Sam is a twenty-eight-year-old man who has lately been drinking a lot. He is als

Question

Sam is a twenty-eight-year-old man who has lately been drinking a lot. He is also seeing a counselor, whom he told that his alcohol consumption has increased because he wants to regain the buzz in his life. He confessed that all his attempts to go without drinking had failed in only about four days of remaining sober. He also mentioned that when he attempted to refrain from drinking, he experienced mood swings, stomach irritation, and sleeplessness, but denied having tremors or shakes. However, Sam denied undergoing any prior treatment for alcoholism.

Sam told his counselor that he recently broke up with his girlfriend after he had two nearly fatal car accidents in the last six months. Both happened because he had been drinking heavily. However, Sam believes that their breakup was a result of his girlfriend overreacting after the accidents. Sam knows that he was a teenager when he lost his father due to alcoholism and that his uncle is facing serious medical complications due to his drinking.

Using the DSM-V criterion, what would Sam’s diagnosis be? What intensity level (i.e., mild, moderate, or severe) would he be? Be sure to explain the diagnosis fully, including the concepts of withdrawal, tolerance, physical dependence, comorbidity, and psychological dependence.

Explanation / Answer

303.90 alcohol use disorder, severe

Symptoms

1. Alcohol is taken in large amounts.

2. Tolerance : increased consumption to get the desired effect (buzz in life according to him)

3. Unsuccessful effort to cut down or control alcohol use.

4. Withdrawal symptoms : sleeplessness when refrained from alcohol use.; also psychological dependence leading to mood swings ; physical dependence symptom of stomach irritation  

5. Continued alcohol use despite interpersonal problem (break up with girl friend ;even though it is mentioned as exagerated response by his girl friend)

6. Recurrent alcohol use in situations in which it is physically hazardous. (two fatal accidents while driving under the influence of alcohol).

Six or more symptoms make the criteia for severe level.

Withdrawal : presence of a characteristic withdrawal syndrome that develops within several hours to a few days after the cessation of (or reduction in) heavy and prolonged alcohol use . The withdrawal syndrome includes two or more of the symptoms reflecting autonomic hyperactivity and anxiety , along with gastrointestinal symptoms. Withdrawal symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. The symptoms is not attributed to another medical condition and are not better explained by another mental disorder (e.g., generalized anxiety disorder), including intoxication or withdrawal from another substance .

Tolerance : 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.

Physical dependence : indicated by appearance of withdrawal symptoms when use of the substance is discontinued especially of physical nature.

Psychological dependence : dependency of the mind which leads to psychological symptoms such as craving for the subsyance, sleeplessness, mood changes & irritability, etc.

Comorbidity : presence of another diagnosable mental disorder which is not necessarily due to substance use.

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