MS Alcohol Case Studies

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Alcohol Use and Misuse and Patient Care

Goal: After taking this course, medical students will be able to recognize and categorize alcohol use disorders, as well as the negative health impacts alcohol has on the body.

Learning Objectives

  1. Recognize the continuum of alcohol abuse or dependence as a disease.
  2. Recognize morbidity and mortality in excessive alcohol use.
  3. Achieve successful alcohol intervention through population-tailored treatment.
  4. Identify health disorders caused by drinking above recommended limits.
  5. Identify common warning signs and symptoms of alcohol use and misuse.

Case Study 1: Amanda

Case Focus: Amanda is presented in two different, non consecutive pages. The first time we encounter Amanda is in a "Clinical Choice" question immediately following a discussion of the continuum of alcohol use problems. The second time we meet Amanda is immediately following a page about alcohol consumption in older adults. Again, Amanda's discussion is presented as a "Clinical Choice" question for medical students.

Case Goal: Medical Students will apply their understanding of alcohol use disorders and determine what is best clinically for an older adult who drinks more than the recommended guidelines.

Course Objectives Met: 3 and 4

Patient: Amanda - 67 YOWF

  • Chief Complaint: Difficulty sleeping that hasn't resolved despite past office visits
  • Narrative: Amanda is a 67 year old woman who has a complaint of difficulty sleeping. She has tried OTC and Ambien.
  • Alcohol Use: Two glasses of wine/night
  • AUD Diagnosis: At risk for abuse; drinking above recommended guidelines for her age
  • Relevant Past Medical, Psychosocial, Family History: Difficulty sleeping, not remedied by OTC or Ambien. Revealed that a friend passed away one year ago. Amanda's alcohol use increased at this time; she now is drinking 2 glasses wine/night
  • Take Home Message: In older adults, increased use of alcohol at night can cause increased health concerns. In this case, Amanda's daily use of alcohol is causing her sleep difficulties.
  • Practice Tip: Medical students should be aware that alcohol misuse can manifest differently in older adults than in younger persons.
  • URL's: Meet Amanda; Amanda's Alcohol History

Case Study 2: Phoebe

Case Focus: Phoebe is presented in two different, consecutive pages. The first time we encounter Phoebe is in a "Clinical Choice" question in the last section of the course. We once again deal with Phoebe in the same office visit. Again, Phoebe's discussion is presented as a "Clinical Choice" question for medical students. The case focuses on treating adolescents and determining whether alcohol is a contributing factor in a depression diagnosis.

Case Goal: Medical Students will apply their understanding of alcohol use disorders among adolescents, as well as their understanding of consent.

Course Objectives Met: 5

Patient: Phoebe - 15YOWF

  • Chief Complaint: Suspected depression, coupled with other contributing factors, such as rebellion and known alcohol use
  • Narrative: Her mother brings her in and describes the difficulties of the past year. Among these troubles, the mother recounts conflicts about piercings, tattoos, musical taste, clothing selection, and alcohol use. Phoebe is being brought to your attention due to mother's concern about whether her daughter has depression.
  • Alcohol Use: 2 beers at a sitting during parties with friends
  • AUD Diagnosis: At risk for alcohol use disorder. Though her use is illegal as she is underage, her use has not had any significant medical repercussions.
  • Relevant Past Medical, Psychosocial, Family History: Parental stress combined with adolescent peer pressure may be contributing to problem
  • Take Home Message: Sometimes alcohol use may be present, but may not be the entire diagnosis. In this case, Phoebe shows signs of depression, her alcohol use contributing to this disorder. The medical student should counsel Phoebe as any alcohol use at her age is illegal.
  • Practice Tip: Speaking to Phoebe without her mother in the room helped her be more honest.
  • URL's: Case Study


The Role of the Physician in Alcohol Abuse Detection and Treatment

Goal: Through this course, students will understand how their role as a physician can influence patients who misuse alcohol, learn effective communication skills, and gain clinical skills in interviewing and working as part of a multi-disciplinary team.

