Juan Case Study
Based on the case study and the DSM, the best diagnosis for Juan is moderate alcohol use disorder. This takes place when individuals with consistent problems with alcohol keep drinking in excess. An individual with this disorder has a powerful desire for alcohol, experiences difficulty controlling its use, and keeps using it regardless of the impairment or distress caused. Research shows that even when there are serious consequences, an individual prioritizes alcohol over commitments and other events in their life, and with continued use, their tolerance builds up (Lenora, 2017). The DSM-5 lists the following symptoms: alcohol is regularly taken in more significant amounts or for a period longer than was anticipated; there is an excellent amount of time that is spent indulging in activities that are necessary to obtain or use alcohol or recover from the effects, there is an insistent desire or unsuccessful efforts made to control or cut down on alcohol, strong urge or desire to use alcohol, continue the use of alcohol despite having recurrent or persistent interpersonal or social problems exacerbated or caused by alcohol effects, recurrent alcohol use that fails to fulfill essential role obligations at home, work or school, important recreational, occupational or social activities are given up or lessened due to alcohol use, tolerance, and alcohol use continues regardless of the knowledge of a recurrent or persistent psychological or physical problem that is likely to have been exacerbated or caused by alcohol among others (Buddy, 2021). This paper will focus on the diagnosis, causes of the disorder, and treatment plan for Juan.
In the case of Juan, the symptoms that are considered dysfunctional are as follows. Firstly, Juan has a high tolerance for alcohol. This implies that alcohol has a significantly diminished effect on Juan with continued use of the exact quantities of alcohol. Juan proudly claims that he can out-drink everyone and would still be standing, and he also claims that he never gets a hangover. This symptom is dysfunctional because it encourages Juan to drink an even more significant amount of alcohol; it might cause alcohol dependence, could affect task performance, could cause organ damage, increase the risk of alcoholism and toxicity of other drugs, and could also cause medications to be ineffective (Buddy, 2020). Secondly, Juan denies that he has an alcoholism problem. Denial is a problem because Juan does not believe he has a problem, causing him to be reluctant to seek the necessary help to quit. Denial is likely to cause problems in finding help for Juan. He claims that the fact that he never gets a hangover implies he lacks a drinking problem. The third symptom is that Juan continues to make use of alcohol even though it results in interpersonal problems due to his drinking problem. He got divorced because of his drinking problem, and his relationship with his sons is deteriorating as he refuses to admit that he has a problem. This symptom is dysfunctional since a lousy relationship with the people close to him can only worsen his drinking problem. The fourth symptom is a recurrent use of alcohol, which causes a failure to accomplish significant obligations at work. Juan is unable to get back to work due to his ill health, exacerbated by the drinking problem. At work, his memory loss has been considered alcohol-related, and this might prevent him from flying again. Being out of work might impact his mental and physical health and might also cause financial problems that could result in an inability to pay rent, causing him to be homeless. This might exacerbate his problem. The fourth symptom is an excessive intake of alcohol over a long period. Juan can drink more than one six-pack of beer and still take more potent drinks. He has been drinking for an extended period now, and this impacts his health negatively and might trigger another heart attack and other complications.
Sociocultural Psychological Model
The sociocultural model cites that the cultural standards set by society, together with the negative consequences of society and culture on individuals’ behavior, can cause addiction (Horvath et al., 2021). Therefore, this model suggests that altering the sociocultural environment is a better solution than treating the individual. In the US, intoxication is not only tolerated but also considered humorous. Backed by peer pressure, Juan claims to engage in alcohol drinking together with his pilot friends, where drinking competitions are encouraged and where he became famous for his ability to take large amounts of alcohol and remain standing. Alcohol problems are not common among Hispanics (Castañeda et al., 2019). However, for Hispanics (particularly those acculturated in the US) who drink, their level of drinking is said to be higher than that of non-Hispanic Whites (National Institute on Alcohol Abuse and Alcoholism, 2021). Juan is a Hispanic male who overindulges in drinking, and this could be caused by the cultural acceptance of excessive alcohol drinking in the US culture.
Additionally, some studies suggest that among Latino men, heavy drinking patterns are influenced by the concept of masculinity, which is integral to Latino male identity. This enables them to appear more masculine and robust due to their cultural values, and drinking excessive amounts of alcohol exemplifies their masculinity (Sudhinaraset, Wigglesworth & Takeuchi, 2016). Furthermore, parenting contributes to drinking behaviors, and for the case of Juan, it can be noted that his biological father introduced him to alcohol, and he claims to like it and that both of them had “a taste for the hard staff.” The normalization of this drinking behavior as a way of bonding with the father, together with the concept of masculinity, can help explain Juan’s symptoms. High and low socioeconomic status are also associated with excessive drinking, even though studies show that economic deprivation is a worse risk factor for increased alcohol consumption (Castañeda et al., 2019). Juan’s socioeconomic status is unknown, but given his current profession as a commercial pilot residing in a “nice condo,” it can only be assumed that his SES is between middle and high, and this could help explain his ability to quickly gain access to alcohol and indulge in excessive drinking, particularly in social settings.
Causes and Treatment for AUD
There are various causes for AUD. Social, psychological, physiological, and genetic factors can all be integral. Psychological traits like the need for approval, low self-esteem, and impulsiveness trigger alcoholism. Some individuals drink to medicate or cope with emotional problems. Furthermore, environmental and social factors like peer pressure and the ease of availability of alcohol can also play an important role. Others include sexual or physical abuse as well as poverty, which heightens the odds of alcohol dependence development.
