Discussion

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3 REFERENCES

Diagnostic criteria for Alcohol Use Disorder
The diagnostic criteria for Alcohol use disorders has recently changed with the DSM-5.  In the DSM-5 a patient can be diagnosed with an Alcohol Use Disorder on three different severities of mild, moderate and severe.  The level of severity is based on the number of presenting symptoms out of eleven total possible symptoms.  Mild presentation is two to three symptoms, moderate is four to five and severe is six or more symptoms (APA, 2013).   The eleven symptoms for criteria are as follows:

Alcohol is often taken in larger amounts or over a longer period than was intended.
There is a persistent desire or unsuccessful efforts to cut down or control alcohol use.
A great deal of time is spent in activities necessary to obtain alcohol, use alcohol, or recover from its effects.
Craving, or a strong desire or urge to use alcohol.
Recurrent alcohol use resulting in a failure to fulfill major role obligations at work, school, or home.
Continued alcohol use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of alcohol.
Important social, occupational, or recreational activities are given up or reduced because of alcohol use.
Recurrent alcohol use in situations in which it is physically hazardous.
Alcohol use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by alcohol.
Tolerance, as defined by either of the following: a) A need for markedly increased amounts of alcohol to achieve intoxication or desired effect, or b) A markedly diminished effect with continued use of the same amount of alcohol.
Withdrawal, as manifested by either of the following: a) The characteristic withdrawal syndrome for alcohol b) Alcohol (or a closely related substance, such as a benzodiazepine) is taken to relieve or avoid withdrawal symptoms. (APA, 2013)

Evidenced-based psychotherapy and psychopharmacologic treatment
The treatment of alcohol use disorder is very dependent on the individual and how committed to the process they are.  The first step of treatment for each person remains the same in detoxing the individual.  Detoxing can occur with or without the assistance of medications depending on the patients’ needs and level of dependence.  Some medically assisted models are Schick Shadel and the use of a CIWA in the inpatient setting.  Once the person has detoxed the medical assistance can continue with one of two main medications depending on the patient’s willingness to stay committed to sobriety.  One medication, Antabuse, will cause an adverse reaction if the patient does drink alcohol (Stahls, 2014).  The other, Naltrexone, will help to mitigate the cravings for alcohol (Stahls, 2014).  Psychotherapy also can help the individual to address underlying issues that cause the person to drink (Sadock, 2013).  Individual and group therapy can be beneficial with CBT to help identify triggers and a new way to cope (Sadock, 2013).  Finally, a group setting that can help with accountability such as Alcoholics Anonymous can also be help for ongoing support and encouragement for sobriety.  
Clinical presenting features
A patient that I have experienced was a middle aged male who was terminated from his job and experiencing a marital separation.  He was terminated from work for attendance issues, quality of work issues and showing up to work under the influence.  His marriage was showing signs of effects of alcoholism because he was experiencing an increase in alcohol use causing strain on finances and was becoming easily agitated followed by blackout event.  The comparison of his symptoms and the DSM would reveal that he was suffering from severe alcohol abuse because of the increased use, the effect on his personal and work life as well as the increased cravings for use. 
American Psychiatric Association.  (2013).  Diagnostic and statistical manual of mental disorders (5th ed.).  Washington, DC: Author.
Sadock, B. J., Sadock, V. A., & Ruiz, P. (2014). Kaplan & Sadock’s synopsis of psychiatry: Behavioral sciences/clinical psychiatry (11th ed.). Philadelphia, PA: Wolters Kluwer.
Stahl, S. M.  (2014).  Prescriber’s Guide: Stahl’s Essential Psychopharmacology  (5th ed.).  New York, NY: Cambridge University Press.

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