DSM-IV-TR Criteria for Testing Substance Abuse Disorder - Report Example

Response to a Case Scenario Name: Institution: DSM-IV-TR Criteria for Testing Substance Abuse Disorder DSM-IV-TR diagnostic schema is based on clusters of behaviors and physiological effects occurring within a specific period. Carol meets criteria B of DSM-IV-TR for substance dependence exhibited through maladaptive pattern of drinking culminating into significant distress. The distress caused by drinking manifested through the following acts that have occurred within a period of twelve months. From the definitive diagnosis of substance abuse as per the case study, Carol displays alcohol tolerance through the need for increased amounts of alcohol to achieve significant intoxication. She has also depicted a withdrawal symptom as manifested through the use of cannabis and drinking as the sole way of relaxing her mind as well as forgetting her past. Furthermore, according to Girlo, Becker, Anez & McGlashan (2010), a person diagnosed with substance dependence often uses alcohol in larger amounts or over a longer period than was intended. This is witnessed from Carol’s case where she changes from occasional drinking to daily excessive drinking. The Prevalence of Cannabis Use in AUSTRALIA Cannabis remains the most widely and readily available used illicit drug in Australia. According to the previous National Drug Strategy Household Survey (NDSHS), approximately one-third of Australians have tried cannabis, and about one in every ten have used it in the past year (Australian Institute of Health and Welfare [AIHW], 2008). However, the prevalence of cannabis use has declined in the Australian population since the late 1990s. Despite the decline, heavy patterns of cannabis use are prevalent among 14-19-year-olds while daily use is prevalent among 20-29-year-olds (AIHW, 2008). The NDSHS carried out an investigation in 2004-2005, and 2007, which revealed high rate of cannabis use by unemployed Australian males than females. Possible Causes The motives behind cannabis use among the Australians revolve around enhancement of body activity and the perceived improvement of social relations. Australian students are motivated to use cannabis by the notion that it would increase knowledge, critical evaluation of information and resolve circumvent related to decision making (Roxburgh et al., 2010). In addition, cannabis use has been linked with the urge to cope with the negative mental state among the depressed. Moreover, the use of the drug is associated with the reduction of dysphoria, boredom, and psychotic symptoms. Hospital Rates and Burden of Disease Related to Cannabis Use in Australia Hospitalization rates associated with cannabis use have been relatively high among the Australians. For example, there were 8,389 hospital separations in Australia between 2005 and 2006 with cannabis having the highest percentage (Roxburgh et al., 2010). Between July 2002 to June 2004, 284 Australians were hospitalized with mental disorders caused by precursor effects of the use of cannabis (Roxburgh et al., 2010). Women aged 15-19, and 20-24 years had the highest drug-related hospital separation rates among all the age groups in 2005-2006. The burden of diseases associated with drug use in Australia between 2004 and 2005 was estimated to be $56.1 billion, in which 15 percent ($8.1 billion) related to cost of illicit drug, with cannabis being the highest contributor (AIHW, 2007). Possible Causes as Per the Case Study People result into drug abuse because of different motivations. The unemployment status of Carol features as a possible cause of her condition. An environment inhabited by unemployed youths exacerbates the risk of the residents falling for antisocial tendencies such as substance abuse. According to the AIHW (2008), illicit drug, use is common in Australia among the unemployed people and school dropouts. Therefore, the patient’s claim over unemployment as the main drive gets substantial backing from the AIHW findings. Another possible cause revolves around the issue of family breakdown in which family functioning and resilience serve as a protective factor while family stressors form risk factors towards drug abuse. As implied throughout the bad company often contributes towards spread of unwanted behavior especially drug abuse. Carol claims that she smokes cannabis because her friends do it, thereby using her friends’ behavior to justify her behavior. In the Australian population, peer pressure forms the second most common factor driving first users of drugs after curiosity (Pennay, Lubman & Maclean, 2011). Peer pressure influence is likely to be stronger among those encountering stressful home life. It is evident from the extract that Carol lived a stressful life during her young age characterized by constant quarrels between the parents. Carol also lived in fear, which was occasioned by yelling from her parents. These causes are supported by Carol’s assertion that the smoke and drink brings relaxation and makes her forget her bitter past. Thus, her increased alcohol and cannabis intake may be associated with peer pressure and family system breakdown. The use of drug is also associated with the urge to cope with the increased negative mental state. Mental health associated problems and disorder victims have a potential of increased substance use and antisocial behaviors. According to 2004-2005 National Health survey done on