Adolescents-at-Risk for Alcohol Use Disorders:
A Case Study Approach
Katie (17) became sad, withdrawn, and stopped eating when her boyfriend, John, broke up with her. Katie is in her second semester of her freshman year at an Ivy League university. Katie was an excellent student in high school and very loved by her small town. Now, she feels overwhelmed, lost, lonely and out of place at the Ivy. A pretty girl, she was wooed by several frat boys. In order to fit it, Katie did a lot of drinking. Now, second semester, John broke up with her, she stopped going to class and she drinks daily. As a college counselor, what additional information would you like to know about Katie? What diagnoses would you consider and what interventions?
Even though the DSM-IV-TR (www.Psychiatryonline.com) is more appropriate for adults than teens (see my last post), it can still provide some useful guidelines to understanding addictions. And, because it is the industry standard, it is important to be knowledgeable about the diagnostic criteria for substance dependence. The symptoms of substance dependence include 3 of the following list and must be causing significant impairment over the previous 12 months: tolerance, withdrawal, inability to cut back or control use, excessive amount of time/effort seeking out the substance, giving up important social, occupational, and/or recreational activities due to the substance, and continued use despite knowing that the substance is exacerbating a medical condition.
Again, I really want to emphasize that diagnosing a teen is much more difficult than diagnosing an adult because some teens are experimenting and will grow out of their use and they have a relatively short use history. Obviously, the goal with a young person is to try to prevent them from becoming dependent. The questions then become - how and when to intervene? Are there symptoms of early onset of alcoholism? Which interventions are effective (www.nida.gov)? Believe me, if I had the answers to all these questions, I would be God, Mother Teresa, or a fairy godmother (which I am not). Many times as a therapist, I have wished I had a magic wand that I could simply wave and make things better. Unfortunately, I don't. And, neither does anybody else. But, still not doing anything is not an option. So...we proceed with our limited tools and try to avoid doing harm.
How would you help Katie? What additional information would you like to know?
