Question

Provide the case DSM-5 Diagnosis and the rational:
Andrew is a 19 year old male who comes for

assessment due to his wife of one year threatening to leave him if he does stop using drugs. Andrew stated that his wife has returned to her parents’ home and has refused to speak to him for the past four weeks. Andrew has been smoking marijuana since he was 13 years old. He does not understand why his wife has a problem with his use since she knew about it prior to being married and used to smoke with him on a daily basis. She stopped smoking three months ago when she found out she was pregnant and does not want him smoking around her. Andrew was smoking 2-3 days per week until about 18 months ago, when it began taking more marijuana to relax him. He slowly increased his use and has smoked daily for the past nine months. He has tried several times in the last four week to stop smoking, but finds himself angry, anxious and craving marijuana. He believes that there is nothing wrong with smoking marijuana because it is natural and helps him manage anxiety. Andrew stated that before he started smoking he would feel anxious and keyed up all the time. When he smokes he is “mellow” and does not lose his temper. Andrew’s wife has complained for the past 6 months that Andrew smokes so much that he no longer helps her around the house, no longer engages in their relationship and has been threatened to be fired twice for showing up to work “high”.

    Andrew added that he has also used cocaine for the past year. He reported that he only snorts cocaine one to two times per month. His wife discovered his cocaine use one month before she left the home. She informed Andrew that if she found out he was continuing to use she would leave. Even though Andrew knew his wife was serious, he met some friends the next night and used cocaine. He reported that he knows his cocaine use is more serious but finds it difficult to say no to his friends when they get together to use. He has experienced heart attack like symptoms on four occasions after snorting cocaine. On two occasions the symptoms were so severe he ended up in the emergency room and hospitalized overnight. The doctor has told him that if he continues to use it will likely damage his heart. Andrew will cancel time with friends and family to use cocaine with his “secret buddies”. He feels guilty about neglecting these relationships, but continues to choose use of cocaine over his wife, friends and family. He has also missed two opportunities for advancement at work due to choosing to meet “buddies” instead of completing a specialized training program.

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