Development of a Major Substance Use Disorder From a Patient’s Birth Through His Early Twenties

Abstract

This is a pediatric case of a male patient who initially presented with multiple, nonspecific physical complaints. The patient was followed by the same pediatrician into young adulthood. These physical complaints were paired with social and academic dysfunction and a self-perception of being “unhealthy.” This is a pattern of physical expression of psychiatric illness that is referred to as somatization, and is quite common with complex patients, particularly those with very high utilization of medical services associated with minimally beneficial results. The patient's ongoing and escalating pain disorder plus comorbid generalized anxiety and major depressive disorders ultimately led to a protracted and complex substance use disorder. The patient experienced major disruptions in his social and interpersonal functioning as well as profound discontinuity in his academic development as a result of his complex array of symptoms and their consequences.