Substance Abuse Case Study

Substance Abuse Case Study: Multi-Axial Diagnosis

Substance Abuse

Substance Abuse Case Study: DSM-V-TR Multi-Axial System Diagnosis

Substance Abuse Case Study: DSM-V-TR Multi-Axial System Diagnosis

Al (A.L.) is obviously in enough distress that his family felt the need to drag him, kicking and screaming, to the emergency room. Despite having a normal appetite, concentration, energy levels, interest, and sleep patterns, the alcohol abuse, deep despondency, and acute family concern suggest that this behavior is abnormal for Al and the family as a whole. This type of behavior would also be abnormal for the general public, therefore a multi-axial system diagnosis is warranted.

Axis I: 305.00 alcohol abuse; 309.28 adjustment disorder with mixed anxiety and depressed mood, acute; 309.21 separation anxiety disorder

Axis II: 317 mild mental retardation

Axis III: none

Axis IV: marital difficulties

Axis V: GAF = 55, current.

Axis I

When Al was brought to the emergency department (ED) for evaluation, he smelled of alcohol and appeared intoxicated. The wife's report that Al had been drinking more heavily since they began to have marriage problems, together with the DUI, was deemed sufficient to diagnose Al with alcohol abuse (305.00).

The Axis I adjustment disorder (309.28) diagnosis is based in part on the Axis II diagnosis of mild mental retardation. Although the DSM recommends that a diagnosis of adjustment disorder not be given when the criteria are met by an axis II diagnosis, the description of mild mental retardation is sufficiently vague to warrant further elaboration on the symptoms. Al's depressive and anxious symptoms developed within 3 months of the onset of marriage difficulties, the main stressor, which satisfies one of the diagnostic criteria. In addition, the stressor is being blamed as the cause for alcohol abuse and three consecutive days of tearful hopelessness. Based on these symptoms, Al seems to be having a difficult time adjusting to the reality that his marriage is in trouble.

Al could be experiencing the beginnings of a major depressive disorder, single episode, but not enough information is provided in the vignette to determine whether Al meets the necessary diagnostic criteria. Al had experienced 3 days of tearful hopelessness concerning his marriage before presenting in the ED, but the only mood-related history provided by the family is that Al had been increasing the amount of alcohol consumed during the preceding two months. Since the diagnostic criteria for a major depressive disorder, single episode, requires the symptoms to be present for at least two weeks Al does not meet the criteria for this diagnosis. In addition, Al's appetite, concentration, interest, energy levels, and sleep patterns are reportedly normal, which is inconsistent with a depressive episode. If this is a depressive episode, it is very likely that it was precipitated in part by Al's alcohol consumption; however, the degree of contribution that alcohol is making to the mood change cannot be established until Al has stopped drinking. The relatively recent onset of these symptoms rules out dysthymia and the symptoms do not meet the criteria for anxiety disorders.

The Axis I diagnosis of separation anxiety disorder (309.21) is also provided to help describe the symptoms Al presented with upon arrival in the ED. Even though Al fails to meet the age criteria of 18 or younger, if he is suffering from mild mental retardation then at age 20 he would probably be developmentally under 18 years of age. A diagnosis of separation anxiety disorder is given when excessive anxiety is produced in anticipation of, or after, separation from a place or person. A significant impairment in daily activities is another criterion that must be met for this diagnosis. A person with mild mental retardation would be predicted to have a hard time…