Criteria of Substance Abuse Disorder - Case Study Example

Running Title: Assessment Item 3 (Case Study Learning outcomes) Student’s Name: Instructor’s Name: Course Code and Name: University: Date Assignment is due: DSM-IV TR criteria of Sam’s Substance Abuse Disorder The DSM-IV, short form for the Fourth Edition of Diagnostic and Statistical Manual of Mental Disorders, is a new edition of diagnosis criteria developed for outpatient, inpatient, consultation, clinic, primary care and private practice applications for psychiatrists, counselors, social workers, psychologists, nurses as well as rehabilitation and occupational therapists (American Psychiatric Association, 2000). Since its launch in 1994 after over six years of research, DSM-IV has become a necessary tool for mental health specialists to collect and communicate accurate public health statistics based on three components namely, diagnostic classification, diagnostic criteria and finally descriptive text (American Psychiatric Association, 2000). These criteria can be used to diagnose Sam as having a mental disorder. His is a substance abuse disorder. In substance abuse, there is a set of disorders including, alcohol dependence, amphetamine dependence such as of stimulants, cannabis dependence, cocaine dependence, hallucinogen dependence such as of psychedelics, inhalant dependence such as of sniffing glue, opioid dependence such as of heroin, phencyclidine dependence and finally sedative dependence such as sleeping pills (Dawe et al, 2002). Sam’s dependence is of alcohol and thus his mental disorder purely alcoholism. In alcohol abuse, Sam’s addiction is apparent in that he has a noted destructive pattern not only of using alcohol consistently, but also of resulting to significant occupational (he had just been fired for poor performance), social (his wife and children have left him and he has been arrested for a violent conduct) and even medical impairment (slurred speech, poor judgment etc). As it is, Sam’s alcohol use has reached its worst levels, since he has achieved alcohol tolerance (he has admitted to increased amounts of the amount of alcohol needed to reach intoxication). Further, his conduct has increasingly gained frequent physical agitation outbursts that his wife attests of. The other indication that Sam’s has become addicted to alcohol and has an alcoholism disorder is that he now admits to taking alcohol to relieve stress for having a painful past and for having been left by his family (American Psychiatric Association, 2000). A very significant diagnosis for Sam is that he is abdicating important occupational and social activities to use alcohol, such as taking alcohol during lunch time despite the harm it wrecks in his employment. Finally, Sam has been warned by his boss and wife for many times but he continued to use alcohol, despite the knowledge of what his persistent and recurrent psychological and physical problem being worsened by the alcohol use. Epidemiology of Substance Abuse Disorder in Australia According to Ross (2007), the term epidemiology is used to refer to the estimates calculated for the number of current and lifetime users of a specific drug class as provided for by household survey results and studies, each of which must be specifically designed in a way that estimates the drug user’s population. The following graph as published by Ross (2007), gives an overview of substance abuse in Australia with an overall prevalence of each substance based on the 2004 NDS survey (National Drug and Alcohol Research Centre, 2003), of households. The graph represents both the lifetime prevalence and the preference consequent to the 12 months prior to the survey. Source: Ross (2007) According to Ross (2007), in Australia, cannabis remains the single most used illicit drug, especially gaining in usage frequency among the Aboriginal populations and Torres Strait Islanders. Meth/amphetamine follows closely second with over 9.1% of the Australian population already addicted. But as illustrated by the graph, among the non-illicit substances, it is alcoholism that has gained a worrying trend with 90.7% having used alcohol in a lifetime and a whopping 83.6% having used it recently. This is then closely followed by tobacco at 47.1% and 20.7% respectfully. Ross (2007) attributes this noted rise in substance abuse to availability of the same and increasing lifestyle stress. Hunt et al (2002) (in Meadows, Singh & Grigg, 2007), conducted a study in Australian recently to analyze effects of substance abuse on the user’s medication compliance as well as their four year outcomes. Researchers found that most Australians abusing drugs were more likely to be re-admitted in hospital after every 10 months as compared to non-users whose median re-admission was after every 37 months (Treatment Protocol Project, 2004). This therefore creates a hospital burden with an almost 400% increase consequent