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Topic: Substance Use Disorder
Case scenario:
Pam is a 53-year-old woman who comes into the clinic reporting problems with sleep for the past 5 months. She tells you that she has been using over-the-counter sleep aids but has not found them helpful. Even though they help her fall asleep, she wakes up multiple times every night. She also feels groggy for several hours in the morning.
Pam later explains that in fact she has always had sleep issues. She used to drink a glass of wine in the evening, and that was enough to put her to sleep. In recent years, one glass has not been sufficient, and even when she drinks three or four glasses of wine, that might not be enough. As you inquire further about her alcohol use, you find out that on average, she drinks two glasses of wine on weekday evenings and three to four glasses of wine on weekend evenings. She says that she never gets drunk and she does not think that her drinking is problematic.
You remember that you attended a training on Screening, Brief Intervention, and Referral to Treatment (SBIRT) and decide to put it to good use. You administer an Alcohol Use Disorder Identification Test (AUDIT-C) screen and give Pam a score of 8. You perform Brief Intervention (BI) and schedule her to return in 2 weeks for a follow-up. Three days later, you receive a call from a nearby hospital. Pam was arrested for drunk driving, and during the encounter with law enforcement officers, she fell and hit her head. During transport, she had an episode of emesis, aspirated, and had to be intubated. The technicians found your card in her wallet.
Three days into her admission, Pam develops a generalized tonic-clonic seizure. After hospital discharge, the patient returns to your office and admits that she had minimized her alcohol drinking and that, in fact, she drinks more than twice as much as she had initially told you. She did not start drinking alcohol until her late 20s, but in her mid-40s, her two best friends were killed in a car accident. She was the only survivor of the car crash, and she began drinking heavily afterward. Pam tried to quit “cold turkey” on multiple occasions but each time would feel “sick” to the point where “only alcohol would make me feel better.” She had made attempts to cut down but found that she would begin drinking more within a few days. She has never been in formal alcohol treatment.
Pam thinks that her drinking makes her depression worse, because “it just makes me numb, but my life is still a mess when I sober up, so I feel even worse and drink again.” Although she wakes up early, she feels anxious and shaky in the morning and then drinks alcohol to calm herself. She then has to wait at least 4 hours before she can start her day, and this affects her work. She has received several citations at work because of her behavior. The patient tells you she wants help quitting alcohol and that she never wants to drink again.
· How would you classify Pam’s drinking habits?
· How does alcohol affect sleep?
· What is SBIRT? How is it effective in helping clients?
· What laboratory testing will you recommend for Pam?
· What are the signs and symptoms of alcohol intoxication?
· What is the cause for Mrs. Pam’s seizure?
· What medications are effective in treating alcohol withdrawal disorder?
