PS511 Unit 3 Alcohol Use Disorder Case Study Example

The Widower's Woodpile: A PS511 Unit 3 Case Study Diagnosing Alcohol Use Disorder With DSM-5-TR Criteria

[Student Name]

Purdue University Global

PS511: Chemical and Psychological Dependency Counseling

Unit 3 Alcohol Use Disorder Case Study

[Instructor Name]

[Date]

The client, his family, the clinic and every detail of the case are composite and illustrative; the sources cited are real.

Identifying Information and Referral

Arvid is a 63-year-old retired logger who lives alone in a house outside Virginia, Minnesota. His wife of thirty-eight years died of cancer in March of last year. In January he fell on the icy steps of his garage, broke his wrist and was found by a neighbor after lying in the snow for an hour. The emergency room recorded a blood alcohol level well above the legal driving limit at ten in the morning. His primary care doctor referred him to our clinic, and he came, he said, "because my daughter made me."

History of Use

Arvid drank two or three beers on weekends for most of his adult life and rarely more. In the months after his wife's death, he began drinking in the garage, where he splits and stacks firewood. By summer he was drinking a twelve-pack most days, starting before noon, and adding whiskey at night "to sleep." He stopped attending the Lutheran church where he and his wife had been members, stopped meeting two friends for coffee on Thursdays and has not gone deer hunting in two seasons. He has tried twice to "take a week off" and lasted two days each time, feeling shaky, sweaty and unable to sleep. His doctor has told him his liver tests are abnormal. He still drives to the liquor store.

Testing the History Against the Manual

The manual's rule is that two or more of eleven listed problems, appearing within one year and causing real harm or distress, establish an alcohol use disorder (American Psychiatric Association, 2022). Hasin et al. (2013) explain the 2013 redesign: what had been two separate labels became a single condition, arrests no longer count toward it, craving was added and the number of items met now sets how serious it is. The text revision kept that structure.

Arvid's history provides evidence for the following criteria. He drinks more and for longer than he intends, starting in the morning when he had planned to wait for evening (criterion 1). Two planned weeks off each collapsed after two days (criterion 2). He spends much of the day drinking or recovering, by his own account most hours between noon and bedtime (criterion 3). He reports strong urges to drink when he wakes up, which counts as craving (criterion 4). He has given up church, coffee with friends and hunting (criterion 7). He drives after drinking, and he fell while intoxicated on icy steps (criterion 8, recurrent use in physically hazardous situations). He continues to drink knowing his liver tests are abnormal (criterion 9). He now needs far more alcohol for the same effect than he did a year ago (criterion 10, tolerance). His attempts to stop brought shaking, sweating and insomnia, and he uses whiskey to sleep (criterion 11, withdrawal).

That is nine criteria. Two do not apply clearly. He is retired and lives alone, so failure to fulfill major role obligations at work, school or home (criterion 5) has little to attach to, although his daughter says he has missed his grandchildren's events. Continued use despite social or interpersonal problems caused by drinking (criterion 6) may apply, since his daughter has argued with him about it, but he describes the arguments as rare.

Nine criteria with clear evidence places Arvid in the severe range, though he insists he is "just a sad old man who drinks too much."

Diagnosis

Alcohol use disorder, severe (six or more criteria). Because Arvid's withdrawal symptoms were reported, he also needs medical assessment for withdrawal risk before any reduction in drinking. Grief is clearly relevant. The death of his wife preceded the escalation, but the information available does not yet support a separate diagnosis, such as a depressive disorder or prolonged grief disorder, and that question should be assessed once he has been abstinent for several weeks, since heavy drinking can produce depressive symptoms on its own.

Biopsychosocial Formulation

Biologically, Arvid's age, the abnormal liver tests and the withdrawal symptoms make medical care the first priority. Psychologically, alcohol began as a way to manage grief and insomnia and became the center of his days. Socially, he has lost the structure his marriage provided and has withdrawn from the church and friends who could support him. Living alone in a rural area, and driving to buy alcohol, add risk.

Proposed Interventions

The first step is a referral back to his doctor for a medically supervised withdrawal plan, which may be possible on an outpatient basis given his daughter's support, and for consideration of medication. Jonas et al. (2014) reviewed medications for alcohol use disorder in outpatient settings and concluded that two drugs, acamprosate and naltrexone taken by mouth, each lowered the share of patients who went back to alcohol, and naltrexone also cut the share who went back to drinking heavily. Both are options his doctor can weigh against his liver tests, since naltrexone requires attention to liver function.

The second step is counseling built on his own reasons for change. Arvid's strongest stated reason is his grandchildren, who are no longer allowed to visit when he has been drinking. Sessions will use motivational interviewing to strengthen that reason and grief counseling to address the loss directly.

The third step is rebuilding structure. Arvid agreed to rejoin the Thursday coffee group with his daughter driving the first two weeks, and his pastor has offered to visit. We discussed moving the firewood work to mornings, before he usually starts drinking, and keeping no alcohol in the garage.

Measurable Goals

Within two weeks, Arvid will complete a medical evaluation and begin a withdrawal plan. Within six weeks, he will report no drinking on at least five days a week, confirmed by his daughter. Within three months, he will attend coffee group and church at least three times a month and will be screened again for depression. Each goal will be reviewed at his monthly treatment plan meeting.

Conclusion

Nine items on the manual's list have clear support in Arvid's story, which puts his drinking problem in the severe band. His age, withdrawal symptoms and liver tests make medical management the first step, and Jonas and colleagues' review supports discussing medication with his doctor. Counseling will address grief and rebuild the social structure he lost, using his grandchildren as the strongest reason for change.

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

Jonas, D. E., Amick, H. R., Feltner, C., Bobashev, G., Thomas, K., Wines, R., Kim, M. M., Shanahan, E., Gass, C. E., Rowe, C. J., & Garbutt, J. C. (2014). Pharmacotherapy for adults with alcohol use disorders in outpatient settings: A systematic review and meta-analysis. JAMA, 311(18), 1889-1900. https://doi.org/10.1001/jama.2014.3628