Posted: June 16th, 2024

Jax is a 66-year-old Caucasian female whose wife has encouraged her to seek treatment

Jax’s Case: An Analysis of Alcohol Use Disorder

Presenting Problems/Issues

The primary presenting issue is Jax’s excessive alcohol consumption, which has escalated to approximately a six-pack of beer per day. This level of alcohol intake is indicative of an alcohol use disorder (AUD). Additionally, her wife has reported instances of argumentative and irritable behavior while intoxicated, as well as falls and injuries resulting from her alcohol use. It is crucial to gather more information regarding the duration and severity of Jax’s alcohol use, any previous attempts at abstinence, and the presence of any withdrawal symptoms. Furthermore, an assessment of her physical and mental health, family history, and social support system would be beneficial in formulating a comprehensive diagnosis and treatment plan.

Diagnoses and Diagnostic Codes

Primary Diagnosis: Alcohol Use Disorder, Severe (DSM-5: 305.00, ICD-10: F10.20)
The diagnostic criteria for Alcohol Use Disorder, Severe, as outlined in the DSM-5, include:

– Consuming larger amounts of alcohol or over a longer period than intended
– Persistent desire or unsuccessful efforts to cut down or control alcohol use
– Spending a great deal of time obtaining, using, or recovering from the effects of alcohol
– Craving for alcohol
– Recurrent alcohol use resulting in a failure to fulfill major role obligations
– Continued alcohol use despite 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 or alcohol is taken to relieve or avoid withdrawal symptoms

Jax exhibits several of these criteria, including consuming larger amounts than intended, persistent desire to cut down, spending a significant amount of time obtaining and using alcohol, craving, recurrent use resulting in physical hazards (falls and injuries), and tolerance.

Differential Diagnosis: Alcohol-Induced Depressive Disorder (DSM-5: 291.89, ICD-10: F10.34)
Based on the information provided, it is essential to rule out the possibility of an alcohol-induced depressive disorder, as prolonged alcohol use can contribute to the development of depressive symptoms.

Physiological and Psychological Processes Leading to Substance Dependence

Substance dependence, including alcohol use disorder, is a complex interplay of physiological and psychological factors. Physiologically, prolonged alcohol use can lead to changes in the brain’s reward and stress systems, resulting in tolerance and withdrawal symptoms (Koob & Volkow, 2016). The development of tolerance is associated with adaptations in the gamma-aminobutyric acid (GABA) and glutamate systems, while withdrawal symptoms are linked to dysregulation of the brain’s stress systems, including the corticotropin-releasing factor (CRF) and norepinephrine systems (Koob & Volkow, 2016).

Psychologically, factors such as genetic predisposition, environmental influences, stress, and co-occurring mental health disorders can contribute to the development and maintenance of substance dependence (Volkow et al., 2019). Individuals may use substances as a means of coping with negative emotions, trauma, or stressful life events, which can reinforce the addictive cycle (Volkow et al., 2019). Additionally, social and cultural factors, such as peer pressure and societal attitudes towards substance use, can influence substance use behaviors (Volkow et al., 2019).

In summary, the physiological and psychological processes involved in substance dependence are multifaceted and involve complex interactions between genetic, neurobiological, and environmental factors.

References:

Koob, G. F., & Volkow, N. D. (2016). Neurobiology of addiction: a neurocircuitry analysis. The Lancet Psychiatry, 3(8), 760-773. https://doi.org/10.1016/S2215-0366(16)00104-8

Volkow, N. D., Koob, G. F., & McLellan, A. T. (2019). Neurobiologic advances from the brain disease model of addiction. New England Journal of Medicine, 374(4), 363-371. https://doi.org/10.1056/NEJMra1511480

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596

World Health Organization. (2019). International statistical classification of diseases and related health problems (11th ed.). https://icd.who.int/
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Case Study: Jax
Purpose: Scenario:
Analyze and apply critical thinking skills in the psychopathology of mental health patients and provide treatment and health promotion while applying evidence-based research.
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:
Remember to answer these questions from your textbooks and NP guidelines. At all times, explain your answers.
1. Describe the presenting problems/issues. Is there any information that was not provided that you would need to formulate a diagnosis? 2. Generate a primary and differential diagnosis using the DSM5 and ICD 10 codes. 3. What physiological and psychological processes lead to substance dependence?
Submission Instructions:
• Your initial post should be at least 500 words, formatted and cited in current APA style with support from at least 2 academic sources. Your initial post is worth 8 points.

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