Case Studies – Diagnosing Substance Use Disorders

Case Studies – Diagnosing Substance Use Disorders

The first case is of a seventeen-year-old girl, Staria, brought to the clinic for treatment by her mother. She has been suspended from school on two occasions over the past six weeks for disorderly conduct and fighting and has a history of recurrent detention and classroom dismissal. Further assessment revealed that she once possessed a small quantity of marijuana and a pint of alcohol. She seemed intoxicated in this instance and tested positive for marijuana. Collaborative history from the mother revealed that she had stolen alcohol and marijuana from her father’s stash. Her family history revealed that her grandfather had died of cirrhosis.

Staria has a substance abuse disorder. Substance abuse disorder involves the excessive use of alcohol, nicotine, and other illicit substances. As per DSM-V, a positive diagnosis of substance abuse disorder is made when an individual takes a substance of abuse longer than they are meant to and in large quantities, spends longer using or attempting to get these substances, continuing to use these substances in the presence of apparent problems to their social lives, using these substances even when it put these individuals in danger, and when the development of withdrawal symptoms can be relieved by taking more of the substance (Pasha et al., 2020). Assessment findings of Staria are suggestive of substance abuse disorder. She was found in possession of a pint of alcohol and marijuana. Her behavior has contributed to her suspension from school. She has a history of recurrent detention. Additionally, she steals from her father’s stash to sustain her behavior. These manifestations are highly suggestive of physical dependence and point to substance abuse disorders.

The second case is of a client, George, struggling with a drinking problem. He has had many attempts at refraining from alcohol but failed. He has been drinking more frequently and even drinks before going to work. He has a family history of alcoholism. He is embarrassed of himself and has the urge to stop. His drinking has brought him considerable problems in his health and social relationships. These include arrest for driving under the influence, loss of job, mood swings, fights and arguments, blackouts, and the need to increase alcohol amounts to get high.

George has an alcohol abuse disorder. Per DSM, a positive diagnosis of alcohol abuse disorder is made in the presence of two or more manifestations of the set criteria within a year. This criterion is alcohol being taken longer than intended and in larger quantities, unsuccessful attempts at refraining from alcohol, craving for alcohol, reduced involvement in social activities due to alcohol, taking alcohol even in hazardous situations, and the development of withdrawal symptoms. George’s manifestations are highly suggestive of alcohol abuse disorder. Per the assessment findings, George has developed tolerance, as demonstrated by his need to take more alcohol to get high. He has also developed a physical and psychological dependence on alcohol. Physical dependence on alcohol defines the growing need to take alcohol to function optimally (Yang et al., 2022). In George’s case, his dependence is manifested by him taking alcohol frequently, even when going to work. George’s craving for alcohol is suggestive of psychological dependence on alcohol.

Subsequently, psychological theories about alcoholism detail the influences social learning, classical conditioning, personality, and other psychoanalytical factors have on an individual’s likelihood of developing alcoholism. The positive reinforcement theory, a subset of the classical conditioning theory of alcoholism, details the influences of alcohol-associated euphoria and the social enhancement effects of taking alcohol in the ultimate development of alcoholism. Per this theory, individuals tend to take alcohol because of these effects. This ultimately becomes a habit and binds the individuals to an unending cycle in which they require alcohol to function (Cho et al., 2019). In George and Staria’s cases, their alcohol-taking behavior may be attributed to these substances’ social enhancement effects, as evident in the case. George had an unending craving for alcohol despite its negative impact on his socialization. Likewise, Staria saw nothing wrong with his behavior and would even steal from her father’s stash to sustain her behavior.

References

Cho, S. B., Su, J., Kuo, S. I.-C., Bucholz, K. K., Chan, G., Edenberg, H. J., McCutcheon, V. V., Schuckit, M. A., Kramer, J. R., & Dick, D. M. (2019). Positive and negative reinforcement are differentially associated with alcohol consumption as a function of alcohol dependence. Psychology of Addictive Behaviors, 33(1), 58–68. https://doi.org/10.1037/adb0000436 

Pasha, A. K., Chowdhury, A., Sadiq, S., Fairbanks, J., & Sinha, S. (2020). Substance use disorders: Diagnosis and management for Hospitalists. Journal of Community Hospital Internal Medicine Perspectives, 10(2), 117–126. https://doi.org/10.1080/20009666.2020.1742495 

Yang, W., Singla, R., Maheshwari, O., Fontaine, C. J., & Gil-Mohapel, J. (2022). Alcohol use disorder: Neurobiology and therapeutics. Biomedicines, 10(5), 1192. https://doi.org/10.3390/biomedicines10051192 

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Read the two case studies below. Then answer the questions in a Word document.

Case Study 1

Staria is a seventeen-year-old girl who has been brought to your outpatient treatment center by her mother. Staria has been suspended from high school on two occasions over the past six weeks for fighting and disorderly conduct. She has a history of recurrent detention and classroom dismissals for similar, though less severe, behavior at her previous high school. On the last occasion, she and another student were engaged in an altercation in the hallway. When security was called in, it was discovered that Staria had a pint of vodka and a small quantity of marijuana in her locker. At the time, it was noticed that Starina seemed intoxicated. She later tested positive for marijuana.

You meet Staria and her mother and learn that Staria stole alcohol and marijuana from her father’s stash and that he was outraged by the discovery. Staria blames her parents for her school dismissal and feels she is being blamed and scapegoated by her parents. According to her, her parents are the ones who need counseling. She also reports that her grandfather recently passed away due to cirrhosis. Her mother states that Staria has a twin sister, who never uses drugs, cigarettes, or alcohol and that Staria should be more like her sister.

Case Study 2

George is a civil service employee who has been struggling with his drinking problem for years. He has tried to control his alcohol use and has made many attempts to refrain. Lately, he has been drinking more frequently to feel the same effect; he even drinks before he goes to work. His family has a history of alcoholism. Although George is aware of the genetic origins concept, he feels embarrassed and struggles to identify himself as an alcoholic. He compares himself with others who drink far more than he does, and in his perception, this rationalizes that he is not that bad.
George continues to drink despite the adverse consequences on his health and sociocultural relationships. In the past three years, he has experienced the following consequences:

One arrest for driving under the influence (DUI)
Loss of a job
Mood swings
Fights and arguments with family members over his drinking
Frequent inability to stop drinking
Blackouts
Need for increasing amounts of alcohol to get high
George’s present employer asks him to attend Alcoholics Anonymous meetings. George responds, “I am not like those people. I am not that bad.”

Based on the case studies given above, create a Microsoft Word document that answers the following:

Using the DSM-V criterion, diagnose Staria and George. Explain the diagnosis by incorporating discussion over the concepts of addiction (i.e., withdrawal, tolerance, physical dependence, comorbidity, and psychological dependence). Be sure to explain the selected diagnosis.
The models for substance use can be categorized as physiological and psychological. Within each of these general categories, however, are different specialized foci. Review the Theories of Alcoholism document, as well as conduct research to determine which model(s) aid in understanding what is happening with Staria and George.