to drug abuse. In yet another study in Australian, Fowler et al (1998) (in Meadows, Singh & Grigg, 2007), established that substance abuse victims increased hospitalization rates by over 38% and also caused increased criminal behavior tendencies, suicide attempts and early onsets of mental illness. Ross (2007) concurs that most clinical studies as well as population surveys indicate that cannabis and alcohol are the two most abused substances by Australians with noted psychotic disorders. Fowler’s study (1998), also noted a rise in tobacco, caffeine, amphetamines and alcohol abuse in Australia (Meadows, Singh & Grigg, 2007). Causes and Psychodynamics behind the Development of Sam’s Disorder To begin with, Sam’s disorder has resulted from a behavior that he might have formed before he was addicted. He admits to consuming three or four alcoholics every night after coming back from work. While it may have been an innocent behavior at first, his body and mind became conditioned to the fact that he can only ‘feel relaxed and good’ after the drinks (Kneisl & Trigoboff, 2009). Within time, the alcohol he needed to get intoxicated or to that level of feeling ‘relaxed and good’ became more such that for two weeks now, he drinks almost a whisky bottle nightly and carries some to the office as the only guarantee of maintaining that ‘relaxed and good’ feeling. This resulted to addiction and reliance on alcohol that he could no longer control even at the risk of losing a job and his family (Barker, 2004). Secondly, Sam is a product of behavioral conditioning, owing to a psychological acceptance of his version of reality (Happell et al., 2008). He has believed that he ought to drink and that it is okay to be an alcoholic since, “I’m like dad’ and that ‘We both love alcohol’. The problem is that while he admits to have failed in his social responsibility due to drinking, he is also quick to result to self-denial when he says ‘There is nothing wrong in that” (Happell et al., 2008). In this, Sam concedes to the fact that he is doing the right thing by drinking and that it is not his fault since it is genetic predisposing (Dawe et al, 2002). The very fact that he refuses to take responsibility of his drinking problem only acerbates the problem (Happell et al., 2008; Barker, 2004). Further assessment reveals that Sam is also a product of psychological torture since his father used to do exactly what he is doing, something that made him suffer during childhood (Elder, Evans & Nizette, 2005). The father shouted and yelled at him while drunk. Again, the father was given to bashing his wife while drunk. While knowing that such conduct was wrong, the torture that Sam was subjected to in his childhood years triggers a defense mechanism in him that can only be satiated by acquiring the same conduct that kept caused his problems. By aligning his conduct to that of the father, he is trying to escape the trauma that his father’s conduct caused him (Elder, Evans & Nizette, 2005). Again, he suffered the poor relationship with a father because of alcohol, a relationship built around worry, low self-esteem, insecurity, guilt and fear. Research has shown that such children grow up to be even worse aggressors as they try to override the pain of their childhood with the exact conduct or worse, that caused their pain while growing up (Barker, 2004). Another important aspect to understand about Sam is that alcohol has become a form of escape for him (Happell et al, 2008). He uses alcohol to escape painful past, to escape the daily work stress and to escape the memories of his dysfunctional marriage. All these factors combine to increase the amount of loneliness, worthlessness, boredom, guilt, despair and hopelessness in his life, further pushing him to drunkenness, again, as a form of escape (Happell et al., 2008). Sam’s Multiple Mental Health Issues Sam is currently facing multiple mental health issues. First he is depressed about his problems. He is missing his wife and children. He feels very lonely and depressed. Secondly, Sam is entering the suicidal phase of mental illness (NSW Department of Health, 2005). He is admittedly bored with his life and even wishes that he were dead. Thirdly, Sam has lost the purpose of living, become dejected and lost the will to make anything right since he believes he can’t be any better. He admits to feeling hopeless, and despairing (Elder, Evans & Nizette, 2005). He admits to being ‘a failure and no good for anyone’ simply because he has lost a wife, his kids and a job. At this point, he is not willing to change for the better since he sees no point in such change and worse, he believes he cannot change even if he wanted to since he is ‘a failure and no good for anyone’ (Barker, 2004). Recommended Nursing Interventions There are three nursing interventions possible in Sam’s multiple mental health issues, namely curing the depression, treating the