mental health and risk drinking from Australians aged 18 years and above, the prevalence of high risk drinking was high among the women with high levels of psychological distress than those with moderate or lower levels of psychological distress (Australian Institute of Health and Welfare, 2007). From the case study, Carol has a high psychological distress characterized by feelings of loneliness, feelings of being down, and constant arguments with her family and ex-boyfriend. Thus, the aggregation of these factors may be possible causes of Carol’s disorder. Psychodynamic Factors Affecting Mental Health Mental health problems can stem from a combination of factors including the physiological factors and social factors. Psychological state has the potential of influencing an individual’s mental and emotional condition particularly if one is coping with traumatic or abusive past. Psychodynamic components affecting mental health constitute of conflicts between the conscious and unconscious forces in one’s mind (Lewis, Dennerstein & Gibbs, 2008). They also involve lack of important relationships with crucial people from early childhood, and destructive behaviors, which result into emotional problems or create psychological stress. From the case study, Carol’s state of mind was disturbed by her past family relationship characterized by constant quarrels between her parents and lack of parental love. This is also supported by Carols’ claim that she takes alcohol and cannabis to forget about the past. In addition, things that happen around someone, and how he or she perceives them can have a big influence on his or her mental health. For example from the case study, Carol has been experiencing psychological stress, which makes her to lose hope in life. This is evidenced by her claim that she is jobless, has no boy friend, and family, and her life is wretched. AOD/Mental Health Issues Experienced by Carol Carol is facing the following mental health issues or potential risk as depicted from the case study. i. Delirium, which is a mental disorder that makes a person lose awareness of his or her surroundings. People depicting this condition act, speak in a disorganized manner, and are easily distracted and confused. In addition, they exhibit signs of mental impairment and attention problems. ii. Schizophrenia is a serious mental condition that impairs individuals thinking, emotion, perception, and behavior. Victims also demonstrate disorganized and decreased speech, peculiar behavior, and decrease in mental abilities. In addition, they exhibit signs of psychotic illness. iii. Personality disorder or mood disorder. They involve general disturbance of persons mood, hopelessness, and worthless. The personality disorder is characterized by aggressive and harmful behavior. Relevant Nursing Interventions for the above Mental Health Issues Delirium. The first nursing intervention in delirium involves a psychotherapy intervention where the physician makes the client learn more adaptive ways of responding or behaving. Cognitive behavioral therapy focuses on teaching patients how to retain their thinking patterns, and correction of distorted thinking that contributes to troublesome emotions (Fine & Fine, 2011) Regular counseling of the victim can also treat Delirum condition by focusing on teaching skills, combined with sessions aimed at rebuilding damaged structures of thought and memory. Another intervention involves the use of antipsychotic drugs that play a great role in treating the condition especially where signs of distortions in thinking are evident on the victim. In addition, psychiatric hospitalization combined with medication may be effective intervention especially on severe cases of delirium. Schizophrenia. Schizophrenia can be treated by use of somatic therapy intervention, which involves the use of medications because the condition is caused by increased chemical imbalance in the brain. The somatic therapy has the power of bringing balancing up brain neurotransmitters (James & Adams, 2003). The mental disorder can also be treated through the administration of electroconvulsive therapy, which involves passing of an electric current through the brain. Moreover, the situation can also be dealt with through psychotherapy and rehabilitation because people in this situation have difficulties in performing ordinary life skills. Personality disorder or mood disorder. Personality disorder can be corrected through pharmacological interventions treatment based on specific target symptoms exhibited by the client. This will involve the administration of heterocyclic antidepressants and selective serotonin inhibitors to the client. In addition, psychiatric hospitalization combined with medication may be effective intervention especially on severe cases. Moreover, group and individual psychotherapy may be effective in treating the disorder (Abass, Town & Driessen, 2011). Psychotherapy helps an individual learn about his or her condition and mood, feelings, thoughts, and behavior through the facilitation of a mental health expert. In addition, the knowledge and insight gained can help the victim to learn healthy means of managing his or her symptoms. Rationale for Nursing Interventions in Treating Delirium Early detection of risk and preventive treatment may significantly reduce delirium and its effects on a victim. Psychotherapy interventions forms an effective nursing intervention for delirium treatment