adverse emotional states may also prompt stronger craving episodes H u m a n i t i e s

adverse emotional states may also prompt stronger craving episodes H u m a n i t i e s

For the first two discussion responses Evaluate their response with an eye to adding information to their discussion that fully describes the issues they have addressed.

1. Distinguish between substance use, abuse, and dependence. Be sure to use current DSM-5 terminology and conceptualizations as you respond to this task.

Substance use is using alcohol or other drugs to socialize and feel effects. Use may not appear abusive and may not lead to dependence. Abuse of alcohol or drugs includes at least one of the following factors in the last 12 months: Recurrent substance use resulting in failure to fulfill obligations at work, home or school. Recurrent substance use in situations that are psychically hazardous. Recurrent substance-related legal problems. Continued substance use despite having persistent or recurrent social or interpersonal problems caused by or exacerbated by the substance. Dependence is also known as addiction and is a pattern of use that results in three or more of the following symptoms in a 12-month period: Tolerance is needing more of the drug or alcohol to get “high”. Withdrawal is physical symptoms when alcohol or other drugs are not used, such as tremors, nausea, sweating, and shakiness. Substance is taken in larger amounts and over a longer period than intended. Persistent desire or unsuccessful efforts to cut down or control substance use. A great deal of time is spent in activities related to obtaining the substance, use of the substance, or recovering from its effects. Important social, occupational, or recreational activities are given up or reduced because of substance use. Substance use is continued despite knowledge of persistent or recurrent physical or psychological problems caused or exacerbated by the substance (SAMHSA, 2020; APA, 2013).

– Compare the presentation differences you could expect to see in an individual diagnosed with a generalized anxiety disorder who is dependent on one of these:

– Marijuana: impaired motor coordination, euphoria, anxiety, sensation of slowed time, impaired judgement, and social withdrawal.

– Alcohol: inappropriate sexual or aggressive behavior, mood lability, and impaired judgement.

– Methamphetamines: anxiety, paranoia, aggressive behavior, irritability, confusion, tremors, euphoria, hypersomnia, decreased appetite, and increased physical activity.

– Cocaine: euphoria or blunt affect, changes in sociability, hypervigilance, interpersonal sensitivity, anxiety, anger, and impaired judgement (APA, 2013).

– Briefly assess the factors involved in at least one ethnic and cultural issue related to substance abuse that is at the heart of a current controversy, being sure to include a perspective on diathesis-stress issues.

The DSM-5 states that ethnic minority populations living in economically deprived areas have been overrepresented among individuals with opioid use disorder. Over time, opioid use disorder has been seen among white, middle-class individuals, especially females, suggesting that differences in use reflect the availability of opioid drugs and that other social factors may impact prevalence (APA, 2013).

2. Distinguish between substance use, abuse, and dependence. Be sure to use current DSM-5 terminology and conceptualizations as you respond to this task.

While substance abuse was a previously used term in past diagnostic manuals, it is no longer used in a clinical framework. One of the reasons for this is because of the meaning and implications of using the word abuse. As the DSM-5 (APA, 2013) asserts, one of the key features in distinguishing substance use disorder, or dependence, is a change in the brain circuits that may persist beyond detoxing from the substance (p. 483). The American Society of Addiction Medicine (2015) explains that a substance use disorder is characterized by a cluster of cognitive, behavioral, and physiological symptoms (p. 14). Once an individual has become dependent on a substance like alcohol, for example, a larger amount is being used, attempts to quit are unsuccessful, there are strong craving and urges, work and home life are negatively affected, etc. Withdrawal symptoms are another sign that a person has become dependent. Individual’s may choose to continue to use substances in order to avoid such symptoms (APA, 2013), and thus the cycle continues. Interestingly, the DSM-5 (APA, 2013) has combined the previous diagnoses of substance abuse and substance dependence (ASAM, 2015) and now uses specifiers to distinguish severity. To me this indicates that they are very closely related. With this in mind, it appears that the term substance use is used when usage is more mild or casual and does not lead to adverse effects within the major life areas. As Dr. B notes in his Unit 6 video, there may be different consequences to using different drugs even just casually. For example, although an individual may only use a substance once, they could run the risk of an overdose, or other dangerous situations making the term substance use seem incongruent with the consequences.