symptoms of the addiction and finally overcoming the addiction by regaining his self-esteem. First his depression needs to be treated before it gets worse (Elder, Evans & Nizette, 2005). This will require that he is placed under medications for depression (anti-depressants) for a short period of time during which time, he should undergo therapeutic sessions to help him deal with the depression (Elder, Evans & Nizette, 2005). This will eventually help him eliminate the triggers of the depressions (depressants such as being at home alone) and avoid the depression cycles once he learns to monitor their onset (NCETA, 2004). The risk here is that he might get addicted to the antidepressant medication too, moving him from one addiction to the other (Elder, Evans & Nizette, 2005). The second intervention will involve treating the medical consequences of his addiction such as slurred speech and trembling hands. There are medications available to help overcome such symptoms although they have considerable side effects (Kneisl & Trigoboff, 2009). Thirdly, Sam also needs extensive counseling so that he stops blaming his genes, his father and childhood for his drinking problem (Happell et al, 2008). Rationale for the Nursing Intervention Sam’s depression is accompanied by alcohol dependence and may be impossible to cure without medication to begin with. With medication, progress can be made on the alcoholism front, such that Sam is no longer addicted to alcohol and thus no reason to be depressed (Elder, Evans & Nizette, 2005). The medication can be stopped immediately that the addiction is overcome, to prevent a secondary addiction (Elder, Evans & Nizette, 2005). Secondly, the withdrawal symptoms that will result after abandoning alcohol consumption can be reduced in effect using medication. Given the depression status of Sam, reducing withdrawal symptoms effect will help him advance on overcoming alcoholism better than he would without them (Elder, Evans & Nizette, 2005). Finally, Sam needs to take responsibility of his problems and see himself not as a victim but as an aggressor. Accepting responsibility will help him overcome alcoholism since it will help him realize that he has control over his alcohol consumption (Happell, et al, 2008). He can therefore be able to avoid what he has control of. He also needs to learn that all is not lost. He needs to appreciate the possibility and need to change (Happell, et al, 2008). Once he realizes that he can correct his mistakes and that it is possible, then he will easily gain hope. Hope of change is enough to help him overcome the dependence on alcohol because it will have given him a purpose to live for (Happell, et al, 2008). References American Psychiatric Association (2000). Diagnostic and statistical manual of psychiatric disorders (DSM-IV TR). Washington: American Psychiatric Association.. Psychology Net (2010). Alcohol Dependence. Retrieved 9th August, 2010, from http://www.psychologynet.org/dsm/alcohol.html Barker, P. (2004). Assessment in psychiatric and mental health nursing. Cheltenham, UK: Stanley Thornes. Dawe, S., Loxton, N.J., Hides, L., Kavanagh, D.J. & Mattick, R.P. (2002). Review of diagnostic screening instruments for alcohol and other drug use and other psychiatric disorders, (Second Edition). Publications Production Unit (Public Affairs, Parliamentary and Access Branch) Psychology Net (2010). DSM-IV Diagnostic Criteria of Mental Disorders. Retrieved 9th August, 2010, from http://www.psychologynet.org/dsm.html Elder, R., Evans, K. & Nizette, D. (2005). Psychiatric and mental health nursing. Marrickville: Elsevier Australia. Happell, B., Cowin, L., Roper, C., Foster, K. & McMaster, R. (2008). Introducing mental health nursing: A Consumer-oriented approach. Crows Nest, NSW: Allen & Unwin. Kneisl, C. & Trigoboff, E. (2009). Contemporary psychiatric-mental health nursing (Second Edition). New Jersey: Prentice Hall. Meadows, G., Singh, B. & Grigg, M. (2007). Mental health in Australia: Collaborative community practice (Second Edition). South Melbourne: Oxford University Press. National Centre for Education and Training on Addiction (NCETA) Consortium (2004). Alcohol and other drugs: A handbook for health professionals. Melbourne: Australian Government Department of Health and Ageing. National Drug and Alcohol Research Centre (2003). The Treatment of alcohol problems. Canberra: Publications Production Unit. NSW Department of Health (2005). Framework for suicide risk assessment and management for NSW health staff. North Sydney: Better Health Centre- Publications Warehouse. Ross, J. (2007). Illicit drug use in Australia: Epidemiology, use patterns and associated harm. (Second Edition). Sidney: National Drug & Alcohol Research Centre. Treatment Protocol Project (2004). Management of mental disorders. Darlinghurst; NSW: World Health Organization Collaborating Centre for Evidence in Mental Health Policy. Read More