James Fit: A Case Study Essay

Client reported alcohol as his drug of choice with the last use date of March, 2017. No acute intoxication or withdrawal symptoms were reported. No treatment plan was developed in this dimension. Client appears to be stable at this time.

At each visit, the study assessed the severity of patient 's depression, as well as the frequency and amount of drinking between visits. After 12 weeks in the study, 53% of participants were in remission from their depression. Two thirds or 66% had avoided relapsing into heavy drinking, and 49% totally refrained form drinking during the study. Results showed that any relapse to heavy drinking was associated with reduced likelihood of a depression remission or depressive symptoms.

On December 23rd, 1954 an interview was taken place with a new client by the name of Andrew Laeddis. In order to assist Andrew with the highest patient care, a full detailed biopsychosocial assessment report has been processed on his behalf. This assessment consists of Andrew’s demographics, his presenting problem, any potential precipitating factors, social relationships, hobbies/activities, occupation/education status, medical history, legal status, and substance use/abuse. This will also include a brief statement of Andrew’s participation, personal values/attitudes, personal strengths, and diagnosis.

F.C. is a 54-year-old man with a history of chronic heavy alcohol use. He has frequent bouts of gastrointestinal bleeding for which he has been hospitalized on six separate occasions over the years. He continues to drink and exhibits most of the common manifestations of alcoholic cirrhosis. He was recently hit by a car and was hospitalized for a broken leg. He appeared to be under the influence of alcohol at the time of the accident and had a blood alcohol level of 0.18. F.C.’s family reports that his mental functioning has deteriorated significantly over the past few months.

Research was done to compare gabapentin to lorazepam in the treatment of alcohol withdrawal. Myrick, Malcolm, Randall, Boyle, Anton, Becker, and Randall (2009) performed a randomized double-blind treatment on 100 individuals seeking outpatient treatment of alcohol withdrawal with Clinical Institute Withdrawal Assessment for Alcohol-Revised(CIWA-Ar) ratings ≥10. Subjects were either given 2 doses of gabapentin, 900 mg tapering to 600 mg or 1200 mg tapering to 800 mg; or given lorazepam, 6 mg tapering to 4 mg for 4 days. Severity of withdrawal from alcohol was measured by the CIWA-Ar on days 1-4 of treatment and days 5, 7, and 12 post treatment. Verbal reports and breath alcohol levels were measurements of alcohol use. Results showed that CIWA-Ar scores reduced in all groups overtime. High-dose gabapentin statistically did the best but was clinically similar to lorazepam. Lorazepam patients had higher probabilities of drinking on day 2 (the first day the dosage decreased), as well as the second day off the medication. Gabapentin treated groups were less likely to have craving, anxiety and sedation compared to the lorazepam treated groups. Overall, the gabapentin treated group had a less probability of drinking and was well tolerated. Some limitations to the study were that the participants selected had mild to moderate withdrawal severity and were in better general health than patients presenting the ED or hospitals. Also, no placebo group was

Alcohol withdrawal syndrome: A group of symptoms which may range from mild to severe, usually occurring 6-24 hours after the last alcohol intake. The health issues involved in this syndrome are delirium tremens, seizures, Wernicke-Korsakoff syndrome, depression, liver disease, and electrolytes disturbances. The mild symptoms may be managed at the outpatient setting and there severe symptom in the hospital under close supervision and benzodiazepine therapy (McKeon, Frye & Delanty, 2008)

Current symptoms or indicators: Recently admitted to emergency room with heart attack symptoms. Chest pain, inability to breathe and irregular heartbeat Client has admitted he is scared

The principle of treatment therapy is to helping the patients to reduce problematic drinking, deterring relapse back to heavy drinking and achieving and maintaining abstinence from alcohol (Edmunds, 2014). An oral naltrexone (ReVia) or injectable Vivitrol, Acamprosate and Disulfiram are used for the treatment of alcohol abuse (Edmunds, 2014). Disulfiram are used more often if unpleasant physical symptoms when alcohol is ingested but is reported to be more expensive and have reported to have adverse reaction to the patients (Edmunds, 2014). Benzodiazepines such as Lorazepam and Diazepam are also widely used for treatment of alcohol withdrawal. With the side effects and overdosing of benzodiazepines remains controversial in treating alcohol withdrawal and is always in need to monitor the patient for abuse (SAMHSA, 2013). Additionally, social detoxification and lifestyle management would benefit the whole treatment process such as referring the patient to social support groups and encouraging the family to support the patient during the treatment

Alcohol dependence treatments include naltrexone, acamrosate and disulfiram. Naltrexone inhibits opioid receptors that play a role in the pleasure effect of drinking and craving for alcohol. Acamprosate is believed to have effects on reducing withdrawal symptoms like insomnia, anxiety, restlessness and depression. This may be appropriate for patients who are severely alcohol dependent. Disulfiram impedes the breakdown of alcohol which results in vexing symptoms like nausea, flushing, and palpitations if the patient consumes alcohol (National Institute on Drug Abuse, 2009)

Physical symptoms also occur after within an individual addicted to alcohol. Such symptoms include abdominal pain, nausea and vomiting, trembling, and loss of appetite. Signs of physical withdrawal after a period of not drinking, such a waking up in the morning, start occurring because their body builds up a tolerance and then can’t function properly without the alcohol. Withdrawal symptoms begin within 6 to 48 hours and peak about 24 to 35 after the last drink of a person with alcoholism. (Alcoholism, 2010).

Alcohol-dependent people are often unable to stop drinking once they start as alcohol dependence is characterized by tolerance or the need to drink more to achieve the same "high", in addition, serious withdrawal symptoms if drinking is stopped suddenly. The sooner that the individual begins to receive help for the treatment of their alcoholism means that, the shorter period that they will be able to stop use. Individuals who receive treatment

Ethanol’s primary effect on the central nervous system is as a depressant. Chronic alcohol consumption, the CNS remains chronically depressed. This in turn causes down regulation of inhibitory systems, and up regulation of excitatory systems within the body. If chronic alcohol consumption is abruptly stopped the long term depression of these systems is as well. However, now there is a relative excess in excitatory influences such as norepinephrine, cAMP, glutamate receptors, neuronal calcium channels and NMDA channels and a relative deficiency in inhibitory deficiencies such as GABA. While benzodiazepines are the mainstay of alcohol withdrawal treatment, they act only GABA channels to enhance the inhibitory effects of GABA. Dysfunction

Have you ever been sitting in your door room bored when all of a sudden your alcoholic friend texts you and asks if you want to drink? Since you're bored you tell him sure come on over. You invite a couple more friends over and you're having a good time. Then you fall asleep well passed the time your doctor recommends.

Physicians have several options for treating alcohol use disorders. Behavioral therapy can help alcoholics recognize and avoid high-risk situations, and referral to programs that provide peer support, such as Alcoholics Anonymous, can increase a person’s chance of recovery. Therapists can also prescribe medications that decrease the appeal of alcohol. Studies show disulfiram, acamprosate and naltrexone help most people abstain from alcohol. Disulfiram causes unpleasant side effects such as sweating, nausea, headache, vomiting and chest pain when patients consume alcohol. The severity of the effects differs among patients, and is correlated with the amount of alcohol consumed. Naltrexone inhibits euphoric effects or feelings of intoxication

A client admits to alcohol dependency on a consistant and regular basis because the loss of job. The client exhibits hopelessness and depression. The client has explained they experiencing insomnia, and decreased energy to do anything. This explains their poor personal hygiene. As the clinician the safety of the client is of the utmost importance.