Substance Disorders And Alcohol-Related Disorders

Of The Substance Disorders Alcohol Related Disorders Are The Most Pre

Of the substance disorders, alcohol-related disorders are the most prevalent even though only a small percentage of individuals actually receive help. Recidivism in the substance treatment world is also very high. As research into treatment has developed, more and more evidence shows that genes for alcohol-metabolizing enzymes can vary by genetic inheritance. Women have been identified as particularly vulnerable to the impacts of alcohol. Native Americans, Asians, and some Hispanic and Celtic cultures also have increased vulnerability to alcohol misuse.

Despite these developments, treatment continues to spark debate. For many years, the substance use field itself has disagreed with mental health experts as to what treatments are the most effective for substance use disorders and how to improve outcomes. The debate is often over medication-assisted treatment (MAT) versus abstinence-based treatment (ABT). Recently, the American Psychiatric Association has issued guidelines to help clinicians consider integrated solutions for those suffering with these disorders. In this context, addressing a client with a substance use disorder involves careful assessment, diagnosis, and tailored intervention considering cultural and individual factors.

Paper For Above instruction

The case presents a client suspected of having a substance use disorder, specifically related to alcohol. This paper will diagnose the client using DSM-5 criteria, explain the diagnosis, propose assessment tools, clarify the diagnosis to the client, discuss engagement strategies, initial treatment recommendations, and relevant resources tailored to the client’s cultural background.

Diagnosis: Based on the case details, the client most likely meets criteria for Alcohol Use Disorder (AUD). According to DSM-5 (American Psychiatric Association, 2013), AUD is characterized by a problematic pattern of alcohol use leading to significant impairment or distress, as evidenced by at least two of eleven criteria within a 12-month period. These include consuming alcohol in larger amounts or over longer periods than intended, unsuccessful efforts to cut down, persistent desire or cravings, and continued use despite social, occupational, or health problems. Severity is classified as mild (2-3 symptoms), moderate (4-5), or severe (6 or more).

Assuming the client exhibits symptoms such as cravings, unsuccessful attempts to quit, and continued drinking despite adverse health effects, the diagnosis would be "Alcohol Use Disorder, moderate severity." The ICD-10-CM code for this diagnosis is F10.20. Additional Z codes, such as Z63.0 (family history of substance misuse) or Z91.12 (personal history of alcohol misuse), may be relevant if applicable.

Matching Symptoms to Criteria: Symptoms such as craving, inability to control drinking, and health consequences directly align with DSM-5 criteria. For instance, if the client reports unsuccessful attempts at abstinence and spends considerable time obtaining or recovering from alcohol use, these meet the relevant criteria. Furthermore, acknowledging cultural susceptibilities—such as increased vulnerability among Native Americans, Asians, and some Hispanic populations—helps contextualize their disorder (Gowin et al., 2017).

Assessment Strategies: Validating the diagnosis involves structured tools such as the Alcohol Use Disorders Identification Test (AUDIT) and the DSM-5 Self-Rated Level 1 Cross-Cutting Symptom Measure. These assessments evaluate severity, patterns, and consequences of alcohol use. Clinician-administered interviews like the Structured Clinical Interview for DSM-5 (SCID) ensure diagnostic accuracy. Tracking progress over time can be achieved by repeated administrations of AUDIT or tracking biomarkers such as gamma-glutamyl transferase (GGT) levels and carbohydrate-deficient transferrin (CDT).

Explaining the Diagnosis: When discussing the diagnosis with the client, it is essential to use clear, empathetic language. Explaining that the disorder involves a pattern of problematic alcohol use that affects their health, relationships, and daily life helps demystify the condition. Emphasizing that AUD is a recognized medical condition with effective treatments encourages hope and engagement. Clarifying that genetics and cultural factors influence vulnerability fosters understanding and reduces stigma.

Engagement and Cultural Considerations: Engaging the client involves establishing rapport, validating their experiences, and exploring their readiness for change. Considering cultural factors—such as beliefs about alcohol, family influences, and community attitudes—is crucial. For example, Native American populations may have unique historical and cultural relationships with alcohol, necessitating culturally sensitive approaches (Reus et al., 2018). Incorporating culturally appropriate interventions, such as involving family or community supports, enhances treatment engagement.

Treatment Recommendations: Initial treatment should involve a comprehensive assessment leading to a personalized plan. Given the evidence, Medication-Assisted Treatment (MAT)—including naltrexone or acamprosate—can reduce cravings and support abstinence. Combining MAT with behavioral therapies like Cognitive-Behavioral Therapy (CBT) and Motivational Enhancement Therapy (MET) improves outcomes (Reus et al., 2018). For some clients, abstinence-based approaches or 12-step programs like Alcoholics Anonymous (AA) may complement pharmacotherapy. The choice depends on the client’s preferences, severity, and cultural background.

Resources and Referrals: Relevant resources include addiction treatment centers offering MAT, culturally tailored support groups (e.g., Native American recovery programs), and outpatient therapy services. Referrals to culturally competent counselors, community organizations, and peer support networks can provide ongoing support. For clients from specific ethnic backgrounds, involving community leaders or spiritual advisors may enhance engagement. Additionally, addressing co-occurring mental health issues, such as depression or anxiety, through integrated care improves overall outcomes.

References

  • American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author.
  • Gowin, J. L., Sloan, M. E., Stangl, B. L., Vatsalya, V., & Ramchandani, V. A. (2017). Vulnerability for alcohol use disorder and rate of alcohol consumption. American Journal of Psychiatry, 174(11), 1094–1101. https://doi.org/10.1176/appi.ajp.2017
  • Reus, V. I., Fochtmann, L. J., Bukstein, O., Eyler, A. E., Hilty, D. M., Horvitz-Lennon, M., ... Hong, S.-H. (2018). The American Psychiatric Association practice guideline for the pharmacological treatment of patients with alcohol use disorder. American Journal of Psychiatry, 175(1), 86–90. https://doi.org/10.1176/appi.ajp.2017
  • Morrison, J. (2014). Diagnosis made easier (2nd ed.). Guilford Press.
  • Stock, A.-K. (2017). Barking up the wrong tree: Why and how we may need to revise alcohol addiction therapy. Frontiers in Psychology, 8, 1–6. https://doi.org/10.3389/fpsyg.2017.00884
  • World Health Organization. (2018). Global status report on alcohol and health. WHO Press.
  • Lee, A. M., & Dietrich, A. (2018). Cultural influences on alcohol consumption. Alcohol Research: Current Reviews, 39(2), 125–132.
  • Hingson, R., Zha, W., & White, A. (2017). Drinking beyond the binge threshold: Effects on health outcomes. Epidemiologic Reviews, 39(1), 71–85.
  • Johnson, B. A., & Roache, J. D. (2017). Pharmacotherapies for alcohol use disorder. Alcohol Research: Current Reviews, 39(1), 17–24.
  • O’Malley, S. S., & Froelich, C. (2018). Medications for the treatment of alcohol use disorder. New England Journal of Medicine, 378(2), 184–185.

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