– Compare the presentation differences you could expect to see in an individual diagnosed with a generalized anxiety disorder who is dependent on one of these:

It has been hypothesized that adverse emotional states are higher in individuals who have mood or anxiety disorders. Adverse emotional states may also prompt stronger craving episodes (Fatseas et al., 2018). Research shows that anxiety disorders are correlated with greater cravings and in turn influence the frequency with which the individual uses substances (Fatseas et al., 2018). Dyer et al. (2019) notes that anxiety disorders and alcohol disorders often interact. One of the ways an individual with generalized anxiety disorder present with combined usage of alcohol may present is more relaxed and, in addition, perhaps show an increase in self-confidence. While such presentation may occur early on, alcohol dependency may increase anxiety symptoms over time (Dyer et al., 2019).

In comparison to individual’s with GAD and alcohol, individuals with GAD using cannabis may display more social anxiety and marked social avoidance (Feingold et al., 2016). When an individual is craving using cannabis, anxiety symptoms will likely increase, similar to those using alcohol. It is also noted that prolonged cannabis use may cause increase in anxiety and anxiety may lead to greater rates of cannabis use (Feingold et al., 2016). Individuals who are using methamphetamines and cocaine may present with increased speed in speech, headaches, tinnitus, etc. (APA, 2013). The DSM-5 (APA, 2013) suggests that individuals using stimulants may have histories of anxiety attacks and generalized anxiety disorder like symptoms. This factor could be complicated in deciphering which symptoms are due to the anxiety disorder and which are from the stimulants being used. As the differential diagnosis section suggests, symptoms from generalized anxiety disorder should be distinguished from those of stimulant use (APA, 2013, p. 566), however I believe this would be a difficult task.

– Briefly assess the factors involved in at least one ethnic and cultural issue related to substance abuse that is at the heart of a current controversy, being sure to include a perspective on diathesis-stress issues.

The current study presented by Amatullah et al. (2020) suggests that Indian culture is commonly known to abstain from substance use. Moreover, those who are practicing Sikh religion believe that using substance disrupts the spiritual path and that they alter consciousness (Amatullah et al., 2020, p. 348). It is noted that in the last 20 years there has been a rise in substance dependence within the culture for both men and women. Amatullah et al. (2020) suggests that globalization and the constant increase in social acceptance of alcohol is a primary factor in the rise in substance dependence. This generation of urban Indian youth are more connected to other cultures than ever before and the rates of Indian individuals using substances at a younger age are more prevalent. The man followed in the case study presented by Amatullah et al. (2020) shared that he felt very liberated and connected to his peers who are from urban Bangalore. He shared that he used cannabis to alleviate his internal and external pressures and stressors that arose from his incongruent feelings around his religion and how he was raised. As the DSM-5 (APA, 2013) suggests, cultural concept of stress and how an individual views their own experience and is able to communicate it may be culturally sensitive as well. While, In Western culture it may be ‘normal’ for teens to experiment with alcohol and cannabis, it is clear that other cultures believe it will affect the spirit and, in some cases, is forbidden. The diathesis-stress model is present here in that the, among other factors, the stress of not being allowed to try cannabis with his peers pushed his to use cannabis and he self-reported feeling far better and continued to use (Amatullah et al., 2020).

identify at least one insight into diagnostic issues that your peer has identified that you did not (the auto accident). Evaluate that insight, and explain your reasons for agreeing or disagreeing with its applicability in this case.

