The Case of Sook

The Case of Sook

F10.20 Alcohol dependence in remission

Z71.1 Person with feared health complaint in remission

The diagnosis of alcohol dependence in remission is supported by several criteria evident in the case study of Sook. Firstly, Sook’s history reveals a pattern of escalating alcohol consumption, from occasional beer drinking during her sophomore year to frequent heavy drinking sessions, including multiple vodka and cranberry juice mixed drinks. She admits to using alcohol as a coping mechanism, mainly to alleviate hangover symptoms such as nausea and tremors and to manage chronic anxiety. This pattern aligns with the diagnostic criteria for alcohol dependence, which includes increased tolerance, withdrawal symptoms, and using alcohol to relieve or avoid withdrawal symptoms (Diagnostic and Statistical Manual of Mental Disorders: FITFH edition, text revision: DSM-5-TR 2022).

Furthermore, Sook’s use of alcohol has had adverse effects on various aspects of her life. She reports experiencing interference with her academic performance due to fatigue and sleep disturbances resulting from her drinking habits. Additionally, she acknowledges difficulties in maintaining limits on her alcohol consumption, often exceeding self-imposed restrictions. These consequences correspond with the diagnostic criterion of continued alcohol use despite significant social, occupational, or recreational problems.

Sook’s symptoms also reflect the specifier “in remission,” indicating that while she no longer meets the full criteria for alcohol dependence, she still exhibits residual symptoms or impairment from past alcohol use. This is evident in her ongoing struggles with sleep disturbances, anxiety, and difficulties with concentration, which persist despite her attempts to reduce her alcohol intake.

A differential diagnosis considered for Sook could be Alcohol Use Disorder (AUD), Z87.891, and a personal history of alcohol use disorder. However, AUD encompasses a broader range of severity, from mild to severe. In contrast, the specific criteria outlined in the case study align more closely with the diagnosis of alcohol dependence in remission. Sook’s symptoms indicate a past pattern of severe alcohol dependence, which is now in partial remission, as she no longer meets all the criteria for a current diagnosis of AUD (Diagnostic and statistical manual of mental disorders: FITFH edition, text revision: DSM-5-TR 2022). The severity of her symptoms, including tolerance, withdrawal, and impairment in various life domains, indicates a history of alcohol dependence rather than the broader spectrum encompassed by AUD.

Given her Korean heritage and immigrant background, cultural factors play a significant role in Sook’s case. Cultural concepts of distress may influence Sook’s perception and experience of her symptoms and willingness to seek help. The stigma surrounding mental health and substance use issues within specific cultural communities may contribute to Sook’s reluctance to acknowledge her difficulties or seek appropriate treatment (Diagnostic and Statistical Manual of Mental Disorders: FITFH edition, text revision: DSM-5-TR 2022). Moreover, cultural norms and familial expectations may have influenced Sook’s academic and occupational pursuits, potentially exacerbating her stress and contributing to her alcohol use as a coping mechanism.

The Z codes selected for Sook Z71.1 and Z87.891 reflect her past struggles with alcohol dependence and associated health concerns, as well as her current efforts to address these issues and maintain sobriety. Additionally, these codes acknowledge the psychosocial and environmental impact of Sook’s condition within the last 12 months, encompassing her academic, occupational, and interpersonal challenges related to her alcohol use and recovery journey.

References

Diagnostic and statistical manual of mental disorders: FITFH edition, text revision: DSM-5-TR. (2022). American Psychiatric Association Publishing.

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Explain how you support the diagnosis by specifically identifying the criteria from the case study.
。 Describe in detail how the client’s
symptoms match up with the specific diagnostic criteria for the disorder (or all the disorders) that you finally selected for the client. You do not need to repeat the diagnostic code in the explanation.
• Identify the differential diagnosis you considered.

The Case of Sook

• Explain why you excluded this
diagnosis/diagnosis.
• Explain the specific factors of culture that are or may be relevant to the case and the
diagnosis, which may include the cultural concepts of distress.
Explain why you chose the Z codes you have for this client.
。 Remember: When using Z codes, stay focused on the psychosocial and
environmental impact on the client within the last 12 months.