Case 039: Substance-Related Disorders

PATIENT PRESENTATION

Chief Complaint

“I want to stay sober. I am tired of living this way”

History of Present Illness

Over the past couple of years Daniel has struggled with Alcohol Use Disorder. He has not been able to maintain sobriety and would like options to help him abstain from alcohol.

Link to EMR

Student Work-Up

TARGETED QUESTIONS

1. What signs & symptoms of alcohol withdrawal is Daniel currently experiencing?

   Hint: See Table 37-4 in PPP

2. What is the CIWA-Ar and how can it be utilized for this patient?

   Hint: See Table 37-2 and Treatment of Withdrawal Syndromes in PPP

3. What is the treatment of choice for the management of alcohol withdrawal?

   Hint: See Treatment of Withdrawal Syndromes in PPP

4. What nonpharmacologic therapy should be recommended?

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

5. What are pharmacologic treatment options for the maintenance treatment of Alcohol Use Disorder?

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

FOLLOW-UP

Which one may be the best option for Daniel

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

CASE SUMMARY

Global Perspective

Alcohol misuse is a concern worldwide. According to the World Health Organization's Global status report on alcohol and health there were 3 million deaths or 5.3% of global deaths were alcohol related in 2018. The incidence of alcohol use does vary depending on the country and other factors. For example, countries with greater economic wealth had higher rates of alcohol consumption and higher prevalence of current drinkers. Globally, consequences associated with alcohol such as health problems, mental health conditions, violence and motor vehicle accidents are also concerns. It is important to recognize that the use of alcohol is not only a concern within the United States, but also is a challenge globally.

Key References