Case: Date:

Diagnosis (is): DSM V:

1. Determine a formal diagnosis
2. Other Conditions That May Be a Focus of Clinical Attention :)
3. Discuss any alternative diagnoses that were considered, and how the differential was made.
4. What level of severity is her addiction (if there were any)
5. Rational should be in your own words
6. 2 pages based on the below reading.

Case- Clinical Vignette

Carey is a 21-year old woman who has been struggling to maintain sobriety from polysubstance abuse over the past 3 years. Her family history includes numerous individuals with alcohol abuse and dependence symptoms.

When she was 11 years old, Carey and four classmates were arrested when they stole liquor from their homes and became intoxicated in a public park after curfew. When she was 13, Carey escaped out of back window when police arrested some of her classmates and several older "acquaintances" during a secret party that involved alcohol and marijuana. She smoked cigarettes on a regular basis throughout her teen years but was never "hooked" on them. Carey's first semester at college was, in her words, "a complete disaster." because she was "always" either drunk, high, or recovering from episodes of heavy daily substance use-with her room-mate's boyfriend providing alcohol, marijuana ,and cocaine in exchange for being allowed to sell the drugs from their dorm room.

Carey was hospitalized for 3 weeks in February of her second semester at college when she accidentally overdosed on a combination of cocaine, alcohol, and unknown other drugs during a long weekend binges. Hospitalization was characterized by a period of high suicidality during detox and early recovery. Doctors initially were hesitant to use medications to manage her care because of uncertainty regarding what she had been taking. Subsequently, numerous diagnostic labels were applied, including borderline personality disorder, bipolar disorder, and attention deficit disorder without hyperactivity, attention deficit disorder with hyperactivity, depression, anxiety and polysubstance abuse. Carey was prescribed a wide variety psychotropic medication during the months of outpatient follow-up care and warned not to drink alcohol because it interacted badly with the medications. Carey developed a pattern of raking medication as prescribed Monday through Thursday but not taking them on weekends, when she planned to drink with friends and coworkers. She was no longer using "recreational" drugs other than alcohol. Carey's moods, behavior, and ability to function fluctuated wildly during this time.

In March at age 19 ½ years, Carey returned to living in her parents' home. She informed her psychiatric counseling team that she was refusing all medications from here on. Because she could no longer tell that side effects from her root problems, and she never felt "normal." She quit her job as a server in a bar/restaurant and took part-time work in an office setting. Over a period of months she weaned herself from all medications and drugs, including alcohol, tobacco, and caffeine. By fall, feeling that her psychiatric state has stabilized, Carey enrolled in a local community college, with the plan of transferring to a different university when she has completed her general education requirements. Carey found it extremely challenging to perform well in her classes: she had difficulty concentrating and remembering what she read or heard. She also found that the things she knew from high school (where she had been an A-/B+ student) were difficult to recall and apply to her college coursework. She dropped out of this college experience, too and worked again in food services. While working as a server, Carey reengaged in drinking and smoking marijuana with coworkers after her night shifts ended. Her use of these two substances was regular and moderately heavy, but she was not experiencing symptoms of withdrawal. Carey quit working as a server when she realized that she was "wasting time" and "losing the daylight hours" due to the binge drinking and its delayed effects. She also quit using all drugs again and began excising as she had during middle school.

Currently, Carey continues to participate in noncompetitive athletic activities, including yoga. Mindfulness meditation classes have become a central part of her existence. She has returned to the community college on a part-time basis and is performing better than she or her parents expected. Currently, Carey is pleased to be leading a physically healthy, "substance free" lifestyle and feels proud of her academic accomplishments. She lives independently and is reasonably self-supporting while finishing her college education. At this point, Carey refused to take "mood-altering medications" of any kind, because she is afraid that she finds it difficult to "feel happy" at times when she should: She finds that her affect is flat much of the time, and things that should be exciting "just sort of are."