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 vomiting are increasing, intervention may become more critical to avoid further deterioration and health-care costs (Sobell, Toneatto, & Sobell, 1995).
Assessment guidelines promulgated by the National Institute on Alcohol Abuse and Alcoholism (NIAAA, 1995) are reduced to two major recommendations: Ask about typical drinking patterns, and ask about personal and family history. A variety of psychometric instruments can be marshaled into identifying the specifics of a case. Wha...