HSCD 590G Summative Paper: Alcohol Use Disorder, DSM-5 and Reflection

This summative paper, written in APA style, reflects on the student's learning experience in an introductory course on substance use and co-occurring disorders (HSCD 590G). The paper focuses on the context and purposes of diagnosis, critically examining the DSM-5's strengths and weaknesses, particularly in relation to alcohol use disorder. It delves into the diagnostic criteria for alcohol use disorder, including withdrawal symptoms, tolerance, and craving. The paper also addresses the interplay of privilege and oppression within the context of substance use disorders, highlighting the challenges and opportunities in working with individuals facing these issues. The student reflects on the course, emphasizing the importance of multidimensional thinking, individualized patient care, and the essential qualities for effective substance abuse counseling. The paper incorporates references to support the analysis and reflections, providing a comprehensive overview of the course's key takeaways.

Alcohol and Mental Health
1

Diagnostic and Statistical Manual of Mental Disorders (DSM–5):
Purpose of DSM 5 is to recognise the substance use disorders (SUDs). DSM 5 came
into the picture since concerns were raised for DSM 4. DSM 5 Substance use disorders
working group recognised these issues and recommended revisions for DSM 4. Additional
issues included in the DSM 5 were withdrawal diseases addition for several substances,
configuration of nicotine criteria with other addictive substances, incorporation of new
biomarkers and addition of nonsubstance behavioural addictions (Wakefield, 2016). DSM 5
is universally accepted standard classification system for mental disorders considering
clinical, research, policy and reimbursement. DSM 5 has widespread applicability in
diagnosis, treatment and investigation of SUDs. DSM 5 diagnosis process is balancing act
because it incorporates both scientific evidence and clinical utility and experience. Diagnosis
criterias in the DSM 5 are based on the etiological factors and behavioural descriptors
(Cooper, 2018).
DSM 5 is useful in the diagnosis of SUDs based on the information gathered considering 11
criterias.
These criterias include
1. Consumption of substances in larger quantity and/or for longer duration,
2. Regular attempts and unsuccessful attempts to reduce consumption of substances,
3. Maximum time spent on obtaining substance and use of substance,
4. Strong desire for substance,
5. Persistent use of substance results in failure in performing routine work at workplace
and home,
6. Continuation of substance use despite regular social and interpersonal problems,
7. Decrease in the social, occupational and recreational activities due to substance use,
8. Recurrent substance use despite physically hazardous situation,
9. Recurrent substance use despite knowledge about consequences of its use,
10. Tolerance development,
11. Withdrawal symptoms development.
All these criterias should be assigned as primary, secondary and tertiary based on the
intensity of symptoms. Mental disorders can be categorised as mild, moderate and severe
based on number of symptoms observed in a person. Persons with 2-3 symptoms being
considered as mild, 4-5 symptoms being considered as moderate and more than 6 symptoms
2

considered as severe (Stein et al., 2013; Regier et al., 2015). Based on the diagnostic criteria
SUDs are being classified as alcohol, phencyclidine, inhalant disorder, stimulant
(amphetamine, cocaine and other unspecified-use stimulant), cannabis, other hallucinogen,
opioid, sedative, hypnotic, anxiolytic and tobacco use disorder (Simpson, 2014; Parker,
2014).
Intellectual disability and global development delay:
DSM 5 defines intellectual disability as a neurodevelopmental disorder which is
characterised by intellectual difficulties and difficulties in the conceptual, social and practical
aspects of living. DSM 5 diagnosis of intellectual difficulties should satisfy following three
criteria such as
1. Deficit in intellectual functioning
2. Deficit in adaptive functioning
3. Onset of deficit during childhood (Papazoglou et al., 2014).
DSM 5 defines global development delay as delay in two or more developmental
domains such as gross motor/fine motor, cognitive, speech/language, personal/social,
activities of daily living in young children below 5 years of age (Moeschler and Shevell,
2014; Mc Kenzie et al., 2016).
Pros and Cons of DSM 5:
Advantages of DSM 5 include tightened DSM IV criteria in sensible manner in the
interest of patients. Other advantages of DSM V include ensuring communication among
global population, relevance to the different worldwide systems, relevance to diverse
orientations, documentation, application of social psychological and neurobiological
research, acceptance from all the stakeholders and its clinical utility for diagnosis, prevention,
treatment and prognosis. In case of mental disorders, differential diagnosis is necessary for
the pharmacological and behavioural treatments (Stein et al., 2011). However, in DSM 5,
there is no provision for differential diagnosis for pharmacological and behavioural treatment.
Healthcare professionals dealing with mental and personality disorders differ in their
concepts and opinion. Neurobiology psychiatrists and behavioural psychiatrists differ in their
diagnosis criteria. Primary care physicians use single diagnosis algorithm and specialist
doctors use multiple diagnosis algorithms for diagnosis of mental disorders. However, DSM
3