Genetic factors also make specific individuals more prone to alcohol dependence than others. Twin studies have shown that substance abuse is somehow heritable as male children of alcohol-dependent parents have four times more probability of becoming drinkers compared with those from nondependent parents (Skewes & Gonzalez, 2013). High tolerance for alcohol only enhances alcohol dependence. This can cause physiological alterations that cause drinking to be the best way to prevent discomfort. Such individuals might drink to avoid or lessen withdrawal symptoms.
Cognitive behavioral therapy is one of the most recommended forms of therapy that focuses on altering thoughts, behaviors, and feelings to help manage triggers and urges in AUD (Coates et al., 2018). Physical exercise has also been linked with a lessened urge to drink, increased medication effectiveness and adherence, and improved general health (Jensen et al., 2015). These forms of treatment can be combined with medication like nalmefene and naltrexone, which help lessen heavy drinking days and can help promote abstinence (Litten et al., 2016). Varenicline, topiramate, acamprosate and disulfiram can also be used.
The goal of the treatment plan will be to manage and lessen symptoms of AUD and enhance proper functioning and health. Juan has solid social support from his sons and seems to love his job; before, these can be critical motivators that can help guide the treatment plan and recovery process. Furthermore, his resilience and commitment to working out, eating a healthy diet, and taking medication to prevent a heart attack are critical to the treatment plan. It will be essential to take Juan through individual counseling to help him understand that he has an alcohol problem and needs help to manage it. Once this is done, Juan will be assessed for suitability of medications, and any physical or co-occurring conditions that might cause distress or stress will be assessed. Juan is at high risk of heart attack, and this will be put into consideration in the treatment plan. The appropriate medication will be suggested, and with the help of a therapist, Juan will be put through counseling to help with his memory problems and help in adjusting his behaviors and thoughts. Individual counseling, like CBT, is considered more effective in AUD treatment and can enhance effectiveness (Giles, 2017). Juan will also be referred to a recovery support service where he can obtain a support group to aid his recovery. It will also be essential to make a constant follow-up to monitor Juan’s progress.
Buddy, T. (2020). The Negative Effects of Alcohol Tolerance. Verywellmind. https://www.verywellmind.com/alcohol-and-tolerance-66572
Buddy, T. (2021). What an Alcohol Use Disorder Diagnosis Means. Verywellmind. https://www.verywellmind.com/diagnosis-alcohol-use-disorder-67880
Castañeda, S. F., Garcia, M. L., Lopez-Gurrola, M., Stoutenberg, M., Emory, K., Daviglus, M. L., … & Talavera, G. A. (2019). Alcohol use, acculturation and socioeconomic status among Hispanic/Latino men and women: The Hispanic Community Health Study/Study of Latinos. PloS one, 14(4), e0214906.
Coates, J. M., Gullo, M. J., Feeney, G. F., Young, R. M., Dingle, G. A., & Connor, J. P. (2018). Alcohol expectancies pre-and post-alcohol use disorder treatment: Clinical implications. Addictive behaviors, 80, 142-149.
Giles, A. (2017). A Guide for Clinicians to Initial Treatment for Alcohol Use Disorder. http://www.handshakemediainc.com/2017/09/26/a-guide-for-clinicians-to-initial-treatment-for-alcohol-use-disorder/
Horvath, T., Misra, K., Epner, A., & Cooper, M. (2021). Sociocultural Model Of Addiction And Recovery Implications. Gulf Bend Center. https://www.gulfbend.org/poc/view_doc.php?type=doc&id=48353&cn=1408
Jensen, K., Nielsen, C., Ekstrøm, C. T., & Roessler, K. K. (2019). Physical exercise in the treatment of alcohol use disorder (AUD) patients affects their drinking habits: A randomized controlled trial. Scandinavian journal of public health, 47(4), 462-468.
Lenora, K.M. (2017). Alcohol use disorder: Criteria, symptoms, treatment DSM-5 303.90 (F10.20). Counselling News. https://thriveworks.com/blog/alcohol-use-disorder/
Litten, R. Z., Wilford, B. B., Falk, D. E., Ryan, M. L., & Fertig, J. B. (2016). Potential medications for the treatment of alcohol use disorder: an evaluation of clinical efficacy and safety. Substance abuse, 37(2), 286-298.
National Institute on Alcohol Abuse and Alcoholism. (2021). Alcohol and the Hispanic Community. https://www.niaaa.nih.gov/publications/brochures-and-fact-sheets/alcohol-and-hispanic-community
Skewes, M. C., & Gonzalez, V. M. (2013). The biopsychosocial model of addiction. Principles of addiction, 1, 61-70.
Sudhinaraset, M., Wigglesworth, C., & Takeuchi, D. T. (2016). Social and cultural contexts of alcohol use: Influences in a social–ecological framework. Alcohol research: current reviews.
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Case Study Paper – Online
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 developing the symptoms.
Identify the causes and treatment options for substance-related disorders.
Develop a treatment plan for Juan.
Use the GCU Library databases and include two to three peer-reviewed, scholarly sources from the GCU Library to support your claims. In addition to the scholarly resources from the library, you can include past classroom materials, your textbook, and credible internet-based sources (.org, .edu, .mil, .gov). Sources from the Perdue Library can also be used.
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