PS375 Unit 3 DSM Diagnosis Paper Example

Three Criteria or Four: A PS375 Unit 3 Diagnosis Paper

[Student Name]

Purdue University Global

PS375: Psychology of Addiction

Unit 3 Diagnosis Paper

[Instructor Name]

[Date]

The writer, the program, the client and every detail are composite and illustrative; the sources cited are real.

The Referral

Marcus is sixteen and a junior at a Tulsa high school. His school counselor referred him to our outpatient program in November after he was found vaping cannabis in a school restroom for the second time. Since spring his report card had slid two letter grades, and he had stopped going to basketball practice. He came to intake with his mother.

As intake coordinator, I gather information, run screening tools and schedule assessments, but diagnoses at our program are made by licensed counselors. This paper follows how Marcus's counselor applied the diagnostic criteria, with my notes from intake.

The Diagnostic Rules

The DSM-5-TR (American Psychiatric Association, 2022) requires that a person's use cause real impairment or distress, shown by two or more of eleven listed criteria in the same year. Clinicians often sort the eleven into four clusters: impaired control, such as using more than intended or being unable to cut down; social impairment, such as failing to fulfill obligations at school or work; risky use, such as use in physically hazardous situations; and pharmacological criteria, tolerance and withdrawal. Two or three criteria mean mild severity; four or five mean moderate; six or more mean severe.

Hasin et al. (2013) described the reasoning behind these criteria. DSM-IV had separated substance abuse and substance dependence; research showed that the criteria for both reflected a single underlying condition, so DSM-5 combined them into one disorder with a severity scale. Legal trouble was dropped as a criterion because few people reported it and it told clinicians little, while craving was added because it is common and central to treatment. The workgroup also recognized cannabis withdrawal as a syndrome.

Applying the Criteria

Marcus's counselor interviewed him alone and then with his mother.

Using more than intended: Marcus said he often meant to take "a couple of hits" and finished the cartridge. Met.

Craving: he described strong urges in the morning before school and after arguments at home. Met.

Failure to fulfill major role obligations: his grades had fallen sharply, and he had missed first period eleven times in the fall, often after vaping in the morning. Met.

Tolerance: he said he needed much more than he used to for the same effect. Met.

Important activities given up: he had stopped going to basketball practice. But when the counselor asked why, Marcus said the coach had cut his playing time and he had lost interest. The counselor judged that the link to cannabis was unclear and did not count it.

Withdrawal: Marcus said he had no withdrawal. His mother disagreed. During a family trip in August, when he could not vape for five days, he was irritable, slept badly, hardly ate and was, in her words, "a different kid." Those symptoms match the cannabis withdrawal syndrome. The counselor counted the criterion.

Marcus did not notice his withdrawal; his mother noticed nothing else for five days.

The counselor found no evidence for the remaining criteria, such as use in physically hazardous situations or continued use despite a physical or psychological problem made worse by cannabis, though she noted to watch for the latter given Marcus's reports of low mood.

The Severity Rating

Without the withdrawal criterion, Marcus met four criteria, which already places him at the low end of moderate severity. Adding withdrawal made five, the upper end of moderate. Had the counselor counted basketball as well, he would have met six, a severe rating. The decision not to count it, because the evidence was unclear, kept the rating at moderate.

The rating matters. It shapes the intensity of the recommended treatment and how insurance and schools respond. A severity rating that overstates the problem can stigmatize a teenager and lead to more restrictive treatment than he needs; one that understates it can lead to too little help.

Screening Before Diagnosis

Before the counselor's interview, I gave Marcus the CRAFFT, a brief screening questionnaire designed for adolescents, as I do with every client under eighteen. He answered yes to four of six questions, well above the cutoff that signals a need for full assessment. The screen did not diagnose anything; it told us to look closely. One of his yes answers, to the question about forgetting things he did while using, pointed toward the impaired control criteria the counselor later explored. The screening score and the diagnosis answered different questions, and keeping them separate in the chart avoided the common mistake of treating a positive screen as a diagnosis.

The Interview Setting

The counselor interviewed Marcus alone first, explaining the limits of confidentiality for minors in Oklahoma under program policy, before inviting his mother in. Teenagers often say more without a parent present, and Marcus described his morning use only in the private part of the interview. His mother's account of the August trip came only after he left the room. Each setting produced information the other could not.

Why Adolescents Need Care in Diagnosis

Volkow et al. (2016) note that adolescence is a period of particular vulnerability to addiction, partly because the prefrontal cortex, which supports self-control and planning, is still maturing, and that earlier onset of use is associated with greater risk of later disorder. For Marcus, a moderate diagnosis and prompt treatment are a chance to change course while his brain is still maturing. At the same time, adolescent behavior changes for many reasons, and attributing every problem to cannabis would be a mistake, which is why the counselor was cautious about basketball.

Diagnosis and the Person

The counselor recorded "cannabis use disorder, moderate" in Marcus's chart and spent the rest of the session on what he wanted, which was to get back on the basketball team. Diagnosis organizes treatment, but a sixteen-year-old's goals organize his motivation.

Limits

The assessment relied on self-report and one parent's account. Toxicology confirmed recent cannabis use but cannot measure criteria. School records supported the role-failure criterion but not its cause. A follow-up assessment after several weeks of treatment will show whether the picture changes.

Conclusion

Marcus met five of the eleven DSM-5-TR criteria for cannabis use disorder, a moderate rating, with withdrawal counted on his mother's report and basketball left out because the link was unclear. Hasin and colleagues explain why DSM-5 combined abuse and dependence and recognized cannabis withdrawal, and Volkow and colleagues' account of adolescent vulnerability shows why an accurate rating matters at sixteen.

References

American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.). https://doi.org/10.1176/appi.books.9780890425787

Hasin, D. S., O'Brien, C. P., Auriacombe, M., Borges, G., Bucholz, K., Budney, A., Compton, W. M., Crowley, T., Ling, W., Petry, N. M., Schuckit, M., & Grant, B. F. (2013). DSM-5 criteria for substance use disorders: Recommendations and rationale. American Journal of Psychiatry, 170(8), 834-851. https://doi.org/10.1176/appi.ajp.2013.12060782

Volkow, N. D., Koob, G. F., & McLellan, A. T. (2016). Neurobiologic advances from the brain disease model of addiction. New England Journal of Medicine, 374(4), 363-371. https://doi.org/10.1056/NEJMra1511480