Comprehensive exams for Mental Health Q 82
A male client is brought to the psychiatric clinic by family members, who tell the admitting nurse that the client repeatedly drives while intoxicated despite their pleas to stop. During an interview with the nurse Linda, which statement by the client most strongly supports a diagnosis of psychoactive substance abuse?
A. “I’m not addicted to alcohol. In fact, I can drink more than I used to without being affected.”
B. “I only spend half of my paycheck at the bar.”
C. “I just drink to relax after work.”
D. “I know I’ve been arrested three times for drinking and driving, but the police are just trying to hassle me.”
Correct Answer: D. “I know I’ve been arrested three times for drinking and driving, but the police are just trying to hassle me.”
According to the Diagnostic and Statistical Manual of Mental Disorders, 4th edition, diagnostic criteria for psychoactive substance abuse include a maladaptive pattern of such use, indicated either by continued use despite knowledge of having a persistent or recurrent social, occupational, psychological, or physical problem caused or exacerbated by substance abuse or recurrent use in dangerous situations (for example, while driving).
For this client, psychoactive substance dependence must be ruled out; criteria for this disorder include a need for increasing amounts of the substance to achieve intoxication (option A), increased time and money spent on the substance (option B), inability to fulfill role obligations (option C), and typical withdrawal symptoms.
Option A: A shortened version of the term used in the ICD-10 – Mental and behavioral disorders due to psychoactive substance use. The term encompasses acute intoxication, harmful use, dependence syndrome, withdrawal state, withdrawal state with delirium, psychotic disorder, and amnesic syndrome. For a particular substance, these conditions may be grouped together as, for example, alcohol disorders, cannabis use disorders, stimulant use disorders. Psychoactive substance use disorders are defined as being of clinical relevance; the term ‘psychoactive substance use problems’ is a broader one, which includes conditions and events not necessarily of clinical relevance.
Option B: Production, distribution, sale, or non-medical use of many psychoactive drugs is either controlled or prohibited outside legally sanctioned channels by law. Psychoactive drugs have different degrees of restriction of availability, depending on their risks to health and therapeutic usefulness, and classified according to a hierarchy of schedules at both national and international levels. At the international level, there are international drug conventions concerned with the control of production and distribution of psychoactive drugs: the 1961 Single Convention on Narcotic Drugs, amended by a 1972 Protocol; the 1971 Convention on Psychotropic Substances; the 1988 Convention Against Illicit Traffic in Narcotic Drugs and Psychotropic Substances.
Option C: It is an essential characteristic of the dependence syndrome that either substance taking or a desire to take a particular substance should be present; the subjective awareness of compulsion to use drugs is most commonly seen during attempts to stop or control substance use. This diagnostic requirement would exclude, for instance, surgical patients given opiate drugs for the relief of pain and who may show signs of an opiate withdrawal state when drugs are not given, but who have no desire to continue taking drugs.