3. I’m not sure if it’s a red herring or not but my brain latched on to the mention of Ben being in an auto accident six months prior to the day of the visit in the case study. To be on the safe side I would be inquiring about any historical CT scans or MRIs that Ben have had done to use as a baseline to compare the CT scan that I would order during the visit to. I know that in the case study it says that he has never had any injuries or accidents that resulted in any health problems but it does not say that he never had any accidents or injuries. What about as a child? What about things that weren’t followed up in college when playing intramural sports? What about active hobbies? Was there ever a helmet-less bike crash? Was there ever a car crash off-road that wasn’t reported as teenager? This is based on past experience with individual’s presenting in this fashion suddenly at the hospital and it being a case of CTE or a trauma induced, but previously undetected, set of micro-bleeds in the brain that caused changes in the neural tissue that led to personality changes and a diagnosis of early onset dementia. The youngest individual was 32 and after a series of sports related concussions developed CTE. He had seemed fine, just a little tired, after a minor head injury the previous winter and then the following summer he had personality changes, began using substances, had balance and coordination issues (he was a professional ballet dancer) and was unable to do basic math problems (he had an engineering degree). It took some time to sort out the diagnosis and convince the insurance company that it was correct but he wound up discharged to a memory care hospice setting.

The other thing that caught my attention was that was that the case study leads with the information that Ben is a computer scientist at a large university and then five paragraphs down indicates that he works 50 hours a week for a software company. Software development can be a demanding job with intense deadlines and non-compete clauses in the employment contracts. Keeping up with whatever language is en vogue at the moment can also cause a lot of stress. Long hours with a close knit group of software engineers could lead to experimentation with substances in order to meet deadlines. So the next thing I would order is a series of tests for common substances of abuse and their metabolites. Just for good measure and so long as blood is being drawn I would also do a basic panel to see if blood sugar levels, thyroid hormones, liver and kidney function and any indication of an underlying inflammatory process indicating some other physical abnormality. Another question that I would ask is where Ben jogs. Lyme disease can initially present as personality changes. A tick borne illnesses panel may be indicated if he is a trail jogger. If possible I might suggest a short inpatient stay to see if his behavior begins to return to normal after a couple of days in a controlled environment or if he begins to engage in substance seeking behaviors while in the controlled environment. It seems as though Ben is globally impaired in his functioning which also leads me to consider sleep deprivation. Is he working 50 hours for the software company and 40 or so hours for the university? That plus commute times and the fact that he is clearly leaving time for social events may not be leaving much time for sleep. Long periods of sleep deprivation can also lead to personality changes. Ben may be more inclined to stay inpatient for a sleep study than for suspected substance abuse so this may be a good lead in for cooperative observation.

Comment on what you can learn from one another. next two posts.

4. As human beings, one of our main purposes in life is to make sense of the world around us. Both Existential and Gestalt therapies are known for helping a client do just that. One of the main components of existential psychotherapy is what is known as the “Existential Dilemma”. This dilemma considers humans to be finite beings with no predetermined future or destiny (Wedding & Corsini, 2019). This is a human condition which results in common anxieties, known as the “Ultimate Concern”. As humans, we are prone to worrying about our freedoms, meaning, and our inevitable death (Wedding & Corsini, 2019). In the film, “The Human Dilemma”, Dr. Rollo states that without freedom, anxiety cannot exist (Bloch, Mishlove, & May, 2011). He made a great point in bringing up slavery and how slaves are often depicted with no emotion on their faces. This is because Dr. Rollo states that anxiety stems from the Human Dilemma. In the rare case of slavery, their destinies were controlled and pre-determined. Therefore anxiety, joy, and the other emotions tied existentialism cannot be manifested without the stressor of trying to make sense of the world around you.

There is no therapeutic or medical model existential therapy follows. Instead, the therapist works to bring awareness to the client, help them find their purpose, as well as talk with them through life’s inevitable conflicts.

