Rationale for DSM Diagnosis for DRY

Axis 1: 303.90 Alcohol Dependence with physiological dependence

Augusten has displayed a maladaptive pattern of alcohol use, leading to clinically significant impairment or distress, as manifested by the following symptoms, occurring in the last year:
1. tolerance: a need for markedly increased amounts of the substance to achieve intoxication or desired effect (one liter a day of whiskey).
2. withdrawal (he is given Librium while detoxing to avoid physical shock)
3. the substance is often taken in larger amounts or over a longer period than was intended time (begins with intention to drink until midnight but keeps going until bottle is finished)
4. there is a persistent desire or unsuccessful efforts to cut down or control substance use (even when he has to attend to work responsibilities, Augusten is unable to stop his use)
5. a great deal of time is spent in activities to obtain the substance, use the substance, or recover from its effects (drinks every night and is unable to meet work responsibilities due to lack of sleep and hangovers)
6. important social, occupational or recreational activities are given up or reduced because of substance use (occupational problems due to use, threatened with job loss)
7. the substance use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance (drinks even though he is allergic to alcohol and has to consume large amounts of Benadryl to prevent a reaction from alcohol)
• With physiological dependence is specified due to the evidence of tolerance and withdrawal

Axis II: V71.09 No Diagnosis
No evidence, at least in DRY, of a personality disorder, although this could be assessed further.

Axis III: Allergy to alcohol

Axis IV: Problems with Primary support: Poor relationship with parents who seemed to have abandoned him as a child; mother now suffers from a stroke

Problems with the social environment: enabling drinking friends, living alone, friend with terminal illness

Occupational problems: is threatened with job loss if he does not participate in treatment

Axis 5: 50

Augusten shows a serious impairment in social and occupational functioning, which indicates a GAF of 50. This would be lower if he did not continue to have a job that provides adequate income.