Marci’s primary diagnosis is F10.280 Alcohol dependence with alcohol-induced anxiety disorder , severe . According to the DSM-5, for one to be diagnosed with an alcohol abuse disorder, the patient should have 2 or more of the following symptoms:
Taking alcohol in larger amounts and more time is spent drinking than was intended.
A great desire or urge to use alcohol
A lot of time is spent in activities aimed at obtaining alcohol, use alcohol or recover from its effects
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Recurrent alcohol use affects the ability of an individual to fulfill major obligations at work, at school or at home
Important social, occupational or recreational activities are given up or reduced because of alcohol use
There is recurrent use of alcohol even in situations which are hazardous.
Alcohol use is continued despite knowledge of the existence of a physical or psychological problem that could be made worse by alcohol use
Unsuccessful efforts at cutting down on alcohol use
Continued alcohol use despite the existence of a social or interpersonal problems caused by alcohol use
Tolerance to alcohol
Presence of withdrawal symptoms (American Psychiatric Association, 2013)
Marci meets more than 6 of the above criteria hence the need to categorize her alcohol use disorder as severe. From the narrative of the case, Marci meets the first criteria because she engages in binge drinking and would take alcohol in large amounts and for extended periods as she would drink up to 2 am and she would drink from Friday through to Saturday afternoon. She also meets criteria number 2 since she drinks alcohol whenever she gets a chance which means she has a great desire for alcohol. She meets the third criteria since she has been skipping classes after a night of drinking and her grades are starting to drop. She meets the fifth criteria since she drives while drunk. In addition, she reports symptoms of anxiety and depression which are associated with her use of alcohol. She meets the 6 th criterion since she drinks despite the concerns of feelings of anxiety and depression as well as sleep disturbances. She meets the seventh criterion since she has not been successful at reducing her drinking even after getting into conflicts with her parents. Despite the conflicts and disagreements with the parents, she has not stopped drinking which makes her to meet the eighth criterion. Her symptoms of anxiety and depression can be linked to the excessive use of alcohol which makes her to meet the criteria of the chosen primary diagnosis.
Alcoholism is a common problem affecting most people in the U.S and across the globe. Data from the National Institute on Alcohol Abuse and Alcoholism show that in 2019, 85.6% of people aged 18 years and above confessed to have taken alcohol at some point in their life. Further, 25.8% of the people stated that they had engaged in binge drinking in the past one month. Binge drinking here refers to a pattern of drinking that increases the blood alcohol content to 0.08 g/dL or higher. 6.3% of the people interviewed confessed to have engaged in heavy drinking in the past 1 month (National Institute on Alcohol Abuse and Alcoholism, 2020) . In this case, heavy drinking means drinking more than 4 drinks per day for men and 3 drinks per day for women. It is estimated that 95000 people die annually from alcoholism.
Alcoholism has far reaching consequences for an individual and for the society at large. Importantly, alcohol consumption affects the ability of an individual to function optimally at work, at school and socially. Alcoholics are known to miss work after a night of heavy drinking. In addition, going to work while intoxicated affects productivity because concentration and coordination is lost. At school, alcoholism affects class attendance and impaired concentration affects the ability of the individual to comprehend content. In addition, drunkards get involved in fights with other students and can be expelled from school. At a personal level, alcohol impairs the ability to relate with others in a civil way and this affects interpersonal relationships. Alcoholism has a number of health complications (comorbidities). Excess alcohol consumption causes liver cirrhosis, increases the risk of certain types of cancer, increases the blood pressure and increases the risk of heart disease (CDC, 2020) .
The differential diagnosis for Marci includes: Alcohol abuse with alcohol-induced psychotic disorder , Alcohol dependence and Alcohol dependence with withdrawal . Some of the diagnostic challenges that might be encountered in this case include language barrier, failure for the client to cooperate with the counsellor as some cultures do not allow female patients to be assessed by male practitioners and vice versa.
Secondary Diagnosis 1
Marci’s secondary diagnosis is F12.180- Cannabis abuse with cannabis-induced anxiety disorder, moderate. According to the DSM-5, for one to be diagnosed with a cannabis use disorder, one must exhibit 2 or more of the following symptoms.
Difficulty containing the use of marijuana leading to use of the drug for longer periods than intended and in large amounts
Failed efforts to stop the use of the drug
A lot of time is spent acquiring, using or recovering from the effects of marijuana
Having cravings for cannabis
Continued use of cannabis despite adverse effects from its usage such as criminal charges
The desire to use cannabis supersedes other important activities such as work, school among others
Using cannabis even in hazardous situations such as driving
Continued use despite awareness of psychological or physical problems that are attributed to the drug
Tolerance
Withdrawal symptoms (American Psychiatric Association, 2013)
Marci meets 4 of the above criteria which makes her diagnosis to be classified as moderate. She meets the second criterion because she is unable to stop the usage of marijuana despite having been arrested for possessing marijuana. She meets the 3 rd criteria because she spends a lot of time smoking marijuana when drinking with friends. She meets the fifth criteria because she still uses the drug despite being arrested for possessing the drug. She is aware that she has been experiencing depression and anxiety as well as sleep disturbance because of the drug but still uses the drug. The association of the symptoms of anxiety and marijuana use makes her to meet the criteria for her diagnosis.
Cannabis use is prevalent in the society despite it being banned in most countries. According to the CDC, 22.2 million people abuse the drug per month. Further, 1 out of every 10 people who abuse the drug are likely to get addicted. According to the National Institute on Drug Abuse, in 2011, there were 456000 medical emergencies in which marijuana was implicated (National Institute on Drug Abuse, 2020) .
