Diagnostic Criteria of Alcohol-Related Disorders
Alcohol use disorder defined by DSM-5 criteria is a highly prevalent, highly comorbid, disabling disorder that often goes untreated in the United States (Grant et al., 2015). According to the American Psychiatric Association (2013), for DSM-5 classification of alcohol use disorder (AUD), a person needs to manifest at least two of the eleven diagnostic criteria. The criteria include the person taking in large quantities over a longer than intended period, having a persistent desire or unsuccessful attempts to cut down or control use, spending significant time obtaining alcohol, experiencing intense cravings or urges to consume alcohol or failure to fulfill significant obligations at work, school, or home due to recurrent use (APA, 2013). Individuals suffering from alcohol misuse may also experience continued use, despite having persistent social or interpersonal problems caused by the effects of alcohol (e.g., arguing with others overuse), having important social, occupational, or recreational activities given up or decreased due to alcohol use, recurrent use in situations which may be physically harmful (APA, 2013).
Psychotherapy and Psychopharmacological Treatment
Despite increased AUD prevalence during the past decade, researchers revealed that AUD mainly goes untreated. Rather than lack of insurance, fears of stigmatization, and beliefs that treatment is ineffective explain the lack of AUD treatment in the United States (Grant et al., 2015). Nonetheless, a large body of literature supports the effectiveness of the treatment of AUD. Individuals who participate in 12-step groups increase the likelihood of recovery, consistent with randomized clinical trials testing the efficacy of 12-step facilitation administered by health care practitioners (Grant et al., 2015). An individual motivation to quit will ascertain what approaches can enhance and support the person’s readiness to quit. Since many psychiatric clients are hesitant to stop drinking, treatment often involves augmenting a person’s motivation to quit while successful barriers. It can be achieved effectively using a cognitive-behavioral therapy (CBT) approach. CBT provides behavioral interventions and a beneficial structure to help individuals stop drinking. The group experience benefits were reported as peer support, change of thinking patterns, increased confidence, and self-efficacy. This study suggests that depression management, especially in a group format, should be offered more frequently as an integrated part of alcohol treatment due to the benefits experienced by the participants (Besenius et al., 2013).
In 1948, disulfiram was the first medication approved by the U.S. Food and Drug Administration (FDA) to treat alcohol dependence (Zindel & Kranzler, 2015). Maintenance dose usually 250 mg/day. The drug works by irreversibly inhibiting aldehyde dehydrogenase, the enzyme involved in the second-stage alcohol metabolism (Stahl, 2014). Alcohol is metabolized to acetaldehyde, which in turn is metabolized by aldehyde dehydrogenase; thus, disulfiram blocks this second-stage metabolism (Stahl, 2014). Disulfiram’s effects are immediate; individuals should not take disulfiram until at least twelve hours after drinking. If it works, it increases abstinence from alcohol (Stahl, 2014).
Alcohol use disorders impair productivity and interpersonal functioning and place psychological and financial burdens on those who misuse alcohol, on their families, friends, and coworkers, and, through motor vehicle crashes, violence, and property crime, on society (Grant et al., 2015). Clinical features that I was able to observe with alcohol use disorder would be waking up and drink alcohol soon after, beer more and more beer every day, or someone waking up and has to drink a couple of beers every day (APA, 2013). These behaviors relate to the criteria of an individual having more significant tolerance and withdrawal symptoms. Additional features of withdrawal that I would anticipate are an individual who is employed. For example, this client was referred to the office because he is a truck driver and was informed by his employer to seek medical treatment or “be fired.” Additional diagnostic criteria are met as a person who needs to report to work and has difficulty accomplishing a responsibility to their work under the influence. Significant medical conditions can also outcome from AUD, such as lung and other cancers, cardiac and pulmonary disease, perinatal problems, cough, shortness of breath, and accelerated skin aging (APA, 2013). AUD can also cause interpersonal and relationship issues, especially when one person in the relationship is not an alcoholic.
American Psychiatric Association (APA). (2013). Diagnostic and statistical manual of mental
disorders (5th ed.). Washington, DC: Author.
Besenius, C., Beirne, K., Grogan, S., & Clark-Carter, D. (2013). Cognitive Behavioral Therapy
(CBT) in a Depression/Alcohol Use Disorder Group: A Qualitative Study. https://doi.org/10.1080/07347324.2013.746613
Grant, B.F, Goldstein, R.B, Saha, T.D, et al. (2015). Epidemiology of DSM-5 Alcohol Use
Disorder: Results from the National Epidemiologic Survey on Alcohol and Related Conditions III. JAMA Psychiatry. 2015;72(8):757–766. doi:10.1001/jamapsychiatry.2015.0584
Zindel, L.R. & Kranzler, H.R. (2015). Pharmacotherapy of Alcohol Use Disorders: Seventy-
Five Years of Progress. Journal of Studies on Alcohol and Drugs, Supplement 2015: s17, 79-88. https://doi.org/10.15288/jsads.2014.s17.79
Stahl, S. M. (2014). Prescriber’s Guide: Stahl’s Essential Psychopharmacology (5th ed.). New
York, NY: Cambridge University Press.