Case-study Protocol for an Alcohol

This research sets forth a case-study protocol for an alcoholic coming to a medical clinic with increased nausea and vomiting. The following components of the protocol will be examined: assessment, diagnosis, treatment planning, case management, and teaching the patient how to manage the condition outside the clinical setting. For each component, appropriate evaluation instruments will be identified, and appropriate reference to relevant literature will be made.

Because the case study assumes the patient presents with increased nausea and vomiting, it may seem reasonable to presume that the patient has already been identified as alcoholic, hence subject to a range of symptoms of which nausea and vomiting may be typical and a candidate for acute intervention. Dayer-Berenson (2002) cautions against failing to address alcohol addiction as the underlying cause of another clinic-admitting diagnosis. Alcoholic patients, she explains, "often present with a medical or psychological problem that appears to be totally unrelated to alcohol." That is why appropriate assessment is so important.

Early-stage alcoholism has been associated with gastrointestinal complaints, including nausea, vomiting, indigestion, esophageal reflux (indicating accumulated acid in stomach and/or inflamed stomach lining, consistent with nausea, vomiting) right-abdominal pain, and irritable bowel syndrome, as well as ulcers (Hill & Kugelmas, 1998). If the known alcoholic patient's nausea and vomiti

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or the lack of pressure from family, friends, and employers to seek treatment (Geller, et al., 2000). NIAAA guidelines say that patients should be advised to abstain altogether from alcohol under these conditions: evidence of alcohol dependence history of repeated failed attempts to cut down pregnant or trying to conceive contraindicated medical condition or medication Patients should be advised to cut down drinking if they are drinking above recommended low-risk amounts and "there is no evidence of alcohol dependence" (NIAAA, 1995). In this case, the comorbidity of nausea and vomiting, consistent with the last bulleted item above, suggests that the best plan is to abstain from alcohol. NIAAA guidelines say that the next step is a patient referral for additional diagnosis and treatment, under these conditions: involving the patient in the referral decision; discussing alcohol-treatment services that are available; scheduling a referral appointment with the patient still in the office (NIAAA, 1995). Various abstinence-treatment options and philosophies exist: inpatient, outpatient, and self-help. These options may overlap and converge to some extent. Outpatient treatment programs include education and counseling, group bon

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