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 Respond to  your colleagues who were  assigned a different disorder than you. Compare the differential  diagnostic features of the disorder you were assigned to the diagnostic  features of the disorder your colleagues were assigned. What are their  similarities and differences? How might you differentiate the two  diagnoses? 

                                                             Main Discussion

 

Diagnostic Criteria of Alcohol-Related Disorders

Alcohol  use disorder defined by DSM-5 criteria is a highly prevalent, highly  comorbid, disabling disorder that often goes untreated in the United  States (Grant et al., 2015).   According to the American Psychiatric  Association (2013), for DSM-5 classification of alcohol use disorder  (AUD), a person needs to manifest at least two of the eleven diagnostic  criteria.  The criteria include the person taking in large quantities  over a longer than intended period, having a persistent desire or  unsuccessful attempts to cut down or control use, spending significant  time obtaining alcohol, experiencing intense cravings or urges to  consume alcohol or failure to fulfill significant obligations at work,  school, or home due to recurrent use (APA, 2013).  Individuals suffering  from alcohol misuse may also experience continued use, despite having  persistent social or interpersonal problems caused by the effects of  alcohol (e.g., arguing with others overuse), having important social,  occupational, or recreational activities given up or decreased due to  alcohol use, recurrent use in situations which may be physically harmful  (APA, 2013).  

Psychotherapy and Psychopharmacological Treatment

Despite  increased AUD prevalence during the past decade, researchers revealed  that AUD mainly goes untreated. Rather than lack of insurance, fears of  stigmatization, and beliefs that treatment is ineffective explain the  lack of AUD treatment in the United States (Grant et al., 2015).  Nonetheless, a large body of literature supports the effectiveness of  the treatment of AUD. Individuals who participate in 12-step groups  increase the likelihood of recovery, consistent with randomized clinical  trials testing the efficacy of 12-step facilitation administered by  health care practitioners (Grant et al., 2015). An individual motivation  to quit will ascertain what approaches can enhance and support the  person’s readiness to quit.  Since many psychiatric clients are hesitant  to stop drinking, treatment often involves augmenting a person’s  motivation to quit while successful barriers.  It can be achieved  effectively using a cognitive-behavioral therapy (CBT) approach. CBT  provides behavioral interventions and a beneficial structure to help  individuals stop drinking. The group experience benefits were reported  as peer support, change of thinking patterns, increased confidence, and  self-efficacy. This study suggests that depression management,  especially in a group format, should be offered more frequently as an  integrated part of alcohol treatment due to the benefits experienced by  the participants (Besenius et al., 2013).

In  1948, disulfiram was the first medication approved by the U.S. Food and  Drug Administration (FDA) to treat alcohol dependence (Zindel &  Kranzler, 2015). Maintenance dose usually 250 mg/day. The drug works by  irreversibly inhibiting aldehyde dehydrogenase, the enzyme involved in  the second-stage alcohol metabolism (Stahl, 2014). Alcohol is  metabolized to acetaldehyde, which in turn is metabolized by aldehyde  dehydrogenase; thus, disulfiram blocks this second-stage metabolism  (Stahl, 2014). Disulfiram’s effects are immediate; individuals should  not take disulfiram until at least twelve hours after drinking. If it  works, it increases abstinence from alcohol (Stahl, 2014).

Clinical Features

Alcohol  use disorders impair productivity and interpersonal functioning and  place psychological and financial burdens on those who misuse alcohol,  on their families, friends, and coworkers, and, through motor vehicle  crashes, violence, and property crime, on society (Grant et al., 2015).  Clinical features that I was able to observe with alcohol use disorder  would be waking up and drink alcohol soon after, beer more and more beer  every day, or someone waking up and has to drink a couple of beers  every day (APA, 2013).  These behaviors relate to the criteria of an  individual having more significant tolerance and withdrawal symptoms.   Additional features of withdrawal that I would anticipate are an  individual who is employed. For example, this client was referred to the  office because he is a truck driver and was informed by his employer to  seek medical treatment or “be fired.” Additional diagnostic criteria  are met as a person who needs to report to work and has difficulty  accomplishing a responsibility to their work under the influence.   Significant medical conditions can also outcome from AUD, such as lung  and other cancers, cardiac and pulmonary disease, perinatal problems,  cough, shortness of breath, and accelerated skin aging (APA, 2013).  AUD  can also cause interpersonal and relationship issues, especially when  one person in the relationship is not an alcoholic.

References

American Psychiatric Association (APA). (2013). Diagnostic and statistical manual of mental 

disorders (5th ed.). Washington, DC: Author.

Besenius, C., Beirne, K., Grogan, S., & Clark-Carter, D. (2013). Cognitive Behavioral Therapy 

(CBT) in a Depression/Alcohol Use Disorder Group: A Qualitative Study. https://doi.org/10.1080/07347324.2013.746613

Grant, B.F, Goldstein, R.B, Saha, T.D, et al. (2015). Epidemiology of DSM-5 Alcohol Use 

Disorder: Results from the National Epidemiologic Survey on Alcohol and Related Conditions III. JAMA Psychiatry. 2015;72(8):757–766. doi:10.1001/jamapsychiatry.2015.0584

Zindel, L.R. & Kranzler, H.R. (2015). Pharmacotherapy of Alcohol Use Disorders: Seventy-

Five  Years of Progress. Journal of Studies on Alcohol and Drugs, Supplement  2015: s17, 79-88. https://doi.org/10.15288/jsads.2014.s17.79

Stahl, S. M. (2014). Prescriber’s Guide: Stahl’s Essential Psychopharmacology (5th ed.). New 

York, NY: Cambridge University Press.







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