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DSM-5 Clinical Case # 5 DSM-5 Clinical Case # 5: Addiction (Written by: Petros Levounis, M

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DSM-5 Clinical Case # 5

DSM-5 Clinical Case # 5: Addiction
(Written by: Petros Levounis, M.D., M.A.)
Oliver Vincent never saw himself as an addict. He had always been “on top of things.” At age 25, he was
independently wealthy as the owner of several clothing franchises, lived with an ex-partner in a morethan-
comfortable apartment in New York City, worked out every day, enjoyed the company of a group of
loving friends, and, although single, had not given up on the idea of someday (preferably soon) finding
the perfect man to share his life with. Mr. Vincent came out to his Irish Catholic family when he was 19.
His parents had already guessed that Mr. Vincent was gay long before he told them, and they took the
non-news fairly well. Their main concern had been that their son might be discriminated against because
of his sexuality, get hurt, and live a lonely life. Nothing could be farther from the way things turned out:
Mr. Vincent was “out and proud” and living it up.
When Mr. Vincent found himself with a substance use problem, he addressed it the same way he had
dealt with pretty much everything else: head on. For the first time in his life, he decided to see a
psychiatrist.
Mr. Vincent described a pattern that revolved around weekend “party and play” activities. On Friday and
Saturday evenings—and occasionally during the week—he would go out to dinner with friends and then
to a club or a private party. He tended to drink two or three cocktails and four to five glasses of wine
during the evening. Without the alcohol, he found he could easily say “no” to substances, but “after a
good buzz, if someone has coke—and there is always someone around who has coke—I use. And then my
heart starts to race, and then I do everything I can to hook up. I used to go online, but these days, it’s all
on Grindr.”
Party and play are code words for drugs and sex, respectively. The term is sometimes abbreviated PNP.
Grindr is a smartphone application that uses GPS to identify and connect similarly inclined individuals in
a person’s geographical vicinity.
Overall, Mr. Vincent drank alcohol and used cocaine three to four times a week and “occasionally used
tina and bath salts.” He could hardly attend Monday morning meetings, much less prepare for them, and
had been trying to cut down on his cocaine use for the prior 6 months without success.
Choose a submission type
Tina is slang for crystal methamphetamine. Bath salts is slang for a powder that contains a variety of
synthetic stimulants.
Since Mr. Vincent had started using cocaine regularly, he had lost weight and had trouble sleeping. He
worried that his effort at the gym was going to waste. His business continued to succeed, but his own
effectiveness had decreased. Most importantly, he did not practice safer sex when high on stimulants,
and he worried about HIV seroconversion.