Learning Objectives:

  1. Understand that all physicians, no matter what specialty, can and should assess patients for alcohol abuse or dependence.
  2. Work as part of a multidisciplinary team of physicians and specialists, forming partnerships and utilizing the strengths of each contributory member.
  3. Explain treatment decisions and treatment confidentiality with patients as part of informed consent procedures.
  4. Utilize your position as a physician to listen to patients who are reluctant to disclose alcohol use.

Case Study 1: Tim

Case Focus: Tim is presented in five different, consecutive pages. Tim is introduced in a section titled "Multidisciplinary Teamwork" and follows a page about referral for treatment. Because of the length of this case, Tim's history is thoroughly presented, along with sample patient/doctor dialogue to motivate Tim and seek treatment for his alcohol misuse.

Case Goal: Medical students will apply their knowledge to assess for alcohol use and work as part of a multidisciplinary team, utilizing the strengths of each contributory member, in order to refer to specialist treatment.

Course Objectives Met: 1, 2

Patient: Tim - 32YOWM

  • Chief Complaint: Nausea and sleeplessness
  • Narrative: Tim is a 32 year old construction worker who has received a DUI. In order to get his license back, he must got through court-ordered treatment for his alcohol use. He's been referred to you because of suspected withdrawal symptoms. Tim appears highly motivated to change and has developed a sobriety plan with his treatment counselor.
  • Alcohol Use: 4 drinks about 4 nights a week; once a month drinks 6+ drinks in one sitting. Drives under the influence, scored 24 on AUDIT
  • AUD Diagnosis: Alcohol dependent
  • Relevant Past Medical, Psychosocial, Family History: Single father, Tim's mother takes care of grandchild while Tim's at work. Tim is in need of specialist treatment because of high level of alcohol use. Because of family obligations and trouble with the law, Tim is open to alcohol treatment and shows a willingness to attempt sobriety.
  • Take Home Message: Students should work with other healthcare professionals to obtain treatment for alcohol users if warranted. In this case, Tim agrees to continue outpatient treatment in conjunction with pharmacological treatment for his withdrawal symptoms. Tim is personally motivated to seek treatment; therefore, motivational interviewing should be used to help Tim with his recovery. This case also highlights the importance of follow-up appointments and discussing treatment progression with specialists.
  • Practice Tip: A solid professional support system can help patients seek appropriate treatment for alcohol use disorders.
  • URL's: Beginning of Tim's case

Case Study 2: Rosa

Case Focus: Rosa is presented in 5 different, consecutive pages under a section titled "Reluctant Patients". This case provides sample dialogue of how physicians can interact with patients who are combative or reluctant to acknowledge the presence of an AUD.

Case Goal: To present medical students with a case study involved a patient who is reluctant to acknowledge an alcohol use disorder.

Course Objectives Met: 4

Patient: Rosa - 26YOHF

  • Chief Complaint: Self-described depression. Also unexplained crying, sleeplessness, lack of energy, and frequent headaches.
  • Narrative: Rosa is a 26 year old office clerk at the courthouse downtown. At times, she's reported crying, sleeplessness, and headaches. She's had to miss work periodically because she's been unmotivated to go in and feeling very lethargic, but she quickly rebounds and returns to work as upbeat as ever the next day.
  • Alcohol Use: She drinks two times a week, consuming 3 standard drinks at a time, but indulges in 6 or more drinks once a month during parties. AUDIT score of 14.
  • AUD Diagnosis: At risk for alcohol abuse. Needs to overcome reluctance to treatment; achieved by simple first steps such as changing social situations where drinking is more prevalent
  • Relevant Past Medical, Psychosocial, Family History: Single, multiple friends she spends most of her time with.
  • Take Home Message: Not all patients will accept that they have a drinking problem. Rosa's case presents a patient reluctant to acknowledge a problem. The physician wisely suggests that Rosa try simple steps to slowly decrease alcohol consumption, putting these changes in context of helping her depression. It is not explicitly stated whether Rosa's drinking is a cause of her depression.
  • Practice Tip: By focusing on the problem from multiple angles, it may help the patient approach change more willingly. Give them options, small steps which they can accomplish and make them feel as if they can get a handle on the situation. Also, by not forcing them to change their patterns too drastically, the slow change may be more successful.
  • URL's: Beginning of Rosa's case


Screening, Assessment, and Diagnosis of Alcohol Abuse or Dependence

Goal: As a result of completing this course, medical students will be able to confidently assess and screen individuals for alcohol use disorders.

