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The Case of Kaylin MaKaylin is22yearsold andthe oldest child of two working-class parents. Her father is a heating and air conditioning technician, and her mother is an administrative assistant at a local community college.Both parents immigrated from Korea as children. Kaylin has oneyounger brother,aged 9,who has been diagnosed withattention deficit hyperactivity disorder(ADHD). Kaylin appearednormally dressed and is 5’4” tall. Kaylin’s childhood wasotherwise unremarkable.Shereportedthat she has always worked hard at school and generally was an “A” student through high school. She ran track and was involved in many activities, socializing withboyfriends and her wide friendship circle. She reportedno particular difficulties with herparents other than fighting with them over her decision to leave the state for college. After delaying admission for a year and working, Kaylin left her home in New Hampshire at 20to attend college inFlorida. As a freshman, she lived off campuswith three other roommates. She has been waitressingin Tampa since freshman year at a bar/restaurantto supplement financial aid for tuition. She had very good grades (B+ to A) in her first 2 years of college. Kaylin is now a junior.She complainedof chronic anxietyand problems with concentration and attention. She still works long hours, and she recently took a course in bartending so she can serve drinks and “make more.” She had managed to maintain a B+ grade point average while studying juvenile justice upuntil this year. Kaylin initially began drinking with friends at the restaurantafter closingduring her second semester of sophomore year. She now drinks regularly on weekends with her collegeand “bar”friends. Shereportedthat since her 21st birthday party she has at times been “out allnight partying anddrinking.” She missed enough classes this year that her grades have begun to suffer. She had to drop at least one course (and will need to retake it next year)due to nonattendance. “This is becauseI don’t get enough sleep,” Kaylin said, and she statedthat she was simply unable to wake up in timefor that course. Kaylin attendedthis session with the social work counselor on campus because she hadn’t been interested much in food this past semester. Her roommatesinsisted that she get some help,as she hadgone from “slight”to “reed thin.” Kaylin statedthat they are worried that she has an eating disorder. Kaylin deniedany eating disorder,but she admittedthat she often has no time for mealsand at times has “no appetite.” She often reportedmild nausea. Current weight wasreported at 104 pounds. Upon further assessment,Kaylinreported that she spent much of the last 2 months of weekends drinking atherworkplaceas well asatcollegeparties. She used “hair of the dog” practices—e.g.,a morning Bloody Mary—to feel better this past month,as she sometimes hadmild hand tremors in the morningand wasstrongly nauseous. Sheadmittedto being “foggy.” During these weekend experiences, sheclaimedto have full memory (she denies blackouts) butreportedthat the hangovers make her “sound 
sensitive”with headaches. She said she “feels”normal by the end of the daymost Mondays, but she also statedthat she has trouble sleeping several nights a week without an evening beer. Her mood varies over the week,and she admittedto chronic anxiety and some tendency to get into “arguments”with her roommates whensober.She set some limits for herself, such asthreecocktails per weekendevening, but she has often “not bothered”to maintain those limits for “other reasons.” She admittedoccasional alcohol use in high school,but her status as a varsity athlete motivated her to limit her use. At the time of the assessment she wasnot involved in sports,clubs,or other steady exercise,and she statedthat she “has no time”for that or for boyfriends.  

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Of the substance disorders, alcohol-related  disorders are the most prevalent even though only a small percentage of  individuals actually receive help. Recidivism in the substance treatment  world is also very high. As research into treatment has developed, more  and more evidence shows that genes for alcohol-metabolizing enzymes can  vary by genetic inheritance. Women have been identified as particularly  vulnerable to the impacts of alcohol. Native Americans, Asians, and  some Hispanic and Celtic cultures also have increased vulnerability to  alcohol misuse. 
Even with these  developments, treatment continues to spark debate. For many years, the  substance use field itself has disagreed with mental health experts as  to what treatments are the most effective for substance use disorders  and how to improve outcomes. The debate is often over  medication-assisted treatment (MAT) versus abstinence-based treatment  (ABT). Recently the American Psychiatric Association has issued  guidelines to help clinicians consider integrated solutions for those  suffering with these disorders. In this Discussion, you consider your  treatment plan for an individual with a substance use disorder. 
To prepare:  Read “The Case of Kaylin” and the materials for the week. Then assume  that you are meeting with Kaylin as the social worker who recorded this  case.

Post a 300- to 500-word response in which you address the following:

Provide the full DSM-5 diagnosis for Kaylin. Remember, a full  diagnosis should include the name of the disorder, ICD-10-CM code,  specifiers, severity, and the Z codes (other conditions that may need  clinical attention). Keep in mind a diagnosis covers the most recent 12  months.
Explain the diagnosis by matching the symptoms identified in the case to the specific criteria for the diagnosis.
Describe the assessment(s) you would use to validate her diagnosis, clarify missing information, or track her progress.
Summarize how you would explain the diagnosis to Kaylin.
Explain how you would engage her in treatment, identifying potential cultural considerations related to substance use.
Describe your initial recommendations for her treatment and explain why you would recommend MAT or ABT.
Identify specific resources to which you would refer her. Explain  why you would recommend these resources based on her diagnosis and other  identity characteristics (e.g., age, sex, gender, sexual orientation,  class, ethnicity, religion, etc.).

Note: You do not need to include an APA reference  to the DSM-5 in your response. However, your response should clearly be  informed by the DSM-5, demonstrating an understanding of the risks and  benefits of treatment to the client. You do need to include an APA reference for the assessment tool and any other resources you use to support your response.
 
 
Morrison, J. (2014). Diagnosis made easier (2nd ed.). New York, NY: Guilford Press.
Chapter 15, “Diagnosing Substance Misuse and Other Addictions” (pp. 238–250)
 
American Psychiatric Association. (2013q). Substance related and addictive disorders. In Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author. doi:10.1176/appi.books.9780890425596.dsm16
 
Note: You will access this e-book from the Walden Library databases.
 
Gowin, J. L., Sloan, M. E., Stangl, B. L., Vatsalya, V., & Ramchandani, V. A. (2017). Vulnerability for alcohol use disorder and rate of alcohol consumption. American Journal of Psychiatry, 174(11), 1094–1101. doi:10.1176/appi.ajp.2017.16101180
 
Note: You will access this article from the Walden Library databases.
 
Reus, V. I., Fochtmann, L. J., Bukstein, O., Eyler, A. E., Hilty, D. M., Horvitz-Lennon, M., … Hong, S.-H. (2018). The American Psychiatric Association practice guideline for the pharmacological treatment of patients with alcohol use disorder. American Journal of Psychiatry, 175(1), 86–90. doi:10.1176/appi.ajp.2017.1750101
 
Note: You will access this article from the Walden Library databases.
 
Stock, A.-K. (2017). Barking up the wrong tree: Why and how we may need to revise alcohol addiction therapy. Frontiers in Psychology, 8, 1–6. doi:10.3389/fpsyg.2017.00884
 
Note: You will access this article from the Walden Library databases.

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