Behavioral couples therapy has been shown to improve marital satisfaction, and improving relationship functioning is conducive to sobriety—therefore, patients with motivated partners can ben- efit from this intervention (U.S. Department of Veterans Affairs, 2021). Motivational enhancement therapy is a less intensive psychosocial intervention that utilizes motivational interviewing to elicit patient reactions to feedback, help patients commit to change, and en- courage collaboration on a plan to change their behavior. It helps improve the patient’s awareness of their own ambivalence about changing their behavior and enhances their self-efficacy. Patients are encouraged to involve a significant other in at least one ses - sion in order to improve outcomes (U.S. Department of Veterans Affairs, 2021). Conclusion Patients who suffer from AUD have a number of hurdles to over- come in their road to recovery. AUD can be a serious, lifelong condition that affects many aspects of the patient’s life. Regardless of the severity of their condition, most patients will re- quire customized treatment based on patient factors, preferences, American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders, fifth edition (DSM-5) . American Psychiatric Association (APA). https://dsm. psychiatryonline.org/doi/book/10.1176/appi.books.9780890425596 • American Society of Addiction Medicine. (2020). The ASAM clinical practice guideline on alcohol withdrawal management. Journal of Addiction Medicine , 14 (3S Suppl 1), 1-72. https://doi.org/10.1097/ADM.0000000000000668 • Centers for Disease Control and Prevention (CDC). (2019). Excessive drinking is draining the US economy. https://www.cdc.gov/alcohol/features/excessive-drinking.html • Dugdale, D. (2021). Alcohol withdrawal. National Library of Medicine: Medline Plus. • https://medlineplus.gov/ency/article/000764.htm • Edelman, E. J., & Fiellin, D. A. (2016). In the clinic: alcohol use. Annals of Internal Medicine , 164 (1), ITC1-ITC16. https://doi.org/10.7326/AITC201601050 • Hoffman, R. S. & Weinhouse, G. L. (2021). Management of moderate and severe alcohol withdrawal syndromes. UpToDate . https://www.uptodate.com/contents/management- of- moderate-and-severe-alcohol-withdrawal-syndromes • Holt, S. R. (2021). Alcohol use disorder: Pharmacologic management. UpToDate . https:// www.uptodate.com/contents/alcohol-use-disorder-pharmacologic-management • Kim, Y., Hack, L. M., Ahn, E. S., & Kim, J. (2018). Practical outpatient pharmacotherapy for alcohol use disorder. Drugs in Context, 7, 212308. doi: 10.7573/dic.212308 • Klochkov A., Kudaravalli P., Lim Y., et al. (2022, January). Alcoholic pancreatitis. In StatPearls . • StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK537191/ National Institute on Alcohol Abuse and Alcoholism. (2021). Understanding alcohol use • disorder . https://www.niaaa.nih.gov/publications/brochures-and-fact- sheets/understanding- alcohol-use-disorder • Pace, C. (2021). Alcohol withdrawal: Epidemiology, clinical manifestations, course, assessment, and diagnosis. UpToDate . https://www.uptodate.com/contents/alcohol- withdrawal- epidemiology-clinical-manifestations-course-assessment-and-diagnosis References •
Twelve-step facilitation therapy is utilized to help the patient be- come more actively involved in 12-step programs. It involves 12 sessions of individual therapy that encourage the use of and help the patient understand the steps of the 12-step program. Ses- sions are structured and are spent reviewing events of the past week related to recovery, introducing material related to the 12 steps, and creating a homework assignment and developing a plan for the next week’s recovery-related activities. Twelve-step facilitation therapy has consistently improved participation in 12- step programs and produced significant improvements in some drinking outcomes such as abstinence when compared to cog- nitive behavioral therapy or motivational enhancement therapy (U.S. Department of Veterans Affairs, 2021). and comorbid disease states. Medication options, psychosocial therapy, and nutritional support can be utilized to develop a tai- lored, patient- specific treatment plan. Many patients will require more than one attempt at quitting, and health care providers can offer motivation and support throughout their journey. • Patel R., & Mueller, M. (2022, January). Alcoholic