Analyze and apply critical thinking skills in the psychopathology of mental health patients and provide treatment and health promotion while applying evidence-based research.Scenario:
Jax is a 66-year-old Caucasian female whose wife has encouraged her to seek treatment. She has never been in therapy before, and has no history of depression or anxiety. However, her alcohol use has recently been getting in the way of her marriage, and interfering with her newly-retired life. She describes drinking increasing amounts over the last year, currently consuming approximately a six-pack of beer per day. She notes that this amount “doesn’t give me the same buzz as it used to.” She denies ever experiencing “the shakes” or any other withdrawal symptoms if she skips a day of drinking.
Jax comments that her wife is her biggest motivation to decrease her alcohol use. She tells Jax that she gets argumentative and irritable when she drinks, though she does not always remember these incidents. She has also fallen while intoxicated twice, causing bruises both times and hitting her head on one of the occasions.
Questions:
Describe the presenting problems/issues. Is there any information that was not provided that you would need to formulate a diagnosis?
Generate a primary and differential diagnosis using the DSM5 and ICD 10 codes.
What physiological and psychological processes lead to substance dependence?
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Presenting problems/issues:
- Alcohol use interfering with marriage and daily life
- Increasing amounts of alcohol consumption
- Decreased effect/buzz from alcohol consumption
- Denial of withdrawal symptoms
- Argumentative and irritable behavior while drinking
- Memory loss of incidents
- Falls and injuries while intoxicated
Information needed for diagnosis formulation:
- Duration and frequency of alcohol use
- Level of impairment in daily functioning
- Any history of trauma or co-occurring mental health disorders
- Family history of substance abuse
- Motivation and readiness for change
- Other lifestyle factors and social supports
Primary diagnosis (DSM-5 and ICD-10 codes):
Alcohol Use Disorder
DSM-5 Criteria:
- Alcohol is often taken in larger amounts or over a longer period than was intended
- Persistent desire or unsuccessful efforts to cut down or control alcohol use
- Craving, or a strong desire or urge to use alcohol
- Recurrent alcohol use resulting in a failure to fulfill major role obligations at work, school, or home
- Continued alcohol use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of alcohol
- Important social, occupational, or recreational activities are given up or reduced because of alcohol use
- Recurrent alcohol use in situations in which it is physically hazardous
- Continued alcohol use despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by alcohol
- Tolerance, as defined by either a need for markedly increased amounts of alcohol to achieve intoxication or desired effect, or a markedly diminished effect with continued use of the same amount of alcohol
- Withdrawal, as manifested by either the characteristic withdrawal syndrome for alcohol or the substance is taken to relieve or avoid withdrawal symptoms
ICD-10 Code: F10.20 - Alcohol dependence, uncomplicated
Differential diagnosis:
- Other Substance Use Disorders (based on the substance being used)
- Non-Substance-Related Addictive Disorder (e.g., Gambling Disorder)
- Major Depressive Disorder with Alcohol Use Disorder
- Bipolar Disorder with Alcohol Use Disorder
- Other medical conditions that may mimic alcohol-related symptoms (e.g., neurological disorders)
Physiological and psychological processes leading to substance dependence:
Physiological processes:
- Chronic use of alcohol or other substances leads to neuroadaptations in the brain’s reward center, resulting in a dysregulation of dopamine levels and reward pathways.
- Tolerance develops, requiring increased amounts of alcohol to achieve the desired effect.
- Withdrawal symptoms occur when alcohol use is discontinued, signaling physical dependence.
Psychological processes:
- Alcohol use can function as a coping mechanism to deal with stress, anxiety, or emotional pain.
- Reinforcement and learning principles contribute to substance dependence, as alcohol use is associated with pleasurable experiences or relief from unpleasant emotions.
- Psychological factors such as personality traits (e.g., impulsivity), early-life adversity, and social/environmental factors play a role in the development and maintenance of substance dependence.
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