because of its nature in assisting the victim to realize more adaptive ways of responding to their problems, accurate interpretation of the environment, and maintain realistic orientation to the best of his or her cognitive ability. In addition, pharmacologic interventions help in reducing the amount of stimuli in client’s body, which in turn decreases the possibility of forming inaccurate sensory perceptions (Kranzler & Rosenthal, 2003). Moreover, psychiatric hospitalization intervention is appropriate because it provides a sense of security and stability in the client’s environment in cases of severe delirium by providing regular and comprehensive care by the nurse. Rationale for Nursing Interventions in Treating Schizophrenia The somatic therapy intervention on Schizophrenia is appropriate because it has the potential in restoring chemical balance in the victim’s brain. Since the condition of schizophrenia is perceived to be a combination of thought disorder, mood disorder, and anxiety disorder, its effective treatment can be achieved through the combination of antipsychotic, antidepressant, and anti-anxiety medications (Cather, 2005). In addition, the electroconvulsive therapy interventions can help the victims in reducing disturbances in their minds. Moreover, psychotherapy interventions are appropriate because they help the client in focusing on increasing awareness of unconscious thoughts and behaviors and regulation of relationships. Rationale for nursing interventions in treating personality disorder or mood disorder The pharmacological intervention is appropriate because the heterocyclic antidepressants and selective serotonin inhibitors may be useful in depressing mood, anger, irritability, and hopelessness. The antipsychotic medications help in correcting psychosis and anger problems (Kranzler & Rosenthal, 2003). In addition, the individual or group psychotherapy interventions are appropriate because they help the client in tolerating stress, regulation of emotions, and improve relationship with others especially when dialectical behavior therapy is applied. Psychiatric hospitalization intervention arises as appropriate in treating severe cases of personality disorder especially when one is in an eminent danger of harming himself or someone else. It is also appropriate since it offers a regular supportive care throughout the day. Conclusion In conclusion, this critical analysis detailed Carol’s substance abuse from epidemiological perspective and nursing care. Substance abuse, though a non predictable phenomenon, can root from a complexion of risk factors. DSM-IV-TR diagnostic schema is based on clusters of behaviors and physiological effects occurring within a specific period. Carol meets criteria B of DSM-IV-TR for substance dependence exhibited through maladaptive pattern of drinking culminating into significant distress. Carol had a disturbing past owing to family instability and bad childhood company as well. Early detection of mental conditions can feasibly salvage a patient through preventive care, pharmacological interventions and appropriate therapies. References Abass, A., Town, J., & Driessen, E.(2011).The efficacy of short- term psychodynamic psychotherapy for depressive disorders with comorbid personality disorder. Psychiatry: Interpersonal and Biological Processes, 74(1), 58-71. Australian Institute of Health and Welfare. (2007). The 2004-2005 National Drug Strategy Household Survey: Young Australians: Their health and wellbeing. Canberra, Australia: Australian Institute of Health and Welfare. Australian Institute of Health and Welfare. (2008). The 2007 National Drug Strategy Household Survey: Detailed findings. Canberra, Australia: Australian Institute of Health and Welfare. Cather, C. (2005). Functional cognitive-behavioral therapy: A brief, individual treatment for functional impairments resulting from psychotic symptoms in schizophrenia. Canadian Journal of Psychiatry. Revue Canadienne De Psychiatrie, 50 (5), 258-63. Fine, P., & Fine S. W. (2011). Psychodynamic psychiatry, psychotherapy, and community psychiatry. Journal of the American Academy of Psychoanalysis & Dynamic Psychiatry, 39(1), 93-110. Girlo, C. M., Becker, D., Anez, L., & McGlashan, T. (2010). Diagnostic efficiency of DSM- IV Criteria for Borderline Personality. Journal of Consulting and Clinical Psychology, 72(1), 126-131. James, W.H., & Adams, T. D. (2003). Adults in treatment for alcohol/other drug (AOD) problems: profiles associated with family history positive (FHP) for AOD use problems. Alcoholism treatment Quarterly, 21(3), 81-92. Kranzler, H.R., & Rosenthal, R. N. (2003). Dual diagnosis: alcoholism and co-morbid psychiatric disorders. The American Journal on Addictions / American Academy of Psychiatrists in Alcoholism and Addictions, 12, 26-40. Lewis, A. J., Dennerstein, M., & Gibbs, P. M. (2008). Short term psychodynamic psychotherapy: Review of recent process and outcome studies. The Australian and New Zealand Journal of Psychiatry, 42 (6), 445-55. Pennay, A., Lubman,D. I.,& Maclean, S.(2011). Risky drinking among young Australians -  causes, effects and implications for GPs. Australian Family Physician, 40 (8), 584-8.  Roxburgh, A., Hall, W. D., Degenhardt, L., McLaren, J., Black, E., Copeland, J., &Mattick, R.P. (2010), The epidemiology of cannabis use and cannabis-related harm in Australia 1993- 2007. Journal of Addiction (Abingdon, England), 105 (6), 1071-9. Read More