Alcoholism Clinical Presentation
Chief Complain: “I have been craving alcohol, and all efforts to control or cut down alcohol use have been unsuccessful.”
History of the Presented Illnesses: The client T.J, is a 17yo Caucasian male accompanied by his mother to the psychiatric clinic. His mother complains of excessive consumption of alcohol for the past nine months, affecting the client’s studies, work, and social life. She also reports that the client can no longer participate in managing the family business, something he did before he started drinking excessively. T. J adds that all his efforts to reduce or stop taking alcohol have been unsuccessful. Instead, he experiences a persistent desire to take more alcohol. The client reports spending most of his time at the casino gambling and hoping to get some money to buy alcohol. The mother adds that sometimes the client has persistently low or depressed mood, especially when he has not taken alcohol. The client continues to use alcohol despite having persistent interpersonal problems with his father due to excessive alcohol intake. Since he was 10yo, the client has consistently emerged as the best on the local hockey team. However, he no longer plays hockey, claiming he would not get enough time to go to the casino; hence would lack money to buy alcohol. The client continued to drink alcohol even if his counselor educated him on the dangers of excessive alcohol consumption. The mother expresses her concern for his reckless driving when drunk. However, the client denies suicidal thoughts or ideation. He also denies visual or audio hallucination.
Past Psychiatric History: The client denies a past psychiatric diagnosis.
Psychotherapy: The client was referred to a counselor three months ago following excessive alcohol intake.
Substance Current Use and History: The client reveals a current history of alcohol abuse.
Family Psychiatric/Substance Use History: His elder brother was diagnosed with substance use disorder at the age of 23 years.
Psychosocial History: The client has been taking excess alcohol for the past nine months, adversely affecting his education, work, and social life. His efforts to reduce or stop using alcohol have not been successful. He craves alcohol and spends most of his time gambling to get money to buy alcohol.
Medical History: The client has no history of any medical condition.
- Current Medications: No current medication
- Allergies: No known allergies.
- GENERAL: The client denies fatigue, weakness, or fever.
- HEENT: He denies any injuries to the head. He dies of vision loss. He dies from difficult hearing. He denies bleeding gum or mouth ulcers. He denies having a sore throat.
- SKIN: Denies itching or cracking.
- CARDIOVASCULAR: Denies chest tightness or pressure.
- RESPIRATORY: Denies shortness of breath, coughing, or sputum production.
- GASTROINTESTINAL: Denies constipation, nausea, or vomiting.
- GENITOURINARY: Denies blood in the urine or frequent urination.
- NEUROLOGICAL: Denies dizziness, weakness, or numbness.
- MUSCULOSKELETAL: Denies back, jaw, or back pain. Denies muscle stiffness.
- HEMATOLOGIC: Denies anemia.
- LYMPHATICS: Denies swollen lymph nodes.
- ENDOCRINOLOGIC: Denies change in appetite.
- PSYCH: Denies suicidal ideations or thoughts. Denies visual or audio hallucinations. Reports excessive alcohol intake. The client reveals that he craves alcohol, and his efforts to cut alcohol intake or quit have been unsuccessful.
Vitals: Temp-97.1*F, B/P 119/78-, HR-98 with regular rate, RR-19, Pulse Ox-97%, Weight 145lb, and height 68.8”
General: The client is a 17yo Caucasian male accompanied by his mother to the clinic. He is well-developed and appropriately dressed for today’s weather and time of the year. However, his hair is untidy and not well maintained. Although he answers most interview questions correctly, he does not look relaxed throughout the interview. He is fond of interrupting his mother while speaking. His self-reported mood is “sad.” He appears in cute distress. He is alert and oriented to place, person, time, and situation. He has normal speech and tone. He denies suicidal thoughts or visual hallucinations. He does not seem to be future-oriented.
Head: No trauma evidence on his head. The eyes have equally round pupils that react to light. The ears have no drainage. The nose has no external lesions. No maxillary or frontal sinus tenderness. Throat has no gum ulcers. No bleeding gums. No visible tonsils.
Neck: Neck and shoulders demonstrate full motion.
CV: Normal S1 and S2 present. Murmurs, rubs, or gallops are not heard.
Lungs: Chest has no tender walls. Lungs are clear to auscultation.
ABD: Soft, non-tender, and large abdomen with no masses.
MSK: Normal motor strength and tone.
Neuro: Strong and equal bilateral hand grip.
Psych: Alert and oriented. Sad mood noted.
Alcohol use screening tests: Positive
Carbohydrate-Deficient Transferrin: Positive
The following are the potential diagnosis for this client, starting from the most likely to the least likely diagnosis.