5 does not mention uniform strategy to address the issue of differing concepts and opinion of
healthcare professionals (Wakefield et al., 2016; Uher et al., 2014).
Privilege and oppression:
Its privilege working with the patients of SUDs. Working with SUDs patients
facilitate collaborative and team work with experts from different disciplines such as medical,
psychological and social. Hence, there is great opportunity to learn principals, practices and
processes of medical, psychological and social activities for the diagnosis and management of
patients with SUDs. Personal relationship can effectively address the issue of addiction in
individuals. Hence, its privilege to use personal relationship along with pharmacological and
behavioural aspects for diagnosis and management of SUDs. It can be a difficult decision to
work with SUDs people because changing behaviour of an individual is difficult task.
Moreover, use of addictive substance not only affect patients but also affect family members.
Hence, it is privilege to work with SUDs to improve wellbeing of patient and family
members (Sachdev et al., 2015). Patients with SUDs affects human rights and human
security. Human rights violations and lack of human security might lead to injury and illness.
It can be considered as the oppression for the society. Hence, adverse impact of SUDs on
society should be minimised effectively without oppression on SUD patients (Beech et al.,
2016).
Alcohol use disorder:
Alcohol use disorder is of particular interest because as compared to other SUDs
alcohol use disorder is most common SUD. Alcohol use disorder is a cluster of both physical
and behavioural symptoms which include withdrawal, tolerance and craving. Alcohol
withdrawal symptoms usually evident after 4-12 hours after reducing its consumption.
Withdrawal symptoms indicate consumption of heavy and prolonged alcohol ingestion after
reduction in the alcohol intake. People with alcohol use disorder continue to consume large
amount of alcohol despite adverse events and consequences to circumvent and/or to get relief
from the withdrawal symptoms. Alcohol withdrawal symptoms continue for the longer
duration of time with lower intensity. Hence, person with alcohol use disorder spend
considerable amount of time in obtaining and consuming the alcohol. Craving for alcohol is
4

evident from strong desire to drink alcohol which make it difficult to think of other than
drinking alcohol on the regular basis. It leads to onset of drinking alcohol. Performance at
home and work can adversely get affected either due to aftereffects of alcohol consumption
or actual intoxication of alcohol. It is evident that people consume alcohol in physically
hazardous situations such as driving automobile, swimming and operating machine.
Individuals with alcohol use disorder continue to consume alcohol regardless of information
about its consequences such as physical (liver disease, blackouts), psychological
(depression), social or interpersonal problems (violent arguments and child abuse).
Reflection:
It was a very fascinating and challenging experience of learning course on SUDs. I
learned that only classroom teaching-learning experience is not enough to manage people
with SUDs; however, experience with real life patients is also necessary to acquire adequate
knowledge of SUDs. I learned that multidimensional thinking is necessary for the
management of persons with SUDs because not only pharmacological but also behavioural
and social aspects should be incorporated in the management of such patients. From this
course, I understand it is necessary to consider each patient on individual basis because
common procedure and platform cannot be beneficial for the diagnosis of each patient with
SUD. It is essential for healthcare provider to meet the person with SUD on regular basis.
Moreover, I understand that full recovery is necessary in cases of SUD persons because
partial recovery might lead to relapse of the condition. I understand that I should have
following characteristics to become effective substance abuse counsellor: excellent
interpersonal skills, critical thinking ability, high tolerance of stress, integrity, good
communication skills, adaptability and ability to maintain composure.
5

References:
Beech, A.R., Miner, M.H., and Thornton, D. (2016). Paraphilias in the DSM-5. Annual
Review of Clinical Psychology, 12, 383-406.
Cooper, R. (2018). Understanding the DSM-5: stasis and change. History of Psychiatry,
29(1), 49-65.
Mc Kenzie, K., Milton, M., Smith, G., and Ouellette-Kuntz, H. (2016). Systematic review of
the prevalence and incidence of intellectual disabilities: current trends and issues.
Current Developmental Disorders Reports, 3, 104-15.
Moeschler, J.B., and Shevell, M. (2014). Comprehensive evaluation of the child with
intellectual disability or global developmental delays. Pediatrics, 134, e903-18.
Parker, G.F. (2014). DSM-5 and psychotic and mood disorders. Journal of the American
Academy of Psychiatry and the Law, 42(2), 182-90.
Papazoglou, A., Jacobson, L.A., McCabe, M., Kaufmann, W., and Zabel, T.A. (2014). To ID
or not to ID? Changes in classification rates of intellectual disability using DSM-5.
Intellectual & Developmental Disability, 52(3), 165-74.
Regier, D.A., Kuhl, E.A., and Kupfer, D.J. (2013). The DSM-5: Classification and criteria
changes. World Psychiatry, 12(2), 92-8.
Sachdev, P.S., Mohan, A., Taylor, L., and Jeste, D.V. (2015). DSM-5 and Mental Disorders
in Older Individuals: An Overview. Harvard Review of Psychiatry, 23(5), 320-8.
Simpson, J.R. (2014). DSM-5 and neurocognitive disorders. Journal of the American
Academy of Psychiatry and the Law, 42(2), 159-64.
Stein, D.J., Lund, C., and Nesse, R.M. (2013). Classification systems in psychiatry: diagnosis
and global mental health in the era of DSM-5 and ICD-11. Current opinion in
Psychiatry, 26(5), 493-7.
Stein, D.J., Craske, M.G., Friedman, M.J., and Phillips, K.A. (2011). Meta-structure issues
for the DSM-5: how do anxiety disorders, obsessive-compulsive and related disorders,
post-traumatic disorders, and dissociative disorders fit together? Current Psychiatry
Reports, 13(4), 248-50.
Uher, R., Payne, J.L., Pavlova, B., and Perlis, R.H. (2014). Major depressive disorder in
DSM-5: implications for clinical practice and research of changes from DSM-IV.
Depress Anxiety, 31(6), 459-71.
Wakefield, J.C. (2016). Diagnostic Issues and Controversies in DSM-5: Return of the False
Positives Problem. Annual Review of Clinical Psychology, 12, 105-32.
6