Hi! Below is the case study and I want to make sure I\'m on the right track. I b

Question

Hi! Below is the case study and I want to make sure I'm on the right track. I bolded the questions I'm interested in (1-5). Looking for people who are familiar with the DSM-5/abnormal psychology and able to answer all questions completely. Thank you!

Questions:

1. Diagnosis; what is the evidence for it?

2. Treatment; typical treatment used for this diagnosis AND most effective treatment. IF the person is in treatment, what should we target first in terms of symptoms? How likely are they to stay in treatment and how likely are they to recover? Are meds involved and if so, what broad “type” of meds work for this disorder,?

3. Differential diagnosis (why is it this disorder and not this disorder)

4. Does the person have more than one diagnosis, what would DSM say about the criteria for diagnosing that

5. What would the primary causal theories be?

CASE STUDY BELOW:

Claire is a 26 year old party girl who used to be ridiculously shy. Claire graduated from college and took a job at a New York fashion magazine. Claire goes to work every day, but they hold very weird hours and most people arrive around 11 a.m. and stay until 8 p.m. this works well as they all party every night until at least 3 a.m. and waking up in the morning can be quite difficult. Claire has been arrested (not charged) because of her drunken behavior several times, she has driven drunk on several occasions, she has episodes where she cannot remember what she did or where she was and she sometimes wakes up at other people’s houses in the morning with no memory of how she got there or what they were doing the night before. Claire drinks on a daily basis and also takes many different drugs on the weekends. She is never sober for more than 48 hours and is pretty sure she can’t exist without at least alcohol in her system. She is having financial problems as well as relationship problems as a result of her drug and alcohol use. Claire does not think she has a problem because all of her friends are exactly the same way. Claire also notes that her drinking helps her cope with her disabling anxiety – she is completely unable to interact with large groups of people or go to a party without the benefit of alcohol and she feels she does rely on drugs and alcohol for this purpose perhaps a bit too much, but says that in her industry if she was unable to go to the parties and social functions, she would be fired. Claire notes that her entire family has a history of alcohol abuse but she feels that she is not “like them” and is not addicted to anything. Claire does report that her immediate family is highly dysfunctional and she basically has no relationship with her parents any longer due to their negative behavior (they are alcoholics and quite abusive at times). Claire also is unable to maintain a steady relationship with anyone who is healthy – she is bisexual but has not found a person that she is able to stay with as she always ends up getting into a huge fight and leaving. Claire comes to treatment because her roommate found her naked and wasted walking around outside their building at 4 a.m. one morning. Her roommate said that Claire was talking about suicide and was completely incoherent.

Explanation / Answer

1. Claire is showing symptoms of Alcohol abuse and intermittent drug usage, both of which come under the category of Substance Abuse in the DSM. It is labeled as such due to her dependence on alcohol and showing of symptoms of alcohol abuse. Alcohol Abuse is sometimes called as Alcoholism or alcohol dependence. Symptoms shown by her matches that of alcohol abuse from DSM. Her symptoms include, as mentioned in case study:

She even admits to taking drugs on weekends, but admits to not abusing them regularly or being dependent upon them the way she is dependent on alcohol. Her symptoms of blackouts, excessive drinking, depression (lonely, suicidal, anxiety), having relationship and financial problems, and getting into legal troubles are basic pointers to that of Alcohol Abuse.

2. If Claire goes for treatment she will be treated for her dependence on the alcohol. Treatments available for Alcoholism are usually targeted to change the behavior of craving, while reversing the dependence on alcohol. Most common therapies include counselling, in which Claire will get one-to-one advice and counselling from a trained counsellor regarding her habits, and how to make decision for change. Support groups are another form of therapy available which consists of groups like Alcoholics Anonymous, etc. Such groups help people cope up with alcohol problems by sharing their stories, experiences and how they finally overcame their problem. Group Therapy also works in a similar way, but here the patients will be face to face with other patients and a counsellor during therapy. Rehabilitation and Detox therapies are available for clients wanting to change. Detox involves clients abstaining from such toxic substances and changing their diet to live a healthy life. Rehabilitation includes abstinence, and trying to get back on with everyday life. Behavioral Therapy can be used to help Claire with her shyness, social anxiety, and depression. Most effective treatment is Aversion therapy. It involves use of a chemical stimulus (usually a drug) to create negative side effect that will cause an aversion to the use of alcohol.

In case of Claire, chances of treatment being successful is less because Claire is still in denial of being addicted to alcohol. On top of that Claire herself did not come her, she came here because her roommate was worried about her. Unless a person himself/herself decides to change and seek therapy, the success of therapy will be low and its effects will be less. When the client herself is not motivated to seek treatment, treatment will take long time due to their inconsistency, relapses and lack of motivation to change.

In case of medications most commonly used drugs are usually vitamins, anti-anxiety and anti-depressants medications, seizure medications and anti-abuse medications. Vitamins are given to keep patients healthy and seizure medications help battle sevre withdrawal symptoms that occur during treatments. Anti-anxiety and anti-depressants also help treat withdrawal symptoms as well as any underlying anxiety or depression that may be that cause for alcoholism. Anti-Abuse medications involve Disulfiram (used in aversion therapy), Naltrexone (decreases the pleasure from drinking), or Acamprosate (stops the craving). These medications are usually administered by medical doctors and it would be best that a doctor be consulted before deciding to take medication as medicines have side effects.

3. Given below are differential diagnosis of this disorder and its difference from that of Alcohol Abuse

DIFFERENTIAL DIAGNOSIS

DIFFERENCE FROM ALCOHOL ABUSE

Drug Abuse or other substance disorder

Psychotic disorders (paranoia, schizophrenia, etc.)

Anxiety and Mood related disorders

Bipolar Disorder and related disorders (dysthymia, cyclothymia, etc.)

4. More than one diagnosis are possible, but that is only and only if the individual is known to have co-morbid disorders. Co-morbid disorders for Alcohol Abuse includes social phobia, anxiety disorder, depression, other substance abuse, etc. Since Claire is showing symptoms of mild depression as well as drug usage, she needs to be diagnosed for their severity and treated for all three. DSM-5 specifically states that for Alcohol Abuse to be classified it should satisfy the following criteria:

5. Alcoholism is a disorder that persists in every country and is almost rampant. Its cause is unknown but many researchers say that it is due to the chemical changes that occur in the brain when you consume it. These changes are known to increase as consumption becomes a habit and this start producing a pleasurable experience to the drinker. This ends up causing addiction and dependence on it and not drinking causes withdrawal (anxiety and seizures). Some researchers say that if it runs in the family then the risk factor of acquiring the disorder increases.

DIFFERENTIAL DIAGNOSIS

DIFFERENCE FROM ALCOHOL ABUSE

Drug Abuse or other substance disorder

1. Lack of symptoms of Hallucinations and delusions
2. Blood shot or glazed eyes
3. Physical marks or blue vein
4. Certain substances have more lasting effects as compared to alcohol

Psychotic disorders (paranoia, schizophrenia, etc.)

1. Lack of symptoms of Hallucinations and delusions
2. Blacking out is usually not observed
3. Lack of grandiose thoughts, staying in touch with reality, etc.

Anxiety and Mood related disorders

1. Excess worry of things
2. Mood swings are not due to alcohol
3. Physical symptoms that manifest are not due to alcohol

Bipolar Disorder and related disorders (dysthymia, cyclothymia, etc.)

1. mood swings from being maniac to being depressed (takes weeks or days) not related to alcohol use
2. Decreased need for sleep
3. Symptoms are not manifested due to alcohol use

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