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Chief Complaint

“I’m anxious all the time.”

History of Present Illness

Patient is a 62-year-old male endorsing ongoing severe anxiety, likely secondary to alcohol use disorder. He is requesting a few doses of lorazepam that he can have on hand to ease his fear of not having anything helpful available in the event he has a panic attack. Benzodiazepines such as lorazepam while helpful for treating alcohol withdrawal can worsen alcohol cravings and increase the risk of relapse. Therefore, alternative treatments for anxiety and alcohol use disorder should be discussed and trialed.

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Missing Information?


Patient Database

Drug Therapy Problems

Care Plan (by Problem)


  1. What criteria of substance use disorder does SB meet?

    Hint: See Table 37-1 in PPP

  2. What screening instrument(s) could be used to assess for the presence of alcohol use disorder?

    Hint: See Table 37-2 in PPP

  3. What nonpharmacological treatment options could be recommended for this patient?

    Hint: See General Approach to the Treatment of Substance Use Disorders in PPP

  4. What are the advantages and/or disadvantages of the various pharmacotherapeutic options that could be used to treat his alcohol use disorder?

    Hint: See General Approach to the Treatment of Substance Use Disorders in PPP

  5. Why might SB have been prescribed gabapentin instead of other FDA-approved medications?

    Hint: See Table 36-4 in PPP


What if it was determined that SB also had an opioid use disorder in addition to alcohol use disorder? Would that have changed your approach to this case and if so, how?


Global Perspective

Globally, alcohol use disorders are the most prevalent of all substance use disorders. According to the World Health Organization, about 5% of the global burden of disease and injury is attributable to alcohol, as measured in disability-adjusted life years (DALYs). The burden of disease attributable to alcohol use varies substantially across geographic locations since much of this burden is due to the effect of alcohol on other health outcomes. Beyond health consequences, the harmful use of alcohol brings significant social and economic losses to individuals and society at large. To reduce the burden associated with harmful alcohol use, policymakers worldwide are encouraged to take the following actions that have been shown to be effective and cost-effective: providing accessible and affordable treatment for people with alcohol-use disorders; and implementing screening and brief intervention programs in health services for hazardous and harmful drinking.

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