### Case Study Analysis: Substance Use Disorders
#### Case Overview
**Patient:** Mr. A
**Age:** 45
**Diagnosis:** Alcohol Use Disorder
Mr. A has a history of heavy alcohol use over the past 20 years. He reports consuming approximately 10-12 drinks daily and has experienced withdrawal symptoms during past attempts to reduce his drinking. He has no significant medical history and is currently not on any medication.
#### Drug Treatment Plan
**Step 1: Initial Assessment and Detoxification**
The first step in managing Mr. A’s Alcohol Use Disorder is addressing acute withdrawal, which can be life-threatening. Based on clinical guidelines, benzodiazepines are the first-line treatment for managing alcohol withdrawal symptoms.
**Medication:** Diazepam (Valium)
**Prescription:**
– **Diazepam 10 mg**
– **Sig:** Take 10 mg orally every 6 hours for the first 24 hours, then reduce dose gradually over the next 5-7 days
– **Disp:** Quantity sufficient for 7 days
– **Refills:** None
**Rationale:** Diazepam has a long half-life, which provides smoother withdrawal and reduces the risk of severe withdrawal symptoms such as seizures and delirium tremens (Mayo-Smith, 1997).
**Step 2: Maintenance Therapy and Relapse Prevention**
Once detoxification is complete, the focus shifts to preventing relapse. Several pharmacotherapies are available for maintaining abstinence and reducing cravings.
**Medication:** Naltrexone (Vivitrol)
**Prescription:**
– **Naltrexone 50 mg**
– **Sig:** Take 50 mg orally once daily
– **Disp:** 30 tablets
– **Refills:** 2
**Rationale:** Naltrexone is an opioid antagonist that reduces the euphoric effects of alcohol, thereby decreasing the desire to drink and preventing relapse (Anton et al., 2006).
**Alternative Medication:** Acamprosate (Campral)
**Prescription:**
– **Acamprosate 666 mg**
– **Sig:** Take 666 mg orally three times daily
– **Disp:** 90 tablets
– **Refills:** 1
**Rationale:** Acamprosate helps to maintain abstinence by modulating neurotransmission and reducing post-acute withdrawal symptoms (Mason & Ownby, 2000).
**Step 3: Behavioral and Psychosocial Interventions**
Pharmacotherapy should be combined with behavioral interventions to increase the likelihood of long-term success.
**Recommendations:**
– **Referral to Cognitive-Behavioral Therapy (CBT):** CBT can help Mr. A develop coping strategies to manage triggers and stressors that contribute to his drinking (Morgenstern & Longabaugh, 2000).
– **Support Groups:** Encourage participation in Alcoholics Anonymous (AA) or other support groups to provide social support and accountability.
#### Potential Barriers and Strategies to Overcome Them
1. **Adherence to Medication:**
– **Barrier:** Mr. A may struggle with adherence to his medication regimen due to cognitive impairment or lack of motivation.
– **Strategy:** Use long-acting injectable forms (e.g., monthly naltrexone injections) to improve adherence and reduce the burden of daily medication.
2. **Psychosocial Factors:**
– **Barrier:** Mr. A may face social stigma or lack of support from family and friends.
– **Strategy:** Engage family members in therapy sessions to educate them about Alcohol Use Disorder and create a supportive environment for Mr. A.
3. **Access to Behavioral Therapies:**
– **Barrier:** Limited access to specialized therapists or financial constraints may impede participation in behavioral interventions.
– **Strategy:** Utilize telehealth services for therapy sessions and explore community resources or sliding scale fees for low-cost options.
#### Conclusion
The proposed treatment plan for Mr. A includes initial detoxification with diazepam, maintenance therapy with naltrexone or acamprosate, and integration of behavioral interventions such as CBT and support groups. By addressing potential barriers and providing a comprehensive, multidisciplinary approach, the likelihood of successful long-term recovery is increased.
### References
– Anton, R. F., O’Malley, S. S., Ciraulo, D. A., et al. (2006). Combined pharmacotherapies and behavioral interventions for alcohol dependence: The COMBINE study. *JAMA*, 295(17), 2003-2017.
– Mason, B. J., & Ownby, R. L. (2000). Acamprosate for the treatment of alcohol dependence: a review of double-blind, placebo-controlled trials. *CNS Spectrums*, 5(2), 58-69.
– Mayo-Smith, M. F. (1997). Pharmacological management of alcohol withdrawal. *JAMA*, 278(2), 144-151.
– Morgenstern, J., & Longabaugh, R. (2000). Cognitive-behavioral treatment for alcohol dependence: a review of evidence for its hypothesized mechanisms of action. *Addiction*, 95(10), 1475-1490.
Please let me know if you need any additional information or modifications.
ASSIGNMENT: CASE STUDIES
Case studies are a useful way for you to apply your knowledge of pharmacokinetics and pharmacodynamic aspects of pharmacology to specific patient cases and health histories.
For this Assignment, you evaluate drug treatment plans for patients with various disorders and justify drug therapy plans based on patient history and diagnosis.
RESOURCES
Be sure to review the Learning Resources before completing this activity. Click the weekly resources link to access the resources.
To Prepare:
· Review the case study posted in “Announcements” by your Instructor for this Assignment
· Review the information provided and answer questions posed in the case study
· When recommending a medication, write out a complete prescription for the medication
· Whenever possible, use clinical practice guidelines in developing your answers when possible
· Include at least three references to support your answer and cite them in APA format.
LEARNING RESOURCES
Lecturio Resources
Required Readings
· Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.). Elsevier.
· Chapter 32, “Substance Use Disorders I: Basic Considerations” (pp. 255a–259)
· Chapter 33, “Substance Use Disorders II: Alcohol” (pp. 260–266)
· Chapter 34, “Substance Use Disorders III: Nicotine and Smoking” (pp. 267–272)
· Chapter 35, “Substance Use Disorders IV: Major Drugs of Abuse Other Than Alcohol and Nicotine” (pp. 273–284)
· Chapter 60, “Drug Therapy for Gout” (pp. 528–536)
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