Learning Objectives

  1. Detect red flags or warning signs in a patient which may indicate a potential problem with alcohol use
  2. Choose the proper screening instrument for each patient and know how to screen and interpret the results
  3. Correctly identify the different criteria that denote alcohol abuse and dependence
  4. Diagnose a patient with abuse or dependence and create a plan for treatment

Case Study 1: Mike

Case Focus: Mike is presented in 3 different, non-consecutive pages. Mike's case is intermixed with factual information on tips for screening and using screening results. Mike's case is used to provide students with the opportunity to choose an appropriate screening test and approach the patient with the results. Mike is then referred to again in the next section on "Assessment" to identify possible warning signs of alcohol misuse.

Case Goal: To present medical students with a patient who is a candidate for alcohol screening. The student is expected to choose an appropriate screening instrument and choose an appropriate dialogue with the patient as part of the screening instrument. The student also is asked to choose different possible red flags or warning signs of abuse.

Course Objectives Met: 1, 2

Patient: Mike - 40YOAM

  • Chief Complaint: Pre-operative screening for a torn ACL
  • Narrative: Mike is in the office for a pre-operative screening and has revealed daily alcohol use
  • Alcohol Use: 2-3 drinks every day
  • AUD Diagnosis: Although Mike drinks 2-3 drinks daily, this case does not follow through the entire CAGE to warrant an AUD assessment. This case merely presents ways in which a physician can administer a screening instrument.
  • Relevant Past Medical, Psychosocial, Family History: No known history
  • Take Home Message: It is important for all physicians to routinely question patients about alcohol use. In this case, any alcohol use by Mike may affect his post-operative recovery from a torn ACL. Mike should be administered an alcohol screening instrument and his results used accordingly.
  • Practice Tip: Proper phrasing of the alcohol screening instrument questions will provide better feedback and more valid results.
  • URL's: Meet Mike; Conversing with Mike

Case Study 2: Tommy

Case Focus: Tommy is presented in 6 different, consecutive pages. Tommy is presented in his own section as a thorough case study, including dialogue and a "What Would You Do" clinical question. Tommy's case focuses on tolerance, medical complications (gastritis), and work/social barriers to decreasing alcohol use.

Case Goal: Medical students will be able to detect medical complications from alcohol use and devise a plan for the patient to decrease alcohol use.

Course Objectives Met: 1, 3, 4

Patient: Tommy - 34YOWM

  • Chief Complaint: Pains in stomach
  • Narrative: Tommy is a 34 year old bartender who has worked at the same bar for 5 years and has been a bartender for 10 years.
  • Alcohol Use: 4-5 shots 1-2 times a week
  • AUD Diagnosis: Alcohol abuse. Tommy has gastritis, exacerbated by the fact drinks.
  • Relevant Past Medical, Psychosocial, Family History: 2 year old daughter, Living with child's mother
  • Take Home Message: Tommy needs to commit to a plan where he eliminates alcohol from his daily routine. Tommy has a medical complication (gastritis) which exacerbates the need to decrease/abstain from alcohol use.
  • Practice Tip: Moderation may be a good middle ground step in achieving overall abstinence in the patient. Tommy's work environment perpetuates drinking, and he is reluctant to totally abstain. Creating a treatment plan which at least decreases alcohol use will help Tommy eventually achieve sobriety.
  • URL's: Tommy's Case

Case Study 3: Walt

Case Focus: Walt is presented in 5 different, consecutive pages in his own section. Walt is presented immediately following a section on "Diagnosis" and illustrates that a thorough case history can help in the assessment and diagnosis of a possible AUD.

Case Goal: Medical students will be able to effectively assess and diagnose an older patient with an alcohol use problem.

