Thomas Frost (pronouns he, him, his), a 51-year-old White man, is a partner at a leading financial firm. He has been working with you off and on for several years. His wife Joanne, a White woman (pronouns she, her, hers), with whom you have permission to speak, calls you

Hello, this is Joanne Frost, Thomas’s wife. Thank you so much for taking my call. I’m very worried.

I…I need to talk to you about Thomas’s drinking. I think you know he’s tried to reduce it again? Well, things are not going well with that. It used to be okay. We’d go out with friends; he’d have one or two beers. I’d have a glass of wine.

Last week, I found him passed out at our kitchen counter.

I think even the children know now. Take last night, we were out for dinner. We both had a glass of wine. But he downed his quickly, had another one or two. And the next thing I know, he’s yelling at Christian about making a mess. I think he was drinking before we went out. Christian had no idea why Daddy was yelling at him. And later, Olivia, Olivia told me she doesn’t want to go out to eat anymore.

I’m worrying about his job, too. Thomas doesn’t know I know. But his assistant, Jiao, told me in confidence that he’s falling way behind, and she’s been covering for him. She’s pretty sure the partners are going to notice soon. And if he loses his partnership….

Do you think he really is an alcoholic? He’s not falling down drunk all the time. And he isn’t abusive towards me and the kids. But maybe he does need some kind of treatment plan? How would we deal with withdrawal if he finally stops completely? Can you help us find the right kind of care? Maybe something where this won’t get out in public? I don’t want him to lose his clients.

[sigh] I guess I have a lot of questions and I don’t know what to do.

Part 1:Identify screening/measurement tool to assess for alcohol use disorder and alcohol withdrawal. Complete the screening tool, based on the information that you have

2.As the prescribing provider, you need to evaluate the pharmacological treatment options for Thomas to help with his alcohol use. Choose three medications to treat alcohol use disorder and discuss when and how to use them on this  pt

Part 2: Drug A

Drug Generic and Brand Names

When to Use the Drug for Treating Alcohol Use Disorder

Starting Dose

Maintenance Dose

Patient Education

Reference(s)

Part 2: Drug B

Drug Generic and Brand Names

When to Use the Drug for Treating Alcohol Use Disorder

Starting Dose

Maintenance Dose

Patient Education

Reference(s)

Part 2: Drug C

Drug Generic and Brand Names

When to Use the Drug For Treating Alcohol Use Disorder

Starting Dose

Maintenance Dose

Patient Education

Reference(s)

Part 3

1. Explain the signs and symptoms of alcohol withdrawal to Joanne.
2. When should she expect mild, moderate, and severe alcohol withdrawal symptoms?
3. What should Joanne do if she suspects that Thomas is experiencing moderate to severe alcohol withdrawal?
4. What are the potential dangers associated with alcohol withdrawal?

ANSWER

Part 1: Screening/Measurement Tool and Assessment

For assessing alcohol use disorder (AUD) and alcohol withdrawal, the **AUDIT-C** (Alcohol Use Disorders Identification Test – Consumption) is a widely used screening tool. It comprises three questions that help in identifying risky drinking behaviors and the need for further evaluation.

AUDIT-C Questions

How often do you have a drink containing alcohol?
Never
Monthly or less
2 to 4 times a month
2 to 3 times a week
4 or more times a week

How many standard drinks containing alcohol do you have on a typical day when you are drinking?
1 or 2
3 or 4
5 or 6
7 to 9
10 or more

How often do you have six or more drinks on one occasion?
Never
Less than monthly
Monthly
Weekly
Daily or almost daily

Thomas’s AUDIT-C Assessment

1. How often does Thomas have a drink containing alcohol?
– 2 to 3 times a week

2. How many standard drinks containing alcohol does Thomas have on a typical day when he is drinking?
– 5 or 6

3. How often does Thomas have six or more drinks on one occasion?
– Less than monthly

Part 2: Pharmacological Treatment Options for Alcohol Use Disorder

Drug A: Disulfiram (Antabuse

When to Use: Disulfiram is used as a deterrent to alcohol consumption. It causes unpleasant symptoms when combined with alcohol, discouraging drinking.
Starting Dose: 250 mg daily
Maintenance Dose: 250 to 500 mg daily
Patient Education: Inform Thomas about the disulfiram-alcohol reaction, including symptoms like flushing, nausea, vomiting, and headache. Emphasize the importance of avoiding all forms of alcohol to prevent adverse reactions.
Reference: Substance Abuse and Mental Health Services Administration. (2020). Treatment Improvement Protocol 63: Medications for Opioid Use Disorder.

Drug B: Naltrexone (Vivitrol)

When to Use: Naltrexone helps reduce alcohol cravings and relapse risk by blocking the pleasurable effects of alcohol.
Starting Dose: Oral naltrexone: 25 mg daily; Extended-release injectable naltrexone (Vivitrol): 380 mg monthly
Maintenance Dose: Oral naltrexone: 50 mg daily; Extended-release injectable naltrexone (Vivitrol): 380 mg monthly
Patient Education: Explain how naltrexone works to decrease cravings and suggest combining it with psychosocial therapies for optimal outcomes.
Reference: National Institute on Drug Abuse. (2018). Principles of Drug Addiction Treatment: A Research-Based Guide (Third Edition).

Drug C: Acamprosate (Campral)

When to Use:Acamprosate helps with maintaining abstinence and reducing withdrawal symptoms.
Starting Dose: 666 mg (two 333 mg tablets) three times daily
Maintenance Dose; 666 mg (two 333 mg tablets) three times daily
Patient Education:Educate Thomas about the role of acamprosate in supporting his abstinence efforts, including its effects on neurotransmitter balance.
Reference: Center for Substance Abuse Treatment. (2015). Medication-Assisted Treatment for Opioid Addiction in Opioid Treatment Programs.

Part 3: Alcohol Withdrawal and What Joanne Should Know

Signs and Symptoms of Alcohol Withdrawal: Joanne should be aware that alcohol withdrawal symptoms can include anxiety, tremors, sweating, increased heart rate, nausea, vomiting, and seizures.
Mild, Moderate, and Severe Alcohol Withdrawal Symptoms: Mild symptoms may include anxiety and insomnia. Moderate symptoms can involve increased heart rate, elevated blood pressure, and confusion. Severe symptoms might include hallucinations, seizures, and delirium tremens.
Action for Moderate to Severe Withdrawal: If Joanne suspects Thomas is experiencing moderate to severe withdrawal, she should seek immediate medical attention to ensure his safety.
– **Potential Dangers of Alcohol Withdrawal: Severe alcohol withdrawal, such as delirium tremens, can be life-threatening due to the risk of seizures, cardiovascular complications, and dehydration.

Conclusion

Utilizing the AUDIT-C as a screening tool, considering pharmacological treatment options like Disulfiram, Naltrexone, and Acamprosate, and understanding alcohol withdrawal symptoms and dangers are crucial steps in addressing Thomas’s alcohol use disorder. By working together with healthcare professionals, Thomas and Joanne can navigate the challenges of alcohol treatment and improve Thomas’s overall well-being.