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Assignment:

Respond to at least two of your colleagues who were assigned a different disorder than you.

1. Compare the differential diagnostic features of the disorder you were assigned (Alcohol-Related Disorders) to the diagnostic features of the disorder your colleagues were assigned.

2. What are their similarities and differences? 

3. How might you differentiate the two diagnoses? 

4.  Support your responses with evidence-based literature with at least two references in each colleague’s response with proper citation in APA Format. 

Colleagues Response # 1

Diagnostic Criteria for Hallucinogen-Related Disorders

 Phencyclidine (PCP) use disorder is characterized by a pattern of use that leads to extreme dysfunction, occurs within 12 months and is manifested by at least two of the following: more PCP is taken or taken for longer than intended; continuous want or inability to control use; much time is spent obtaining, using or recovering from PCP; strong urge to use PCP; PCP use resulting in inability to carry out responsibilities at work, school or home; continuing to use PCP despite persistent dysfunctional social or interpersonal problems secondary to the effects of PCP; abandonment or decreased attendance of activities secondary to PCP use; continuous use despite it being unsafe; continued PCP use despite having a physical or psychological problem caused by PCP; tolerance as evidenced by need for more amount of PCP to reach desired effect and/or a decrease effect when using the same amount (American Psychiatric Association [APA], 2013).  Other Hallucinogen Use Disorder has the same diagnostic criteria as phencyclidine use disorder except the substance is a hallucinogenic other than phencyclidine (APA, 2013).   

Psychotherapy and Psychopharmacologic Treatment for Hallucinogen use disorder

 Hallucinogens can have acute and chronic adverse reactions.  An acute reaction that can occur is intoxication.  When intoxication occurs it causes perceptual and dysfunctional behavioral changes as well as physiological symptoms, such as palpitations, tremors, incoordination, sweating, tachycardia and blurred vision (Sadock, Sadock & Ruiz, 2014).  The initial treatment is called the “talk down” technique; it is when a provider offers reassurance in a calm and supportive tone telling the patient that the symptoms are drug induced and will be over soon (Gabbard, 2014).  If medications are needed in acute intoxication, benzodiazepines can be administered (Gabbard, 2014).  If the patient does not respond to the benzodiazepine, an antipsychotic can be administered (Sadock, Sadock & Ruiz, 2014).  Antipsychotics must be used with caution secondary to their ability to lower the seizure threshold (Gobbard, 2014).  

 A chronic adverse reaction can occur when psychosis or delirium continues from weeks to years after use (Gobbard, 2014).  The continuation of symptoms should alert providers to perform a psychiatric assessment.  Oftentimes, prolonged reactions occur as a result of psychiatric illness, continuous use of hallucinogens or poor premorbid adjustment (Gobbard, 2014).  The pharmacological treatment remains the same for long-term reaction as an acute reaction; antipsychotic drugs (Gobbard, 2014).  

Evidence based psychotherapeutic approach for hallucinogen use disorder is cognitive behavioral therapy (CBT) (McKay, 2020).  It is a widely used approach for many substance use disorders (SUDs).  CBT assists patients with SUDs by helping them change their cognitive beliefs and behaviors that make them susceptible to use (McKay, 2020).  It allows individuals with SUDs to gain more of an understanding of their triggers, behaviors and the reasons for them (McKay, 2020).  It also teaches them effective coping skills and motivates them to believe they have the ability to change (McKay, 2020).

Clinical Features Observed in a client with Hallucinogen use disorder

Expected observations in a client with hallucinogen use disorder include making excuses to use hallucinogens, such as a way to deal with stress; deciding to use hallucinogens instead of going to work or attending other obligations; continuing to use despite failing interpersonal relationships; feeling unwell when not using hallucinogens; an unkempt appearance; increased isolation from family and friends; continued use of hallucinogens despite palpitations and known tachycardia; feeling less effects of hallucinogens when using the same amount and becoming increasingly irritable. These clinical features align with the DSM-5 criteria mentioned above.  

Colleagues Response # 2

Opioid use disorder (OUD) is diagnosed in persons who misuse and abuse opiates to the point that they lose control and continue to use despite continuously incurring significant negative effects and other related problems.  Substance use disorders are complicated psychiatric conditions, and not a moral failing (Sadock, Sadock & Ruiz, 2014).  What turns voluntary use into the obsessive-compulsive use is a change in the structure and neurochemistry of the brain.   It is quite easy to become addicted to opiates as they are the drug of choice given by doctors worldwide for the relief of pain.

Cognitive Behavioral Therapy (CBT) is a psychosocial therapy that has been found to be very effective in treating Substance Use Disorder (SUD) relative to standard drug counseling in promoting abstinence from OUD (Barry et al., 2019).  Methadone is the pharmacological treatment of choice used for detoxing those who suffer with OUD.  Clonidine, Bentyl and Ibuprofen are also used as comfort medications.  Methadone along with Buprenorphine can also be used for maintenance therapy for those requiring medication-assisted therapy to continue with long-term sobriety.  Naloxone or Narcan is used in emergency cases of overdosing.  Naloxone is sprayed into the nostrils to knock the opiate off its receptors thus reversing the effects of the narcotics and restoring consciousness and respirations.

Physical manifestations of those with OUD include itching, dry mouth, facial flushing, and heaviness of extremities hence the nodding effect or the look that they are about to tip over.  Respiratory depression, pupillary constriction, and constipation are also associated with OUD.  Characteristics of those with the disorder involve impaired control, persistent drug-seeking behavior, social impairment, and recurrent substance use may result in a failure to fulfill major role obligations at work, school, or home (American Psychiatric Association, 2013).