Course Objectives Met: 1, 2

Patient: Walt - 64YOWM

  • Chief Complaint: Came in for annual physical
  • Narrative: Walt is a 64 year old former factory worker, now retired. He has come in for his annual physical and has had no physical complaints to acknowledge.
  • Alcohol Use: A glass of wine 5 times a week
  • AUD Diagnosis: At risk for alcohol abuse.
  • Relevant Past Medical, Psychosocial, Family History: Married with grandchildren not in immediate area. Blood pressure results are high (160/100).
  • Take Home Message: Alcohol affects older adults differently as they have had changes in their ability to metabolize alcohol. This has negatively affected Walt's blood pressure and should be dealt with accordingly. Walt came in with high blood pressure, which is a common symptom among older adults. However, it is important not to immediately attribute a common symptom with the most common diagnosis. By getting a more thorough case history, you can more accurately diagnose the underlying issue.
  • Practice Tip: Contributing health factors throughout the aging process can cause differences in how alcohol is metabolized and actually cause alcohol to affect the body more strongly than in earlier years.
  • URL's: Walt's Case

Brief Intervention and Treatment Referral

Goal: You will be able to conduct a patient brief intervention.

Learning Objectives

  1. Assess a patient's willingness to change in order to treat alcohol misuse and use this assessment to motivate the patient towards treatment.
  2. Provide a brief intervention to patients and determine whether a patient needs additional assistance with treatment, such as pharmacotherapy or a referral to an addiction specialist or treatment program.
  3. Access and refer those patients, who are at a higher risk level, to a specialist's care.
  4. Assess, manage, or refer a patient's withdrawal symptoms.
  5. Manage patients who have relapsed and encourage those patients to attempt treatment again.

Case Study 1: Melissa

Case Focus: Melissa is presented in 1 page, then picked up again in 5 consecutive pages later in the course. The first time we encounter Melissa is after learning about Brief Interventions. The focus initially of Melissa is to introduce brief interventions; later, Melissa is revealed to have relapsed, and the physician counsels Melissa on giving abstinence another try.

Case Goal: The medical student should learn when to pursue a brief intervention and also be aware that relapse is often a part of recovery.

Course Objectives Met: 1, 5

Patient: Melissa - 32YOWF

  • Chief Complaint: Came in for annual physical, no physical complaints
  • Narrative: Melissa came in for her annual physical and during the lifestyle questions she reveals that she drinks alcohol.
  • Alcohol Use: She usually consumes 3-4 glasses of wine about 5 days/week. The most she has had in the past month is 6 drinks in one sitting.
  • AUD Diagnosis: Alcohol abuse
  • Relevant Past Medical, Psychosocial, Family History: Husband, who doesn't know she drinks as much as she does, and doesn't know she has relapsed
  • Take Home Message: Melissa has a dual role: discuss proper brief interventions and also discuss relapse as a part of recovery.
  • Practice Tip: A good social support system can help patients who have relapsed. In Melissa's case, her husband became supportive of the continued attempts at abstinence and even attended Al-anon meetings.
  • URL's: Meet Melissa

Case Study 2: Sam

Case Focus: Sam is presented in 1 page following information on interviewing skills.

Case Goal: The medical student should learn how to promote self-efficacy in the patient's motivation to change

Course Objectives Met: 2

Patient: Sam - 43YOBM

  • Chief Complaint: Admitted to hospital for abdominal pain, acute pancreatitis
  • Narrative: Sam is a 43 year old man who has a history of alcohol use and still drinks despite his condition. Sam's son is now old enough to understand what continued alcohol use is doing to his father.
  • Alcohol Use: Known alcohol problem, no other information given
  • AUD Diagnosis: Alcohol dependence
  • Relevant Past Medical, Psychosocial, Family History: Son who is now getting old enough to understand the examples his father is setting forth
  • Take Home Message: Sam has a motivation to change through the example he's setting for his son and the support he's getting from his family now
  • Practice Tip: It is important to have a motivational point which the patient can focus on and create a behavioral change.
  • URL's: Meet Sam; Case Study


Pharmacology of Alcohol and Neurobiology of Alcohol Addiction

Goal: After taking this course, medical students will understand the neurological, chemical, and biological aspects of alcohol dependence and addiction and the pharmacology of medications currently available to treat the disease.

