Alcohol Use Disorder
Alcohol use disorder affects millions of Americans. Nearly 15 million individuals aged 12 years and older had AUD in 2019 in the US (National Institute on Alcohol Abuse and Alcoholism, 2021). There were more males than females in this group. This shows how AUD is a severe endemic that requires the attention of the government and healthcare professionals to help tackle it. Healthcare professionals should utilize the DSM-V diagnostic criteria and implement pharmacological and non-pharmacological interventions.
Diagnosis and Current DSM Diagnosis Code
After carefully analyzing Juan’s Case and analyzing the DSM-V diagnostic criteria, the presumptive diagnosis that fits his symptoms is alcohol use disorder. There are three codes for AUD depending on the severity of the symptoms. An individual with two to three symptoms has mild AUD with the code 305.00 (FI 0.10), and 4 to 5 symptoms have moderate AUD with the code. In comparison, those with six or more symptoms have severe AUD with the code 303.90 (FI 0.20) (American Psychiatric Association (APA), 2013). The first diagnostic criterion is a problematic alcohol use pattern that causes severe clinical impairment within the last 12 months. This is characterized by persistent use of alcohol and knowledge of the likelihood of physical harm (APA, 2013). Juan still uses alcohol despite hitting his head and becoming unconscious. Alcohol should also fail to fulfil significant obligations (APA, 2013). Juan has not been able to be cleared to fly in the Air Force due to his alcoholism.
The other symptom the patient has is taking large amounts of alcohol (APA, 2013). Juan drinks a six-pack of beer and three glasses of wine between the afternoon and at night. There is an effort to cut down alcohol use (APA, 2013) unsuccessfully. His doctor told him to cut down on his alcohol use after having a heart attack, but he has been unable to do so. The other symptom is that the patient has a strong urge to use alcohol (APA, 2013). Juan claims that he drank a six-pack of alcohol because he was feeling low. The patient also has developed a tolerance to alcohol (APA, 2013). His son states that even though he drinks a six-pack of beer and three glasses of wine, he does not develop a hangover. The patient has six symptoms in the DSM-V diagnostic criteria, and hence, the diagnosis is severe alcohol use disorder.
Symptoms and Sociocultural Factors
During the entire intake process, the patient showed many disgruntled emotions. At the start of the intake process, the patient was dismissive and very defensive, and he was annoyed because of the questions he was being asked. When the therapist inquired whether his son said they had any truth, he became defensive and shrugged them off. He said that he is a social drinker and has no issue with alcoholism. His son, however, said that whatever his father had said was not valid. The son proceeded to state that Juan had a drinking problem, which caused him to pass out. He hit his head and required medical attention later on. Juan has severe AUD, as evidenced by the DSM-V diagnostic criteria. His alcoholism is bringing issues in his relationship with his children. It is also messing up with his occupation. He cannot fly due to the physical health problems resulting from alcohol use. The patient has also developed alcohol tolerance. He can drink a six-pack of beer and three glasses but still does not have any hangovers. This means that he needs to take larger quantities to give him the desired effects.
Due to the severe AUD, the patient has become very dysfunctional in his professional and personal life. Due to alcoholism, he fell and hit his head, which caused him an injury, and he does not have any memories of this event. The patient cannot fly because of the health issues resulting from his alcoholism. The patient has a strained relationship with his sons and stated that he did not need them because he had Jack Daniels. He is frustrated when the therapist inquires about his family dynamics, and he does not like that they are constantly worried about his drinking problems. His son states that alcoholism has also been an issue between his parents. They had a lot of fights and arguments because of his father’s drinking problems, which eventually led to a divorce.
Sociocultural Psychological Model
According to the sociocultural model, addiction is caused by societal and cultural standards and the adverse effects of society and culture on individual behaviour (De La Rosa et al., 2016). The risk factors linked with AUD include genetics, starting to drink alcohol at an early age, history of trauma, and mental health conditions (APA, 2013). The cultural influences that can influence alcoholism include gender, ethnicity, and nationality. Environmental factors can also contribute to alcoholism, including marital issues, dysfunctional family, anger, loneliness, and low self-esteem. One of these issues can be noticed when the patient visited his father before he went to college. Juan lived with his mother and stepfather. His upbringing was in a religious household where alcohol use was not allowed. Juan tracked his biological father after turning 18 years old. His father left before Juan was born. He stayed with him for three weeks. During this period, they regularly drank beer. Juan realized that made him feel self-conscious and gave him a relaxing effect. Another issue that triggered his alcoholism was the sudden death of his father from a heart attack. This made Juan realize how much time he had lost without spending with his biological father.
