diagnostic statement. This, as stated earlier, is born out of the fact that both of them suffer from Multiple Substance Usage. It can therefore be concluded that Gloria suffers from Mild Alcohol Use Disorder and Mild Cannabis Use Disorder. For James, he has Severe Alcohol Use Disorder, Severe Cocaine Use Disorder, and Moderate Tobacco Use Disorder.
Why Age Is Important When Considering a Diagnosis and Diagnostic Criteria
The age of the client or patient is an important factor when considering the diagnostic criteria and the definitive diagnosis for several reasons. Two of the most important are that tailoring individual treatment modalities will require knowledge of the patient’s age for the appropriate evidence-based approach; and also that psychotherapeutic approaches like cognitive behavioral therapy or CBT require knowledge of the patient’s age in order to be fine-tuned to their circumstances (Alta Mira, 2019).
Additional Questions Before Making a Conclusion
For Gloria, the one question would include “Do you normally take marijuana to forget about problems you have or just to enjoy yourself?” For James, some of them would be “Do you wake up at night to smoke tobacco?” and “Do you have a problem with remembering recent events?” (Wernicke-Korsakoff syndrome caused by alcohol) (APA, 2013).
References
Alta Mira (2019). Polysubstance abuse and multiple addiction treatment. Retrieved 18 September 2019 from https://www.altamirarecovery.com/polysubstance-abuse/
American Psychiatric Association [APA] (2013). Diagnostic and Statistical Manual of Mental Disorders (DSM-5), 5th ed. Arlington, VA: Author.
Connor, J.P., Gullo, M.J., White, A., & Kelly A.B. (2014). Polysubstance use: Diagnostic challenges, patterns of use and health. Current Opinion in Psychiatry, doi: 10.1097/YCO.0000000000000069 Adolescent & Addiction Essay