Learning Objectives

  1. Describe neurobiology and neurochemistry of alcohol addiction
  2. Identify the causes of alcohol addiction, including genetic contributory factors
  3. Choose among various medications currently available to treat alcohol dependence

Case Study 1: Jeannette

Case Focus: Jeannette is presented in 1 page. Her case is set within the section on genetic studies dealing with alcohol outcomes.

Case Goal: Medical students should be able to identify genetic contributory factors that will affect the outcomes of alcohol use.

Course Objectives Met: 2

Patient: Jeannette - 31YOAF

  • Chief Complaint: Drinks occasionally, but has noticed a flushed face each time she consumes alcohol. She is worried about what alcohol does do her face.
  • Narrative: Jeannette is 31 years old and has "flush-faced" syndrome, common in asians with the ALDH2*2 deficiency.
  • Alcohol Use: Very infrequent
  • AUD Diagnosis: Not at risk for abuse
  • Relevant Past Medical, Psychosocial, Family History: Asian family background, which causes genetic pre-disposition
  • Take Home Message: 50% of Asians have ALDH2*2 allele causing decreased elimination of acetaldehyde and alcohol.
  • Practice Tip: Patients may be pre-disposed to some genetic problems
  • URL's: Meet Jeannette

Case Study 2: George

Case Focus: George is presented in 1 pages, immediately following a discussion on Pharmacotherapies.

Case Goal: Medical students should be able to identify medications currently available to treat alcohol dependence and choose the best prescription for the patient.

Course Objectives Met: 3, 4

Patient: George - 23YOWM

  • Chief Complaint: He is seeking pharmacological treatment for his alcohol addiction
  • Narrative: George is 23 years old and has been in treatment previously.
  • Alcohol Use: Known alcohol misuse, not known extent
  • AUD Diagnosis: Alcohol dependence
  • Relevant Past Medical, Psychosocial, Family History: Unknown
  • Take Home Message: George is in need of pharmacological treatment for his alcohol addiction and the best choice for him would be injectable Naltrexone as it has a 30 day duration and a higher treatment adherence because the patient cannot miss doses.
  • Practice Tip: Injectable Naltrexone has a 30 day duration and has a higher treatment adherence because the patient cannot miss doses.
  • URL's: Meet George

Case Study 3: Pauline

Case Focus: Pauline is presented in 1 page, immediately following a discussion on different pharmacological treatment choices.

Case Goal: Medical students should be able to identify medications currently available to treat alcohol dependence and choose the best prescription for the patient.

Course Objectives Met: 3, 4

Patient: Pauline - 36YOHF

  • Chief Complaint: Pauline has come into your office seeking pharmacological treatment for her alcohol addiction.
  • Narrative: Pauline is a 36 year old secretary who is married with 2 children. She needs pharmacological treatment for her alcohol addiction. Complicating matters is that she has hepatic impairment, so selecting her therapy should take that into account.
  • Alcohol Use: Known alcohol use problems
  • AUD Diagnosis: Abuse.
  • Relevant Past Medical, Psychosocial, Family History: 2 children, husband, hepatic impairment
  • Take Home Message: Acamprosate is the best choice for Pauline as does not have any noted contraindications for hepatic impairment.
  • Practice Tip: Co-occurring physical issues must be taken into account when prescribing medication
  • URL's: Meet Pauline

Medical, Psychiatric, and Polysubstance Comorbidities

Goal: After taking this course, medical students will have a better understanding of how co-morbidities might impact treatment, and how to be aware of such co-morbidities.

Learning Objectives

  1. Diagnosis medical complications that arise from increased alcohol use, such as fatty liver, heart damage, and alcoholic hepatitis
  2. Incorporate polysubstance abuse treatment needs in patients who have a co-occurring disorder along with their alcohol abuse
  3. Identify the mental complications that arise from increased alcohol use, such as bipolar disorder, antisocial personality disorder, and suicidality

Case Study 1: Derek

Case Focus: Derek is presented in 5 different, consecutive pages in his own section, following "Medical Complications". We present Derek to show how a medical complication, in this case fatty liver (Steatosis), and how alcohol consumption can affect this medical comorbidity.

