### 1. Presenting Problems/Issues
Jax presents with several critical issues related to her alcohol use:
– **Increased Alcohol Consumption:** Jax reports drinking a six-pack of beer daily, an increase over the past year.
– **Tolerance Development:** She mentions that this amount no longer gives her the same “buzz,” indicating tolerance.
– **Behavioral Changes:** Jax becomes argumentative and irritable while intoxicated and does not remember these incidents, which points to alcohol-induced blackouts.
– **Physical Harm:** She has fallen twice while intoxicated, causing bruises and a head injury.
**Missing Information for Diagnosis:**
To formulate a comprehensive diagnosis, additional information is necessary:
– **Medical History:** Detailed past medical history, including any previous substance use, other health issues, and current medications.
– **Family History:** Information about any family history of substance use disorders or mental health issues.
– **Psychosocial Factors:** Details on Jax’s social environment, stressors, and coping mechanisms.
– **Detailed Drinking History:** Specific patterns of alcohol use, including age of onset, frequency, and context of drinking.
– **Functional Impairment:** Impact on daily functioning, relationships, and responsibilities.
– **Mental Health Symptoms:** Any symptoms of depression, anxiety, or other mental health conditions.
### 2. Primary and Differential Diagnosis
**Primary Diagnosis:**
– **Alcohol Use Disorder, Moderate (DSM-5: 303.90, ICD-10: F10.20)**: Jax meets the criteria for Alcohol Use Disorder due to increased tolerance, persistent desire or unsuccessful efforts to cut down, and continued use despite interpersonal problems and physical harm.
**Differential Diagnoses:**
– **Major Depressive Disorder (MDD) (DSM-5: 296.22, ICD-10: F32.1)**: While Jax does not report a history of depression, mood changes related to alcohol use, such as irritability and argumentativeness, could mask underlying depressive symptoms.
– **Generalized Anxiety Disorder (GAD) (DSM-5: 300.02, ICD-10: F41.1)**: Although there is no history of anxiety, the stress from increased alcohol use and its effects on her life might contribute to anxiety symptoms.
– **Substance-Induced Mood Disorder (DSM-5: 291.89, ICD-10: F10.8)**: The mood changes (irritability) while intoxicated suggest a possible substance-induced mood disorder.
### 3. Physiological and Psychological Processes Leading to Substance Dependence
**Physiological Processes:**
– **Neuroadaptation:** Chronic alcohol use leads to neuroadaptation in the brain, particularly affecting neurotransmitter systems like GABA and glutamate. Over time, the brain becomes reliant on alcohol to maintain neurochemical balance, leading to tolerance and dependence.
– **Reward System Activation:** Alcohol activates the brain’s reward system, releasing dopamine and creating feelings of pleasure. Repeated activation reinforces drinking behavior, making it difficult to quit.
– **Withdrawal Symptoms:** Despite Jax not experiencing noticeable withdrawal symptoms, chronic alcohol use often leads to a withdrawal syndrome when alcohol is not consumed, perpetuating continued use to avoid discomfort.
**Psychological Processes:**
– **Behavioral Conditioning:** Drinking behavior becomes conditioned through repeated pairing with certain environments, social contexts, or emotional states, making it a habitual response.
– **Coping Mechanism:** Jax might use alcohol as a coping mechanism to deal with stress, boredom, or other negative emotions, especially post-retirement.
– **Cognitive Distortions:** Beliefs such as “I need alcohol to relax” or underestimating the severity of alcohol-related problems can maintain drinking behavior.
– **Social and Interpersonal Factors:** Social acceptance of drinking, peer pressure, and marital dynamics can influence Jax’s drinking habits.
### Conclusion
Jax’s case highlights the complexity of diagnosing and treating alcohol use disorders. A thorough assessment considering her medical, psychological, and social history is crucial for accurate diagnosis and effective treatment. Integrating evidence-based interventions, such as cognitive-behavioral therapy (CBT), motivational interviewing (MI), and possibly pharmacotherapy, can help Jax reduce her alcohol use and improve her overall well-being.
### References
American Psychiatric Association. (2013). *Diagnostic and statistical manual of mental disorders* (5th ed.). American Psychiatric Publishing.
National Institute on Alcohol Abuse and Alcoholism. (2018). *Alcohol use disorder: A comparison between DSM-IV and DSM-5*. Retrieved from https://www.niaaa.nih.gov/alcohol-use-disorder-comparison-dsm
World Health Organization. (2019). *International Classification of Diseases for Mortality and Morbidity Statistics* (11th Revision). Retrieved from https://icd.who.int/en
Case Study: Jax
Purpose:
Analyze and apply critical thinking skills in the psychopathology of mental health
patients and provide treatment and health promotion while applying evidence-based
research.
Scenario:
Jax is a 66-year-old Caucasian female whose wife has encouraged her to seek treatment.
She has never been in therapy before, and has no history of depression or anxiety.
However, her alcohol use has recently been getting in the way of her marriage, and
interfering with her newly-retired life. She describes drinking increasing amounts over
the last year, currently consuming approximately a six-pack of beer per day. She notes
that this amount “doesn’t give me the same buzz as it used to.” She denies ever
experiencing “the shakes” or any other withdrawal symptoms if she skips a day of drinking.
Jax comments that her wife is her biggest motivation to decrease her alcohol use.
She tells Jax that she gets argumentative and irritable when she drinks, though she does
not always remember these incidents. She has also fallen while intoxicated twice, causing
bruises both times and hitting her head on one of the occasions.
Questions:
Remember to answer these questions from your textbooks and NP guidelines.
At all times, explain your answers.
1. Describe the presenting problems/issues. Is there any information that
was not provided that you would need to formulate a diagnosis?
2. Generate a primary and differential diagnosis using the DSM5 and ICD
10 codes.
3. What physiological and psychological processes lead to substance
dependence?
Submission Instructions:
· Your initial post should be at least 500 words, formatted and cited in current APA style with support from at least 3 academic sources.
· Due Wednesday July 31
The post Comprehensive Analysis and Diagnosis of Alcohol Use Disorder in a Retired Woman: A Case Study of Jax appeared first on Destiny Papers.