Another factor that contributed to his alcoholism was college. When Juan went to college, alcohol drinking happened more often. He explains to the therapist that they used to drink all the time. He was proud of himself since he was the one who could out-drink anyone at the table. He was famous on campus since he could hold his alcohol. Juan’s joining the Air Force also contributed to his AUD. His relationships with his colleagues in the Air Force led to him becoming a heavy driver. They had weekend parties and ended their evenings with cognac, as narrated by Juan.
Treatment Options for Juan
Medications and behavioural interventions can manage AUD. The three medications that can manage AUD in Juan include Naltrexone, acamprosate, and disulfiram. These drugs are not addictive and can help manage AUD, and they may not be effective for all AUD patients, and treatment plans should be personalized. Naltrexone promotes abstinence and heavy drinking days (Witkiewitz et al., 2019), and it can help manage alcohol cravings in some patients. It can be given as a once-monthly injection or once-daily pill (Witkiewitz et al., 2019). Acamprosate effectively maintains abstinence and reduces heavy drinking after an individual becomes sober (Witkiewitz et al., 2019). It can help in managing cravings in some individuals. Disulfiram causes unpleasant symptoms when alcohol is taken, and it inhibits the breakdown of alcohol in the body, causing symptoms like nausea (Witkiewitz et al., 2019). These unpleasant symptoms may lead to some individuals not drinking.
There is evidence-based psychotherapy that can be used to manage AUD. One such behavioural treatment is cognitive-behavioural therapy (CBT). CBT focuses on feelings, behaviours, and thoughts to help address alcohol triggers and urges (Witkiewitz et al., 2019). It can also help manage mental health comorbidities such as depression or anxiety. Community support groups such as alcohol anonymous can support persons already undergoing treatment (Witkiewitz et al., 2019). No single treatment works for all individuals; hence, treatment must be tailor-made to meet patient-specific needs.
Personalized Treatment for Juan
Both pharmacological and non-pharmacological interventions will manage the patient. He will first be started on a once-monthly injection of Naltrexone. After a follow-up clinical visit, the patient will be referred to a behavioural specialist to help with alcoholism. The patient will also be referred to a local alcohol anonymous group to help him not backslide and start drinking after abstinence has been achieved.
At the intake interview, Juan presented with symptoms that correlate with AUD. He has six symptoms, which made his diagnosis severe AUD. The AUD has significantly affected his health and social and occupational life. Several environmental factors have contributed to this, including college, the Air Force, and his biological father. There are different treatment options for Juan, which include pharmacological and non-pharmacological interventions. The treatment plan for Juan will include once-a-month Naltrexone injection, behavioural intervention, and community support groups.
American Psychiatric Association (APA). (2013). Diagnostic and statistical manual of mental disorders (DSM-5®). American Psychiatric Pub.
De La Rosa, M., Huang, H., Brook, J. S., Sanchez, M., Rojas, P., Kanamori, M., Cano, M. Á., & Martinez, M. (2016). Sociocultural determinants of substance misuse among adult Latinas of Caribbean and South and Central American descent: A longitudinal study of a community-based sample. Journal of Ethnicity in Substance Abuse, 17(3), 303-323. https://doi.org/10.1080/15332640.2016.1201716
National Institute on Alcohol Abuse and Alcoholism. (2021). Alcohol facts and statistics. National Institute on Alcohol Abuse and Alcoholism (NIAAA) | National Institute on Alcohol Abuse and Alcoholism (NIAAA). https://www.niaaa.nih.gov/publications/brochures-and-fact-sheets/alcohol-facts-and-statistics
Witkiewitz, K., Litten, R. Z., & Leggio, L. (2019). Advances in the science and treatment of alcohol use disorder. Science Advances, 5(9). https://doi.org/10.1126/sciadv.aax4043
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Review the vignette on Juan in the attached document, “Juan Case Study.” Write a paper in 1,200-1,500 words addressing the following:
Based on this vignette and in alignment with the current DSM diagnostic codes, what is the best diagnosis for Juan? Share specific elements of the case study that helped you form this diagnosis.
Based on Juan’s case history and presentation, what symptoms is he experiencing, and why are these symptoms considered dysfunctional (pathological)? Consider cultural factors using the sociocultural psychological model (school of thought) and explain how factors within this model play a role in the development of the symptoms.
Identify the causes and treatment options for substance-related disorders.
Develop a treatment plan for Juan.
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