Alcohol use disorder remains one of the most prevalent conditions in the US and across the globe. Figures shared by the Centers for Disease Control and Prevention (CDC) indicate that the number of individuals afflicted by this disorder is worryingly high. According to the CDC, as many as 25.1% of adults in the US report involving in heavy drinking (CDC, 2017). Additionally, CDC data shows that alcohol use disorder is responsible for over 20,000 deaths resulting from liver disease. While shocking, these figures should jolt the US into action. The case of the 51 year old divorcee who has struggled with alcohol use disorder for decades underscores the damage that this condition can cause. Fortunately for this patient, there are a number of effective interventions that can be administered. To treat his condition, it is proposed that he should be provided with lorazepam or oxazepam, some of the pharmacological interventions proven to alleviate the symptoms of and alleviate and facilitate recovery from alcohol use disorder in patients with liver cirrhosis.
Summary of Evidence
The clinical reference provides valuable information that will inform the interventions delivered to the patient. As noted above, this patient is 51 years old and is divorced. He reports that he has struggled with binge drinking for over 36 years. His drinking has taken a toll on his physical and mental health. In addition to being diagnosed with liver cirrhosis which is a direct result of his years of binge drinking, the patient also exhibits symptoms that are consistent with such mental illnesses as depression. For instance, he expresses frustration at his inability to abandon his destructive behaviors and lacks the motivation to attend Alcoholic Anonymous meetings. The patient’s health is not the only component of his life that has witnessed the ravaging effects of his binge drinking. His romantic relationships have also suffered. In addition to leading to his divorce, the alcohol use has also strained his relationship with his fiancé who has made it clear that she will only marry him if he commits fully to treatment. The patient’s sexual health has also suffered the effects of alcoholism. According to the clinical reference, he also reports erectile dysfunction that must have caused damage to his sexual health. There is a need to note that the patient also exhibits symptoms that may not be related to the binge drinking. For example, he is overweight. While there is no explicit evidence that his dangerously high weight is the result of the drinking, this is indeed a possibility. Research suggests that there is a direct relationship between alcohol use disorder and obesity (Marks, 2018). It is unfortunate that the case of this patient is not isolated. There is ample evidence that highlights the damage that alcoholism causes. For example, alcohol use disorder has bene linked to poor mental health outcomes as well as physical ailments such as liver cirrhosis (Maimone et al., 2019). Additionally, research evidence blames for broken marriages and families (Park, Schepp & Park, 2016). To ensure that the patient’s wellbeing does not suffer further, urgent and effective interventions are needed.
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Plan of Care
When developing plans of care, practitioners need to be guided by the symptoms that patients exhibit. The fact that the patient described above presents a number of complex symptoms makes the development of a comprehensive plan of care rather difficult. It is nearly impossible to identify a single intervention that addresses all his needs. The clinical reference provided above offers valuable information that applies directly to the patient’s symptoms, diagnosis and interventions to be administered. For example, in addition to helping the patient to abandon alcohol use, the intervention selected should also help to relieve the symptoms of cirrhosis of the liver. It is also important to ensure that the intervention addresses the patient’s mental health. In an earlier section, it was pointed out that the patient will be provided with lorazepam as part of his treatment. Below, it is shown that there is ample and compelling evidence that establishes Baclofen as a safe and highly effective intervention.
Extensive studies have been conducted to determine the impact of Lorazepam on the outcomes and wellbeing of individuals struggling with substance abuse. Thanks to these studies, it has been proven conclusively that Lorazepam is among the few pharmacological interventions which help to improve the symptoms of patients struggling with alcohol abuse and also ailing from liver cirrhosis. For example, Leggio and Lee (2017) performed a study in which they examined the various treatments for these conditions. In their text, they endorse Lorazepam as among the most effective and safest medications. They add that Lorazepam remains effective even when liver cirrhosis compromises the proper function of the liver. The implication of this observation is that Lorazepam can be administered on patients whose liver disease has reached advanced stages, as is true for the patient in the case study. It should be noted that Leggio is part of a growing list of researchers who have established the safety and effective of Lorazepam. Addolorato, Mirijello, Barrio and Gual (2016) joined Leggio and Lee in endorsing Lorazepam. These researchers report in their article that Lorazepam has the distinct advantage of having a shorter half-life. This means that this medication undergoes faster metabolism and is therefore faster acting.
