tolerance – what tells you this is true? what type of tolerance did you guess was present?
I do believe that a tolerance for alcohol is indicated, but this question was the most challenging for me in this activity. Ultimately, I determined that he is displaying behavioral tolerance. According to Van Wormer, & Davis, (2018) “people with this level of tolerance may be only moderately drunk at the blood alcohol level of 0.4, a level at which a normal drinker might be comatose” (P. 99). Because it was not mentioned how drunk he gets when he drinks, this question gave me pause. However, Van Wormer, & Davis, (2018) go on to state that “many individuals, similarly, smoke a pack of cigarettes a day, a feat that would be highly unlikely for novice smokers who have not yet developed that tolerance” (p. 99). Therefore, because of the amount of alcohol he typically consumes, “upon graduation he limited his use to two to three evenings per week, usually a few drinks. When asked how many a few is he says 6 to 8 and sometimes more,” and also because of his progression from drinking beer to vodka which, “he reports a drink is an 8 ounce glass with 2-3 ice cubes.” The progression from drinking beer to hard liquor, in the large amounts that he consumes, led to my determination on this matter. “The CDC recommends that men not drink more than two drinks a day and women not more than one” (p. Van Wormer & Davis, 2018, p. 98).
loss of control – e.g. episodes of using more than intended, unsuccessful efforts control use or cut down?
I believe that loss of control is evident in this case scenario for alcohol, cocaine and gambling. I arrived at this conclusion because it’s mentioned that “once he begins using cocaine, he uses all he has and does not save some for the next weekend.” Meaning that his efforts to control his usage, fail. Additionally, it’s noted that he has a tendency to gamble when he’s high from cocaine use, and that “He spends $300 – $400 each time he gambles, which causes him stress and anxiety.” However, he continues to use cocaine and gamble thus, perpetuating this self-disclosed anxiety inducing cycle. According to Van Wormer, & Davis, (2018) “in general, biochemical, neuroimaging, genetic research, and treatment research suggest a strong neurobiological link between gambling and substance use addiction…given the substantial co-occurrence of these disorders, it only makes sense that there are linkages on many levels” (p. 134). Moreover, regarding his alcohol consumption it’s noted that he “tries to limit it to 2 drinks a night, but sometimes I have quite a few more.” Once again displaying unsuccessful efforts to control his use.
withdrawal symptoms – observable signs and subjective complaints after stopping the drug
I believe that withdrawal symptoms are indicated in this scenario. I came to this determination because it is noted that, “He reports sometimes getting nervous and jittery in the days after after {sic}drinking a bit, which can last for a day or two.” According to Van Wormer, & Davis, (2018) “when the depressant effects of a sedative drug such as alcohol are removed, there is a rebound effect, and the central nervous system becomes hyperactive. This is because if the drug causes one effect, the body adapts, and removal of the drug brings the opposite reaction…withdrawal symptoms usually start within 24 hours and can last up to several days” (p. 99). I feel that George’s aforementioned statement, fits the criteria for the symptoms of withdrawal, as noted above.
any drug interactions – if so explain which drugs and type of drug interactions you noted,
The drug interactions of alcohol and cocaine are noted in this scenario. It’s stated that “by his account, alcohol is needed to turn down the volume when he feels too anxious, stressed out from losing money gambling and when he gets too energized from cocaine.” Therefore, he’s clearly stated that he uses both drugs at the same time. According to Van Wormer, & Davis, (2018) “the mixture of cocaine and alcohol is probably the most lethal of any two-drug combinations known” (p. 110).
“Justifications” used by the person to explain why he/she continues to use and could not stop,
In reference to the matter of the presence of justifications, there was one statement in particular that stood out to me in this scenario. It’s documented that George, “reports going to work on time, every day and denies his work performance has been affected.” Although this statement is not a blatant justification, I do feel that it alludes to a sense of justification for his ongoing substance use and gambling. However, I feel that George’s statement that “alcohol is needed to turn down the volume when he feels too anxious, stressed out from losing money gambling and when he gets too energized from cocaine,” is an outright justification for his ongoing alcohol use.
List the specific DSM 5 symptoms that indicate: a mild, moderate or severe substance use disorder.
