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feeling ashamed of herself. Additionally, Audrey denies engaging in any purging behaviors that would align with the criteria for bulimia nervosa. Secondly, Christina meets the diagnostic criteria for a Cannabis Use Disorder, Moderate 304.30, F12.20. This is evidenced by the presence of 4 to 5 symptoms of the disorder. They are noted in the history of her use of marijuana, as well as other factors noted throughout her intake and Substance Abuse Assessment. These include Christina’s use of marijuana in larger amounts than previous use in the beginning stages, spending significant amounts of time using marijuana, no desire to stop, and inability to hold a job. Additionally, there is the impact of marijuana use on her family relationships.
Case 3DAndrew 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 andhas 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 meets the diagnostic criteria for a Primary Diagnosis of Cannabis Use Disorder, Severe 304.30(F12.20) and Stimulant Use Disorder, Cocaine, Moderte 304.20 (F14.20).This Cannabis Disorder is evidenced by the presence of 6 or more symptoms in Andrew’s behaviors. They are noted in the history of his use of marijuana that began at age 13 and continues at age 19. Other factors that support the diagnosis include Andrew’s use of marijuana in larger amounts than previous use in the beginning stages, spending significant amounts of time using marijuana, no desire to stop, and continued use despite the threat of losing his job because of his drug use. Additionally, there is the impact of marijuanause on his marriage as it is creating “interpersonal problems caused or exacerbated by the effects of cannabis” evidenced by his pregnant wife’s decision to leave him because of his inability to stop (APA, 2013, p. 509). The differential diagnosis of nonproblematic use of cannabis is ruled out based on the