It is true that there are various medications for treatment of alcohol use disorder among patients who have also been diagnosed with liver cirrhosis. This raises the question of why Lorazepam has been proposed. The reason for the choice of this medication lies in the fact that alternative medications have serious drawbacks. For example, as Mosoni et al. (2018) found out, the safety of such other medications as Baclofen is yet to be proven. They caution that little is known about the safe dosage of this treatment. Furthermore, these researchers add that few studies have been conducted on Baclofen. On the other hand, the evidence establishing the safety and effectiveness of Lorazepam is overwhelming, as shown above. Apart from medication, there are such other interventions as participating Alcoholics Anonymous meetings. In the case study, the patient laments that these meetings are pointless and suggests that they are boring. Since the patient lacks interest in the AA meetings, it would be unwise to encourage him to attend the meetings. Therefore, Lorazepam remains the most promising intervention.
Reflection
The case study involving the patient discussed above has shed light on the complex dynamics involved in meeting the needs of patients. I intend to use the information that I have gathered from this exercise in various ways in my future practice. In particular, through the exercise, I have learnt that Lorazepam is a highly effective medication. I would consider using this treatment in all cases of patients with alcohol use disorder who also wish to be treated for liver cirrhosis. To ensure that this treatment is appropriate, I would require that the patient should exhibit the same symptoms as those of the patient in the case study. This is because I need to exercise care and make sure that the treatment is only administered on patients who stand to benefit. While I am confident about the effectiveness of Lorazepam, I have some serious concerns. Among my main concerns is the fact that this medication does little to address the mental health problems for which patients need treatment. For instance, Lorazepam would not help to elevate the mood of a patient or enable them to combat depression. Another concern is that this medication has some side effects. These include memory loss, restlessness, mouth sores, insomnia and headaches, among many others (“What are the Dangers”, 2019). While these side effects are serious, they do not cause me to worry or be anxious. This is because the benefits of Lorazepam far outweigh the side effects and other risks.
References
Addolorato, G., Mirijello, A., Barrio, P., & Gual, A. (2016). Treatment of alcohol use disorders in patients with alcoholic liver disease. Journal of Hepatology, 65 (3), 618-30.
Centers for Disease Control and Prevention (CDC). (2017). Alcohol use. CDC. Retrieved September 7, 2019 from https://www.cdc.gov/nchs/fastats/alcohol.htm
Leggio, L., & Lee, M. R. (2017). Treatment of alcohol use disorder in patients with alcoholic liver disease. The American Journal of Medicine, 130 (2), 124-134.
Maimone, S., Saffioti, F., Oliva, G. et al. (2019). Erectile dysfunction in compensated liver cirrhosis. Digestive & Liver Disease, 51 (6), 843-9.
Marks, R. (2018). Obesity, depression, and alcohol linkages among women. Advances in Obesity Weight Management & Control, 8 (5), 246-9.
Mosoni, C., Dionisi, T., Vassallo, G. A. et al. (2018). Baclofen for the treatment of alcohol use disorder in patients with liver cirrhosis: 10 years after the first evidence. Frontiers in Psychiatry. doi: 10.3389/fpsyt.2018.00474
Park, S., Schepp, K.G., & Park, D. (2016). Living with appending a scarlet letter: The lifelong suffering of children of alcoholics in South Korea. Journal of Ethnicity in Substance Abuse, 15 (4), 367-85.
What are the dangers of long-term use of Ativan? (2019). American Addiction Centers . Retrieved September 7, 2019 from https://americanaddictioncenters.org/ativan-treatment/long-term