The excessive use of marijuana affects the functioning of individuals who abuse the drug in many ways. At work, marijuana work makes individuals less productive because of impaired thinking and judgement. Further, excessive marijuana use might lead to bizarre behavior and misconduct at the work place which might get one fired. This might occur when one starts experiencing hallucinations and delusions. The same case applies to students who smoke marijuana. A lot of time is spent smoking and acquiring the drug and this leads to wastage of valuable school time. Smoking marijuana also affects the concentration level of the students which might lead to decreased academic performance. At a personal level, marijuana use might lead to strained personal relationships especially with parents who might discourage the behavior. In addition, the drug might make the abusers to engage in violent acts which affects relationships especially with spouses and might lead to increased divorce cases.
Excessive use of marijuana might lead to various comorbid conditions. For example, marijuana use has been linked to the development of mental illnesses such as schizophrenia. In addition, it can lead to increased risk of cancer of the oral cavity, the esophagus and lungs ("Adverse health effects of marijuana use," 2014) . It also leads to development of hypertension and heart diseases as well as COPD.
The differential diagnosis of Cannabis abuse with cannabis-induced anxiety disorder, moderate include Cannabis abuse with intoxication uncomplicated, Cannabis dependence uncomplicated and Cannabis abuse with psychotic disorder with delusions. Some of the diagnostic challenges that might be encountered in this case include language barrier, failure for the client to cooperate with the counsellor as some cultures do not allow female patients to be assessed by male practitioners and vice versa.
Secondary Diagnosis 2
The tertiary diagnosis of the patient is F17.200 Nicotine dependence, unspecified, uncomplicated , mild. According to DSM-5, the diagnosis of nicotine use disorder is made in a person with 2 or more of the following symptoms:
Takes tobacco in large amounts and for longer periods than intended
Unsuccessful efforts at cutting down the usage of tobacco
A lot of time is spent in activities aimed at acquiring or using tobacco
Having cravings for tobacco
Continued use of tobacco despite social problems related to tobacco usage
Tobacco use resulting in inability to fulfill major obligations at work at school or at home
Important activities are given up for tobacco usage
Recurrent usage of tobacco even in situations where it is hazardous
Continued use of tobacco even in situations where one is aware of the physical or psychological impairments that can result from tobacco use
Tolerance
Withdrawal (American Psychiatric Association, 2013)
From the case narrative, Marci meets 2 criteria for the disorder which qualifies the diagnosis as mild. The first criteria is met as she consumers tobacco in large amounts. As per the narrative, she smokes a pack a day which is quite a large amount. She also meets the second criteria as she had stopped smoking about 6 months ago but she is not back at it.
Excessive tobacco use affects the abusers in various ways. First, a lot of money is spent buying cigarettes at the expense of other more important activities. This might lead to financial struggles back at home and constant disagreements with the spouse which might lead to increased cases of divorce. In addition, cigarette smoking leads to deteriorating oral health and can lead to halitosis. This might affect the interaction between the smoker and other people especially the spouse. At work, an individual might spend a lot of time smoking instead of working and this might lead to confrontations with the management. The same case applies to students. A lot of time is wasted smoking and this might affect the amount of time spent studying. In addition, students might use their pocket money to purchase tobacco products at the expense of vital resources such as textbooks. This might affect their performance at school eventually.
According to the CDC, in 2019, 14% of adults aged 18 years and above reported to be smokers. This translates to about 34.1 million adults. In U.S, smoking is attributable to about 480, 000 deaths annually. This represents a prevalence of 1 out of every 5 deaths (CDC, 2020) . There are various comorbidities that are linked to tobacco use. Some of these include: increased risk of lung cancer, it has also been linked to the development of heart diseases, stroke, diabetes, COPD and arthritis (West, 2017) .
Differential diagnosis for Nicotine dependence, unspecified, uncomplicated , mild include: Nicotine dependence, cigarettes, with withdrawal, Nicotine dependence cigarettes, in remission and Nicotine dependence, other tobacco product, with other nicotine-induced disorders. Some of the diagnostic challenges that might be encountered in this case include language barrier, failure for the client to cooperate with the counsellor as some cultures do not allow female patients to be assessed by male practitioners and vice versa.
References
Adverse health effects of marijuana use. (2014). New England Journal of Medicine , 371 (9), 878-879. https://doi.org/10.1056/nejmc1407928
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (DSM-5®) . American Psychiatric Pub.
CDC. (2020, February 20). Current cigarette smoking among adults in the United States . Centers for Disease Control and Prevention. https://www.cdc.gov/tobacco/data_statistics/fact_sheets/adult_data/cig_smoking/index.htm
CDC. (2020, July 30). Drinking too much alcohol can harm your health. Learn the facts | CDC . Centers for Disease Control and Prevention. https://www.cdc.gov/alcohol/fact-sheets/alcohol-use.htm
National Institute on Alcohol Abuse and Alcoholism. (2020, February 18). Alcohol facts and statistics . National Institute on Alcohol Abuse and Alcoholism (NIAAA). https://www.niaaa.nih.gov/publications/brochures-and-fact-sheets/alcohol-facts-and-statistics
National Institute on Drug Abuse. (2020, April 8). What is the scope of marijuana use in the United States? https://www.drugabuse.gov/publications/research-reports/marijuana/what-scope-marijuana-use-in-united-states
West, R. (2017). Tobacco smoking: Health impact, prevalence, correlates and interventions. Psychology & Health , 32 (8), 1018-1036. https://doi.org/10.1080/08870446.2017.1325890