Case Goal: Medical students should be able to diagnose medical complications that arise from increased alcohol use and counsel patients about ways to decrease alcohol use.

Course Objectives Met: 1

Patient: Derek - 29YOWM

  • Chief Complaint: Slight, ongoing pain in abdomen. Pain has continued for a month and OTC pain meds don't relieve pain. Skin appears yellow and abdomen near liver is tender to touch.
  • Narrative: Derek is 29 years old and works in the factory outside town with his father. He is not married, but has a couple of friends from work who he hangs out with socially. Derek comes to the office with abdomen pain. A CT scan reveals an enlarged liver. Diagnosis: fatty liver (Steatosis). Through conversation, it is revealed that Derek started drinking at age 16
  • Alcohol Use: Known alcohol use, coupled with pain medication
  • AUD Diagnosis:At risk for alcohol use disorder. Patient diagnosed with fatty liver, presumably caused by years of drinking.
  • Treatment Decision: In this case, counsel Derek to abstain from alcohol use and develop a treatment plan.
  • Relevant Past Medical, Psychosocial, Family History: Works with father
  • Take Home Message: It is important to probe for alcohol use for all patients. In this case, Derek's long term use of alcohol may have contributed to his developing fatty liver.
  • Practice Tip: It is important that you be forthright about the potential long-term health effects that alcohol can have on patient condition. By outlining what will happen if they continue their bad health habits, it will show the damage that can be done and how to prevent it.
  • URL's: Derek Case Study

Case Study 2: Camilla

Case Focus: Camilla is presented in 5 different, consecutive pages in her own section, following a discussion of psychiatric comorbidities.

Case Goal: Medical students should be able to incorporate polysubstance abuse treatment needs in patients who have a co-occurring disorder along with their alcohol abuse, as well as identify the mental complications that arise from increased alcohol use, such as bipolar disorder, antisocial personality disorder, suicidality.

Course Objectives Met: 2

Patient: Camilla - 44YOWF

  • Chief Complaint: Coworkers concerned about drinking, comes in because she needs a referral for specialist treatment
  • Narrative: Camilla is 44 years old and moved to the local area in 2002 after her divorce. She has no local family, but has built relationships with her coworkers. Camilla has been previously diagnosed with depression and received medication for that. She's also tried AA, but that hasn't worked for her.
  • Alcohol Use: Long term alcohol misuse.
  • AUD Diagnosis: Alcohol dependence
  • Treatment Decision: At this point in her treatment history, Camilla needs a combination therapy to treat her depression and alcohol together and she needs to go to a detox facility. Detox facilities allow concentration on the reasons behind drinking without outside distractions.
  • Relevant Past Medical, Psychosocial, Family History: Divorced, in a community with few friends. Previously diagnosed as depressive.
  • Take Home Message: Detox facilities allow concentration on the reasons behind drinking without outside distractions. Combination therapy allows treatment of co-occurring disorders.
  • Practice Tip: Camilla has been a long term alcohol abuser and has comorbid psychiatric conditions. It is important to treat both alcohol use and psychiatric conditions simultaneously.
  • URL's: Camilla Case Study


Meet Your Patients: Case Challenges

Goal: The goal of this course is to teach medical students how to administer individualized alcohol use treatment.

Learning Objectives

  1. Recognize that alcohol misuse affects each individual differently, and awareness of variations on how alcohol affects different individuals will help when treating patients
  2. Incorporate the background of the patient (medical, social, economical) into your discussions about alcohol use
  3. Tailor specific treatment regimens that are most relevant to treating alcohol use problems in populations such as youth, pregnant women, seniors, the homeless, LGBT, and medical students with alcohol use problems.

Case Study 1: John

Case Focus: John is a 6 page case study highlighting alcohol use with adolescents and how the student can approach John about his illegal alcohol use since he is underage.