liver disease. In StatPearls . StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK546632/ • Reus, V. I., Fochtmann, L. J., Bukstein, O., Eyler, A. E., Hilty, D. M., Horvitz-Lennon, M., Mahoney, J., Pasic, J., Weaver, M., Wills, C. D., McIntyre, J., Kidd, J., Yager, J., & Hong, S. • H. (2018). The American Psychiatric Association practice guideline for the pharmacological treatment of patients with alcohol use disorder. The American Journal of Psychiatry , 175 (1), 86-90. https://doi.org/10.1176/appi.ajp.2017.1750101 • Stahl, S. (2020). Essential psychopharmacology: Prescribers guide (7th ed.). Cambridge University Press. • Stanford University. (2021). What is BAC? https://super.stanford.edu/alcohol-drug-info/buzz- buzz/what-bac • Substance Abuse and Mental Health Services Administration. (2021). Key substance use and mental health indicators in the United States: Results from the 2020 National Survey on Drug Use and Health (HHS Publication No. PEP21-07-01-003, NSDUH Series H-56). • Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration. https://www.samhsa.gov/data/sites/default/files/reports/rpt35325/ NSDUHFFRPDFWHT MLFiles2020/2020NSDUHFFR1PDFW102121.pdf • Tetrault, J. M. & O’Connor, P. G. (2021). Risky drinking and alcohol use disorder: Epidemiology, pathogenesis, clinical manifestations, course, assessment, and diagnosis. UpToDate . https://www.uptodate.com/contents/risky-drinking-and-alcohol-use-disorder- epidemiology-pathogenesis-clinical-manifestations-course-assessment-and-diagnosis • UC Santa Cruz. (2019). Alcohol and your body. https://shop.ucsc.edu/alcohol-other- drugs/alcohol/your- body.html#:~:text=Approximately%2020%25%20of%20alcohol%20 is,understanding%20 the%20effects%20of%20alcohol. • U.S. Department of Veterans Affairs. (2021). VA/DoD clinical practice guideline for the management of substance use disorders. https://www.healthquality.va.gov/guidelines/mh/ sud
ADDICTION MEDICINE PART 2: ALCOHOL Self-Assessment Answers and Rationales
1. The correct answer is C. Rationale: Jane is of Japanese ethnicity. Up to 50 percent of people of Asian descent are less able to metabolize alcohol because of an inactive liver enzyme needed for metabolism, resulting in more rapid intoxication, flushing, dizziness, nausea, headache, and rapid heartbeat with alcohol use. 2. The correct answer is C. Rationale: A number of complications can arise from alcoholic liver disease, including variceal bleeding, ascites, peritonitis, renal failure, and encephalopathy. 3. The correct answer is B. Rationale: Thiamine should be given to prevent Wernicke’s encephalopathy. Folate and magnesium supplementation may be necessary in patients with these nutritional deficiencies, and lorazepam can be used in alcohol withdrawal treatment, but these are not treatments for Wernicke’s encephalopathy. 4. The correct answer is A. Rationale: Age of 48 years is not a risk factor for severe or complicated withdrawal; age over 65 years is a risk factor. Other risk factors include: ● Prior history of alcohol withdrawal seizures or delirium ● Medical or surgical comorbidities, especially traumatic brain injury
● Seizures or significant autonomic hyperactivity during the cur- rent withdrawal episode ● Dependence on medications that enhance GABA such as benzodiazepines or barbiturates ● Use of other addictive substances in conjunction with alcohol ● Signs and symptoms of withdrawal in conjunction with a posi- tive blood alcohol concentration ● Moderate to severe co-occurring psychiatric disorder 5. The correct answer is C. Rationale: Benzodiazepines are recommended as first-line treatment for alcohol withdrawal delirium. Administration of intravenous benzodiazepines to achieve a light sedation where the patient is awake but tends to fall asleep unless stimulated is recommended to help control agitation and maintain patient safety. 6. The correct answer is C. Rationale: Disulfiram is prescribed to help dissuade patients from drinking, and it works by inhibiting aldehyde dehydrogenase, the enzyme involved in metabolism of the primary metabolite of alcohol, acetaldehyde. If alcohol is consumed in the presence of disulfiram, acetaldehyde levels increase to toxic levels, creating very unpleasant side effects.
● Numerous prior episodes of withdrawal ● Long history of regular, heavy alcohol use
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