HINT: This Chapter is on Substance-Related and AddictiveDisorders so the final daignosis should come from that chapter inthe DSM-V

Instructions: Read the case study, The CoffeeShop Waitress, on pages 155-157 in the textbook. Then complete thefollowing sections of the diagnostic report. This assignment shouldbe no more than 5 pages long.

Client strengths: All clients have strengths.What are these client’s strengths and how could they benefit hisrecovery and continued good mental health?

Client limitations: What potential limitationsdoes this client possess in terms of his recovery and continuedgood mental health?

Differentials: List three differentials foreach disorder you are considering, why you considered it, and whyyou rejected it. Your differentials should be rational, not random.For example, do not use Alcohol Use Disorder as a differential whenthe diagnosis is Major Depressive Disorder. The client shouldexhibit some symptoms of the disorder you use as adifferential, but not enough to qualify for the diagnosis.

Diagnosis: List all DSM-V diagnoses andspecifiers for the client in the case. Some will have only onedisorder, others will have multiple diagnoses.

Rationale for diagnosis: Looking at the DSM-Vcriteria for each final diagnosis you select, provide yourrationale for selecting that diagnosis.

Case 2 The Coffee Shop Waitress

Janelle is a 53-year-old widowed Caucasian female who beganindividual therapy three months ago in a women’s outpatientsubstance use treatment program as a self-referral. She wants toquit drinking once and for all and also get help for a deepeningdepression. She reports having been “depressed” since the death ofher second husband four years ago (of a heart attack), but this hasgotten worse in the past six months as she has tried to stopdrinking. Janelle has abused alcohol on and off since she was 15.She takes no other drugs. Janelle’s father and one of her uncleswere alcohol abusers, and her adult daughter (age 29) drinksheavily.

When Janelle began individual therapy, she reported having drunkapproximately 10 beers a day during a previous nine-month timespan, which ended six months ago (after which her depression beganto worsen). During that time, she drank in larger and largeramounts to achieve the desired effect, despite the fact that shewas aware of the possible negative effects on her health. Janellestates that her impulse to drink was strong whenever she tried tostop and that she experienced spells of shaking when she wentwithout alcohol. Janelle reports having abused alcohol for manyyears before that, but not on a daily basis. She was more of a“binge drinker,” drinking mixed drinks in bars and at home to thepoint of passing out, alone or with friends, once every week ortwo. Janelle currently reports having abstained from alcohol forthe past six months, except for two episodes of binge drinkingsince she began treatment one month ago. These episodes wererelated to being alone and feeling lonely.

Janelle admits to feeling “terrible” about herself, because shedrank so much at times. “I must be a real weakling to have to relyon alcohol and not be able to quit. I’m certainly not veryattractive in that condition.” In addition to the issues related toher drinking, Janelle reports intense feelings of loneliness thatshe attributes to a long-term sadness due to the loss of her secondhusband.

Janelle also has a serious physical condition. She was diagnosedwith type II diabetes eight years ago and currently adheres to aspecial diet to control that illness. She reports several pasthospitalizations due to dehydration, which frequently occurs inpersons with type II diabetes. Janelle reports that she must besure to drink enough liquids and watch out for symptoms such asdizziness and feeling weak. Janelle has also experienced episodesof nausea and vomiting since undergoing stomach surgery for anulcer four months ago. Her doctor had told her to expect periods ofnausea related to her stomach condition. Janelle reports that sheused to “love food,” but since the stomach surgery she hasexperienced a decreased appetite and general lack of interest infood. She finds this very frustrating and admits that “now andthen” she “forgets” about her diet and just eats what she wants,even though she may feel ill afterward. Physicians have warned herthat drinking alcohol is hard on her stomach, and although thisserves as a motivator for her to stop, she still can’t “just doit.” She sees her medical doctor regularly but cannot sustain thetreatment plans he initiates with her.

Janelle is currently working as a waitress at a coffee shop. Sheseems to have a strong work ethic and has had a variety of jobsthroughout her adolescent and adult life. They are all unskilledjobs, as Janelle has only a high school diploma and never “sets outto work in one place for too long, because my kids have alwaysneeded me.” Her three children are adults now, but she is highlyinvolved in the lives of her two grandchildren, often caring forthem. Janelle misses work occasionally due to oversleeping or beinghung over, but she has never lost a job due to this behavior. Shestates that she is considered to be “likable” and a “good worker.”She adds that “working has been especially helpful since my husbanddied,” because it keeps her mind off her sadness. She admits thatif she doesn’t have to go to work in the morning, she tends to liein bed alone for many hours, feeling preoccupied with her sadnessand crying about her lack of “purpose” in life.

Janelle currently lives alone in an apartment. She is in regularcontact with her children. Although her family relationshipsprovide her with support, they are also sources of stress inJanelle’s life. Her children make frequent and last-minute demandson her time for child care and financial assistance. Janellecurrently has a romantic partner, who is separated but stillinvolved with his wife. She views this relationship as shallow andtemporary, and she wonders if she will ever again be close to aman. In addition to still grieving the loss of her second husband,she is also mourning the recent death of a good friend. Janellecurrently has few friends, and although her church community is apossible source of support, she is not currently very involved withit. Janelle does not have regular transportation and must rely onfriends and family in order to meet this need.

Despite her current stresses she enjoys some activities, mostnotably fishing and cooking. She values her role as a grandmother.Janelle also maintains a sense of humor about her physical health,her often stressful relationships with her children, and heroverall life situation.

Janelle grew up in a rural community in the mountains ofVirginia. She was raised and continues to identify as Baptist. Sheconsiders herself a religious person, and she attended churchregularly in the past. Janelle’s household featured emotional andphysical family violence. Her father was alcohol-dependent andphysically and emotionally abusive toward Janelle, her twobrothers, and her mother. Janelle identifies using alcohol as oneway she learned to cope with the trauma and stress of her familysituation. Even adolescents easily obtained alcohol in hercommunity,, and Janelle states that she began to enjoy the “buzz”from whisky and wine soon after she began drinking. She and herfriends often drank in each other’s homes and in the nearby woodsand were rarely caught or confronted about their activity.

Shortly after graduating from high school, Janelle married a manshe believed would be a “good provider.” She states that herattraction to the man, whom she never knew “too well,” abated aftera year or so, but she stayed in that emotionally abusive marriagefor 20 years, because “I had kids then.” He berated her as a wife,parent, and person. Janelle worked a series of unskilled part-timejobs during those years and says she was never happy. She saw herlife as “all stress and all work.” She was prone to spells ofextreme hopelessness in which she stayed in bed, wished that shecould die, and wondered why there was nothing “pleasurable” in herlife. Janelle reports that in the past six months, and at severalother times in her life, she experienced symptoms such as low mood,fatigue, feelings of worthlessness, excessive guilt, and troublefalling asleep.