- Alcohol Use Disorder (AUD ) – Primary diagnosis
- Major Depressive Disorder (MDD)
- Antisocial Personality Disorder
- Bipolar Disorder
Alcohol Use Disorder (AUD)
Alcohol use disorder is the primary diagnosis for this client. This condition is characterized by various symptoms, including being unable to control the amount of alcohol consumed; being unable to cut down the amount of alcohol consumed; spending most of the time obtaining alcohol, drinking alcohol, or recovering from using alcohol; experiencing a strong urge to drink alcohol; failing to fulfill one’s duties at school, work, or home; continuing drinking alcohol despite knowing its causing relationship problems; developing tolerance to alcohol; using alcohol in unsafe environments; forgoing work and social activities and hobbies to take alcohol; and experiencing withdrawal symptoms, including shaking, nausea, and sweating Ben (El Jilali et al., 2019). The client depicts most of these symptoms. Upon coming to the clinic, his mother complains of excessive consumption of alcohol for the past nine months, affecting the client’s studies, work, and social life. Secondly, all the efforts to reduce or stop taking alcohol have been unsuccessful. Instead, the client experiences a persistent desire to take more alcohol. The client reports spending most of his time at the casino gambling and hoping to get some money to buy alcohol. He also continues to use alcohol despite having persistent interpersonal problems with his father due to his excessive alcohol intake. Furthermore, the client is no longer interested in playing hockey. Lastly, he continues to drink alcohol even if his counselor informed him about the dangers of excessive alcohol consumption. According to DSMIV, a person is diagnosed with alcohol use disorder if he has been drinking excessively for the last 30 days (Knox et al., 2019). In addition to the presented symptoms, he tested positive for alcohol use screening tests and the Carbohydrate-Deficient Transferrin test. Therefore, alcohol use disorder qualifies as the primary diagnosis for this client.
Major Depressive Disorder (MDD)
The second potential diagnosis for this client is MDD. A persistent sadness characterizes this mood disorder; loss of interest in activities one used to like; changes in appetite, sleep, and energy level; lack of concentration, reduced self-esteem, and suicidal thoughts (World Health Organization, 2017). Clients with MDD also report persistently depressed moods (Schramm et al., 2020). The client qualifies for this diagnosis since he reports a lack of interest in activities he used to like, including participating in managing the family business and playing hockey. Additionally, the client qualifies for MDD diagnosis since the mother reports experiencing persistently low or depressed moods. However, major depressive disorder is ruled out due to the absence of significant symptoms, including changes in appetite, sleep, and energy level, lack of concentration, reduced self-esteem, and suicidal thoughts.
Antisocial Personality Disorder
An antisocial personality disorder is also a potential diagnosis for this client. This condition is characterized by various symptoms, including breaking the law repeatedly, being deceitful, being impulsive, being irritable and aggressive, having a reckless disregard for one’s safety or the safety of others, lack of remorse, or being consistently irresponsible. The client qualifies for this diagnosis since he drinks excessively, hence, being consistently irresponsible. Additionally, the client drives recklessly when drunk, disregarding his safety. However, an antisocial personality disorder is ruled out due to the absence of significant symptoms, including breaking the law repeatedly, being deceitful, being impulsive, and being irritable and aggressive.
This is the last potential diagnosis for this client. This disorder is characterized by extreme mood swings (Baldessarini et al., 2020). People with bipolar disorder experience highs (mania) to extreme lows (depression). The client might have this disorder since he experiences low persistently low or depressed mood. Nonetheless, bipolar disorder is ruled out since the client did not report intense changes in mood, which is a significant feature of this mood disorder.
This client’s treatment for AUD aims to achieve three goals, including reducing alcohol intake, managing symptoms, and improving health and functioning. The treatment plan consists of pharmacological and non-pharmacological interventions. The medication treatment involves administering naltrexone 50mg orally daily. Naltrexone is preferred since it is FDA-approved for treating patients with alcohol use disorder (Ray et al., 2019). Additionally, naltrexone has effectively reduced heavy drinking days and promoted abstinence in individuals diagnosed with AUD (Witkiewitz et al., 2019). Naltrexone also manages alcohol cravings in people with UAD with no side effects. Thus, naltrexone is an effective and safe medication for managing presented symptoms. On the other hand, psychotherapy is a recommendable non-medication treatment for managing AUD symptoms in this client. Specifically, cognitive behavior therapy (CBT) would improve the client’s symptoms. According to Karsberg et al. (2021), CBT gives superior results when used in individuals diagnosed with AUD. This treatment intervention targets relationships among thoughts, behaviors, and feelings to help an individual to manage alcohol cravings and triggers (Zamboni et al., 2021). This therapy can also address co-occurring mental health conditions such as anxiety or depression. Ray et al. (2020) reported that combining pharmacotherapy and cognitive behavioral therapy in treating individuals with substance or alcohol use disorders gives superior results. Therefore, combining naltrexone 50mg orally daily and CBT would effectively manage presented symptoms.