Case Goal: The goal of this case is to present a case involving an adolescent who misuses alcohol and guide the student through appropriate conversations with the patient regarding underage alcohol consumption.

Course Objectives Met: 1, 2, 3

Patient: John - 17YOWM

  • Chief Complaint: Leg muscle strain sustained a day earlier while fooling around with his buddies
  • Narrative: John is a 17-year-old high school student who is the lead quarterback on his football team. He comes to your office with complaints of a muscle strain he sustained yesterday. Through conversation of how John pulled his muscle, it is revealed he was drinking at the time while celebrating his team's success.
  • Alcohol Use: Drinks six packs with friends on occasion(underage)
  • AUD Diagnosis: At risk for alcohol use. John is underage.
  • Relevant Past Medical, Psychosocial, Family History: Friends are fellow drinkers
  • Take Home Message: John's muscle strain occurred while he was drinking with his friends. You treat John's muscle strain but also counsel him on the ramifications (both medical and legal) of his continued alcohol use.
  • Practice Tip: Adapt your discussions on alcohol misuse to the patient's identity. In this case, John is underage, and so discussions of alcohol misuse should take this into consideration.
  • URL's: John's Case

Case Study 2: Sarah

Case Focus: Sarah is a 6 page case study highlighting the effect prenatal alcohol use has not only on the mother, but the baby. This case contains a brief discussion of FASD and examples of assessment and brief interventions for prenatal alcohol use.

Case Goal: The goal of the Sarah case is to present medical students with a case on prenatal alcohol use and demonstrate appropriate assessment and brief intervention techniques with this population.

Course Objectives Met: 1, 2, 3

Patient: Sarah - 27YOBF

  • Chief Complaint: Sarah is at your office for her first prenatal visit. She is currently 10 weeks pregnant with her first child.
  • Narrative: This is Sarah's first prenatal visit at 10 weeks. Through regular prenatal discussions, Sarah admits to occasional alcohol use but insists it is "not a big deal".
  • Alcohol Use: 3-4 glasses of wine -4 times a month, exceeded that once in the past month
  • AUD Diagnosis: At risk for alcohol use disorder. However, because Sarah is pregnant, she should be counselled to abstain from alcohol use for the duration of the pregnancy.
  • Relevant Past Medical, Psychosocial, Family History: Unplanned pregnancy with live-in boyfriend.
  • Take Home Message: Students should be familiar with the detrimental causes of alcohol use during pregnancy, especially during the first trimester. Sarah should be assessed for alcohol use and counselled to abstain for the health of the fetus.
  • Practice Tip: Prenatal treatment should emphasize the dangers of alcohol use during pregnancy
  • URL's: Sarah's Case

Case Study 3: Len

Case Focus: The case study of Len features 6 pages devoted to alcohol misuse in older adults. In addition, Len is of Native American decent, and special considerations with this population are targeted.

Case Goal: The goal of this case is to present alcohol use disorders in the context of older adults, emphasizing how age and social situations (loss of friends, spouses, family as they age/pass away) can affect alcohol consumption.

Course Objectives Met: 1, 2, 3

Patient: Len - 67YONAM

  • Chief Complaint: Restless sleep, stomach pain. Pain and loss of sleep affecting his work as an artist.
  • Narrative: Len is a 67-year-old sculptor who lives in town. He has a brother and niece who reside on the reservation outside of town. He is widowed, having lost his wife to cancer about a year ago. Len is well-known for his art and has many customers in town who frequent his shop.
  • Alcohol Use: AUDIT score of 9. At risk for abuse.
  • AUD Diagnosis: At risk for abuse.
  • Relevant Past Medical, Psychosocial, Family History: Len is 67 years old and recently (past year) widowed. His brother and niece live on the Indian reservation outside of town. Len is an artist, but lately his stomach and restless sleep have disrupted his work.
  • Take Home Message:Medical students should become familiar with assessing alcohol use in older adults and intervening when appropriate.
  • Practice Tip: As a widower, Len is drinking more to cope. Len's drinking has resulted in physical problems, as well as sleep problems.
  • URL's: Len's Case

Case Study 4: Morgan

Case Focus: Morgan is a 21 year old college student who is a member of the LGBT community. This case focuses on two important issues: 1) college-age drinking and 2) drinking within the LBGT community.