Similarly, gestalt therapy works to bring awareness to the client. Gestalt therapy emphasizes what is known as the “Paradoxical Theory of Change”. This paradox states the more a client tries to become something they’re not, the more likely change will seize to exist (Wedding & Corsini, 2019). Gestalt therapists view their clients as holistic creatures that are capable of being self-regulating. Gestalt therapy differs from existential therapy because it typically focuses on the here-and-now, rather than the past or future. Gestalt therapy also utilizes experimentation so that clients can try new things and form healthier habits (Wedding & Corsini, 2019).

After watching “The Human Dilemma”, I learned that interpersonal psychotherapy and the medical model do not always coincide. I believe Dr. Rollo would agree with that stance. In the film, Dr. Rollo states that there is a difference between helping versus curing someone. A medical model supports curing or fixing someone to be healthier. Dr. Rollo states that “no one is cured of anything” (Bloch, Mishlove, & May, 2011). Dr. Rollo stated that a cure is not the answer to life, and ultimately provides nothing but support for a patient at best.

5. The meaning of life, finding a life purpose, and the pain that comes from feeling disconnection with that purpose. These issues and others are addressed more readily in Existential Psychotherapy and Gestalt Therapy than in previous therapy models. Both models claim a more active approach, one in with the therapist and client boundaries are less clear, in that the relationship becomes one of equals journeying together to find answers for the client.

One other similarity between the two models is the therapist-client relational aspect, being perceived as equals in the room. Part of this dynamic leads to a more open and trusting relationship, according to the textbook, “Current Psychotherapies (Wedding, 2019).” Being curious, asking questions, and not being afraid of internal or external conflicts in the room, are all practices that a therapist in either model must inhabit to use it successfully with clients. In “The Human Dilemma,” Rollo May points out that if a therapist has not done his or her own therapy work on comfort with death, acceptance of anxiety and conflict, the therapist will be unsuccessful in helping the client (Mishlove, 2011). While Gestalt does not specifically mention this as a prerequisite for success, it does point out the therapist needs to be strong in their own fields and conscious awareness to be able to help clients achieve the same.

Additionally, both practices incorporate the use of dreams, myths, and parts of ourselves to tell the story of the whole. As we saw in the “Gestalt Integration” video, the therapist uses a technique to create a link between the dichotomies the client is feeling toward her experience of blindness (Zalaquett, 2011). This is similar to how Existential therapy uses dreams and myths to help clients make sense of their competing conscious belief and their unconscious reality.

One additional similarity is the incorporation of the whole person, not just past but present and future. As mentioned earlier, one similar tenet to both models is the experience of looking at the dichotomies in life and incorporating both elements. In this process the therapist assists the client in finding a place on the spectrum for that person to exist comfortably, not at one extreme or the other.

While there are many similarities between the two therapy models, Rollo May points out many of the differences in the video, “The Human Dilemma.” Rollo May speaks about the integration of New Age therapy models with mindfulness, meditation, breathing, and body awareness (Mishlove, 2011). He stated that this integration takes away from the practical acceptance of death, anger, and anxiety by calming the system to focus attention away from those feelings and does a disservice to clients. Gestalt therapists incorporate body awareness and breathwork, not as Rollo sees it, but as a way to connect their body’s way of dealing with the feelings and the brain’s processing of those same feelings (Alexander, 2011). This can help clients understand that if our body is reacting one way, while our conscious processing is reacting differently, we need to merge those two experiences to create balance and an opening for change.

When considering Existential Psychotherapy in contrast with other models, such as Interpersonal Psychotherapy and their medical model, one could see that these ideas are contradictory. Rollo May took a strong stance against separating one’s self from their symptoms or experience of those symptoms. His interpretation of the Existential therapy model is that to overcome feelings, you must embrace them and become comfortable with them in order to see the good that they can offer. His example of this is anxiety, stating that accepting anxiety can push people towards creative action once they stop being debilitated by the feeling.

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