Health Promotion and Patient Education
Patient education and health promotion are significant aspects of treatment for people with AUD. Health promotion aims at enhancing individuals’ control over their health to improve their overall health status. On the other hand, patient education aims at creating awareness to empower individuals to improve their health. Thus, in treating the client who has been diagnosed with UAD, Patient education would create awareness regarding the dangers of excessive alcohol consumption on the client’s health and overall well-being. Educating the client would empower him, enabling him to control his drinking and improve his overall health.
- What are the most effective interventions for managing the client’s AUD symptoms?
- Does combining pharmacotherapy and cognitive behavioral therapy in treating teenagers with alcohol use disorders gives superior results?
The selected article titled “Prevention, screening, and treatment for heavy drinking and alcohol use disorder” was authored by Knox et al. (2019). The article evaluates strategies for preventing, screening, and treating alcohol use disorder. The article presents alcohol use disorder (AUD) and heavy drinking as significant global public health concerns. This article has several strengths. First, the authors have provided statistics to support a dramatic increase in the prevalence of alcohol use disorders worldwide. Secondly, the authors have included search criteria used to obtain articles, which were reviewed during the analysis. Including the search process indicates the eligibility of sources used in the review. Furthermore, the article has captured alcohol prevention interventions, including school-based alcohol prevention interventions, providing solutions to the increasing alcohol abuse. Additionally, the article has included screening interventions, including the AUDIT-C and a single question. Screening tools allow early interventions, preventing people at high risk from developing alcohol use disorder. Moreover, the article has proposed effective interventions for treating AUD, including brief interventions, referral for treatment, and evidence-based behavioral interventions, which are recommendable for heavy drinkers. Thus, the article indicates the effectiveness of evidence-based interventions, including pharmacotherapy and non-pharmacological interventions, in treating this client, who is a heavy drinker. However, the article has not indicated the screening tool that is most effective in identifying AUD in teenagers. Therefore, the article does not propose an effective tool for screening the risk of AUD in the 17yo client.
Baldessarini, R. J., Vázquez, G. H., & Tondo, L. (2020). Bipolar depression: a major unsolved challenge. International journal of bipolar disorders, 8(1), 1-13. https://journalbipolardisorders.springeropen.com/articles/10.1186/s40345-019-0160-1
Ben El Jilali, L., Benazzouz, B., El Hessni, A., Ouichou, A., & Mesfioui, A. (2020). Prevalence of alcohol consumption and alcohol use disorders among middle and high school students in Khemisset, Morocco: a cross-sectional study. International Journal of Adolescence and Youth, 25(1), 638-648. https://doi.org/10.1080/02673843.2019.1700807
Karsberg, S. H., Pedersen, M. U., Hesse, M., Thylstrup, B., & Pedersen, M. M. (2021). Group versus individual treatment for substance use disorders: a study protocol for the COMDAT trial. BMC public health, 21(1), 1-9. https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-021-10271-4
Knox, J., Hasin, D. S., Larson, F. R., & Kranzler, H. R. (2019). Prevention, screening, and treatment for heavy drinking and alcohol use disorder. The Lancet Psychiatry, 6(12), 1054-1067.
Ray, L. A., Bujarski, S., Grodin, E., Hartwell, E., Green, R., Venegas, A., … & Miotto, K. (2019). State-of-the-art behavioral and pharmacological treatments for alcohol use disorder. The American journal of drug and alcohol abuse, 45(2), 124-140.
Ray, L. A., Meredith, L. R., Kiluk, B. D., Walthers, J., Carroll, K. M., & Magill, M. (2020). Combined pharmacotherapy and cognitive behavioral therapy for adults with alcohol or substance use disorders: a systematic review and meta-analysis. JAMA network open, 3(6), e208279-e208279.
Schramm, E., Klein, D. N., Elsaesser, M., Furukawa, T. A., & Domschke, K. (2020). Review of dysthymia and persistent depressive disorder: history, correlates, and clinical implications. The Lancet Psychiatry, 7(9), 801-812.
Witkiewitz, K., Litten, R. Z., & Leggio, L. (2019). Advances in the science and treatment of alcohol use disorder. Science advances, 5(9), eaax4043. Doi:10.1001/jama.2020.2012.
World Health Organization. (2017). Depression and Other Common Mental Disorders: Global Health Estimates. World Health Organization. https://apps.who.int/iris/bitstream/handle/10665/254610/WHO-MSD-MER-2017.2-eng.pdf.
Zamboni, L., Centoni, F., Fusina, F., Mantovani, E., Rubino, F., Lugoboni, F., & Federico, A. (2021). The effectiveness of cognitive behavioral therapy techniques for treating substance use disorders: A narrative review of evidence. The Journal of Nervous and Mental Disease, 209(11), 835-845.
This case study presentation will be strictly written on a 17 year-old male with alcohol use disorder.
This is a master’s degree paper and should be written by professional PMHNP paper writer.