Case Goal: The goal of this case is to present challenges associated with alcohol misuse among college students and the LBGT community. Medical students will become aware of social issues that may impact interventions for alcohol use within these populations.

Course Objectives Met: 1, 2, 3

Patient: Morgan - 21YOBF

  • Chief Complaint: Morgan comes into Student Health complaining of feeling sluggish, having an increased need for sleep, constant headaches, and frequent bouts of colds. These symptoms are affecting her college coursework.
  • Narrative: Morgan is a 21-year-old college student. She is currently a junior at the university and is active in many social causes. Morgan describes herself as an activist who is constantly on the go. However, lately she has been feeling badly and the situation hasn't improved.
  • Alcohol Use: Goes to the bar in the next town twice a week with friends
  • AUD Diagnosis: At risk for alcohol abuse
  • Relevant Past Medical, Psychosocial, Family History: Single, College-aged, Member of the LGBT community
  • Take Home Message: Morgan's drinking is cause for concern, and you should counsel and provide a brief intervention so that her alcohol use does not escalate any further.
  • Practice Tip: It is important to remember a patient's social/age history when counseling about alcohol misuse.
  • URL's: Morgan's Case

Case Study 5: Joe

Case Focus: The focus of Joe is to present, in 6 pages, the case study of a homeless man who uses alcohol as a coping mechanism.

Case Goal: The goal of this course is to present alcohol misuse through the eyes of a homeless man. The student should learn how to interview homeless patients and attempt to develop a treatment plan for Joe.

Course Objectives Met: 1, 2, 3

Patient: Joe - 52YOHM

  • Chief Complaint: Joe has come into the walk-in clinic because he has been nauseated for an extended period of time and has stomach cramps.
  • Narrative: Joe is a 52-year-old homeless Hispanic man who lost his wife six years ago, his only remaining family. Over the course of the next year he went into deep depression and his work ethic suffered. After losing his job he began living on the streets and has been living there for the last five years. Joe often frequents the soup kitchen in town for a meal, as he has little money to support himself otherwise.
  • Alcohol Use: Joe scores a 5 on the AUDIT-12 exam. He is found to be consuming mouthwash as well.
  • AUD Diagnosis: At risk for abuse
  • Relevant Past Medical, Psychosocial, Family History: Widower and homeless
  • Take Home Message: Outreach may be the best first step in reaching the homeless population who are in need of substance abuse treatment.
  • Practice Tip: Attention needs to be paid towards contributing factors to long-term success. It is possible that the homeless population's treatment needs are not met for several reasons: Providers are wary of their high-risk medical problems, Their extensive list of demands/needs, Their unpredictable behavior
  • URL's: Joe's Case

Case Study 6: Amy

Case Focus: The focus of Amy (5 pages long) is to present alcohol misuse among medical students and professionals.

Case Goal: The goal of this case study is to present students with a discussion of how their own peers could be at risk for alcohol abuse.

Course Objectives Met: 1, 2, 3

Patient: Amy - 24YOAF

  • Chief Complaint: Amy comes to the university's Student Health Center because she has been experiencing frequent headaches and intermittent blurry vision.
  • Narrative: Amy is a 24-year-old medical student. She is continuing a family history of entering the medical profession, as both her parents are physicians and her grandparents were involved in medicine. Amy has been commended often for her excellent grades and work ethic.
  • Alcohol Use: She usually drinks an entire bottle of wine a few nights a week in order to relax
  • AUD Diagnosis: At risk for abuse
  • Relevant Past Medical, Psychosocial, Family History: Comes from a family of doctors, so she has alot of pressure to succeed. It's important to question if she has a family history of alcohol use.
  • Take Home Message: Amy's pressures to achieve has pushed her to partake in unhealthy choices, which in turn is negatively affecting her health.
  • Practice Tip: It is important that the doctor-in-training abide by the same healthy behaviors they are taught to promote.
  • URL's: Amy's Case


Curriculum

Framework