Alcohol use disorder is commonly referred to as alcoholism or alcohol addiction. According to the National Institute on Alcohol Abuse and Alcoholism, alcohol use disorder is due to an effect of the cognitive system where an individual is involved in spontaneous drinking habits which they cannot control and experience undesirable sensations whenever they do not engage in drinking ( McHugh, & Weiss, 2019) .
Subjective
Chief Complaint (CC)
The patient’s chief complaint was stress, that led to too much drinking at the end of the day. Her complaints on stress are both work related as well as her personal life and maintenance. Concerning her work, she complains of how her students are mean, cyber harassing her with videos of her using mean titles; and yet, they still go unpunished because they are “rich” (Symptom Media (Producer, 2018). She also complains of another student who humiliated her, and the administration did not tell her counsellor about it. About her personal life, she is stressed about her bills and student loan while also worried about upgrading her car. Additionally, her early childhood must have predisposed her to alcohol abuse since she had a drunkard father. Due to her alcoholism, she has been late for 22 of the classes she teaches (Symptom Media (Producer, 2018).
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HPI
Ally Patel is a 40-year old female who presents with alcoholism that is as a result of a number of reasons. She admits starting her alcohol habits since when she out with her friends, since her mom was strict with her using alcohol. This progressed as she furthered her education to college and has worsened eve since she graduated and started working as a teacher. Due to alcoholism, she has always been late for 22 of her class periods, and this worries the school administration (Symptom Media (Producer, 2018). It also affects her competency as a teacher because she leaves her students to study and make notes on their own while she sleeps on her desk due to hungover. Her alcoholism can be grouped to be as a result of genetic, environmental, social and psychological factors ( McHugh, & Weiss, 2019) . Genetic factors can be traced back to her dad’s drinking habit that she noted since when she was young. Environmental factors include her stressful job encounter with mean students as well as her proximity to access of alcoholic drinks. Social factors include her encounter with her dad’s drinking habits as well as her school peers and friends who organize parties where alcohol is distributed liberally. Psychological factors include stress including personal and job stress, which predispose her to alcoholism.
Past Psychiatrist history : Patient denies having any past psychiatrist history hence no psychotherapeutic interventions.
History of substance use : The patient admits having used alcohol since the first time she attended a high school party.
Family substance use history : The patient admits having a dad who was an alcoholic but got into AA and became sober.
Psychosocial history : Ally Patel is an only child who lived with her parents in San Francisco, CA. She has a PhD in biology and master’s degree in high school education (8–12). Growing up, her mom had been strict on her using alcohol. She currently lives by herself in a rented apartment. She also recently broke up with her boyfriend and they have been apart for more than one year. She admits having a new boyfriend. Most of the time she drinks alone, but also goes out with her friends and colleagues who also drink.
Medical history : She denies having any medical problems in the past, no allergies, no reproductive health problems and her vaccines are up-to-date.
ROS
General: Weight loss and weakness
Cardiovascular: Palpitations, arrhythmia and hypertension
Skin: Inflamed skin and cystic acne
Respiratory: Impaired glottic reflexes and lung abscesses
Gastrointestinal: Impaired muscle function, inflammation of the stomach lining, stomach pain and diarrhea with bleeding
Musculoskeletal: Inflammation in the joints and joint pains.
Genitourinary: Burning sensation when passing urine, headaches
Hematologic: Presence of abnormal blood cell precursors
Objective
Physical exam
The patient appeared stressed and tired. She also expressed increased mood changes, irritability and anger especially when asked about her personal life and how it affects her. She looked tired and anxious. She had eye bags, an indication of deprived sleep and hangover. Reduced self-care especially when she sleeps on her desk during class periods and unkempt hair.
Diagnostic results: Alcohol use disorder (AUD).
Assessment
Mental Status Assessment
Ally Patel, a 48-year old female, did not go through any developmental challenges when growing up. The only challenge she had was having a dad who was a drunkard and to say her mom was strict with her on alcohol might have raised her curiosity levels (Symptom Media (Producer, 2018). When she had the chance, she started drinking and she is now addicted to alcohol use. Her cognition is a bit altered with considering she has to take some time to think before giving answer and impulsive irritation. She also fidgets with her hands after realizing it was the school administration’s idea for her to meet the school counsellor.
Differential Diagnoses
Alcohol Use Disorder
Ally Patel is most likely to be suffering from alcohol use disorder considering her dependence on alcohol to solve her stress problems ( McHugh, & Weiss, 2019) . She says alcohol relieves her of her daily stress and she has to take larger quantities of alcohol to meet her intoxication levels (Symptom Media (Producer, 2018). Ally’s AUD meets the DSM 5 evidence criteria considering all the evidence of intoxication levels, withdrawals, inability to complete her job duties among others ( McHugh, & Weiss, 2019) . The fact that she mostly drinks alone also indicated her distancing from social groups to be able to drink to her limits.
Depression
The second differential diagnosis for Ally Pate could be depression. Considering the events of her life, her break up with her boyfriend, her worries about her bills and loans and also concerning her job which she considers stressful due to mean students who are troublesome (Symptom Media (Producer, 2018). Even though she expresses certain symptoms of depression, it only includes weight loss, fatigue and constantly depressed mood, it does not meet the DSM 5 criteria as the major diagnosis ( McHugh, & Weiss, 2019) . Additionally, depression mostly presents as a secondary effect of alcoholism.
Bipolar
The third differential diagnosis id bipolar. Bipolar is a collective term for cognitive disorders that results to the sudden change in an individual’s energy, moods and functionality ( Grande, Berk, Birmaher, & Vieta, 2016) . Ally has been experiencing mood swings and irritability, inability to complete her duties where she leaves her students to learn on their own. She also prefers to stay alone for some time. Bipolar disorder is also aggravated by stressful situations such as breakups, stressful jobs and personal bills. However, it does not meet the DSM 5 criteria for Ally’s symptoms.
Reflection Notes
If I were to conduct another interview with Ally, I would consider explaining the reason for our meeting before asking any questions aside from greetings. This would reduce the irritability levels of the patient and they would be more willing to open up to get help. As it was in Ally’s case, she only got to relax and sit down to listen and also open up after she was told it was the administration’s idea and the only option for retaining her (Symptom Media (Producer, 2018). The health promotion recommendations for Ally would include exercising and meditation during free times, utilizing counselling services, use of anti-alcohol drugs such as Vivitrol and Revia, detoxification and rehabilitation ( Shen, 2018).
Conclusion
In conclusion, the main challenge Ally is dealing with is AUD which meets the DSM-5 criteria for her symptoms. The health promotion interventions she would need to quit alcoholism include detoxification, use of medication, engaging in exercise activities and counselling; which would include the need of her competence to be able to affectively meet her needs so as to minimize stress .
References
Grande, I., Berk, M., Birmaher, B., & Vieta, E. (2016). Bipolar disorder. The Lancet , 387 (10027), 1561-1572.
McHugh, R. K., & Weiss, R. D. (2019). Alcohol use disorder and depressive disorders. Alcohol research: current reviews , 40 (1).
Shen, W. W. (2018). Anticraving therapy for alcohol use disorder: a clinical review. Neuropsychopharmacology reports , 38 (3), 105-116.
Symptom Media (Producer), & . (2018). Training Title 114. [Video/DVD] Symptom Media. https://video.alexanderstreet.com/watch/training-title-114-2
