Doctors Hospital Family Practice Residency
Grant Family Practice Residency
Columbus, Ohio
Behavioral Case of the Month
(© 2006 Doctors/Grant Family Practice Residencies)
“Substance Abuse” June, 2006
Jeri A. O’Donnell, MA, LPCC and Pat A. Martin, MA, LPCC
CASE: 30 y/o male presents to your office unable to concentrate, agitated, low energy. You
diagnose depression secondary to grief reaction when wife lost fetus late in pregnancy a few
months ago, and begin him on Lexapro. Pt. referred for counseling. During third session wife
was upset as husband was “mean” to her this past week. In further exploring they both
admitted to increased “partying” while taking some vacation time. Our presenting patient
commented further that he was concerned about his drinking lately as it has increased; he is
not exercising as he usually does, and has noticed an increase in blackouts when he mixes
beer and liquor. He has one OMVI from his 20’s. His father is alcoholic as was paternal
grandfather. He commented that in no way does he drink the way his father drinks. How
would you further approach this patient? What are your recommendations?
DISCUSSION:
1. Please note that even though this case is in ref. to alcoholism, the discussion points
can apply to most patients under the influence, also note the resources listed as they
ref. alcohol and drug abuse resources.
2. Be watchful of comparing your drinking to your patients, e.g. “if they drink what I
drink they must not have a problem”. Each person’s tolerance and usage is different.
It may be difficult to refer someone in your age group to AA/NA, yet that is where they
need to be.
3. Most patients will not be as open as the individual in this case regarding alcohol
use/misuse, pay attention to your warning signs: sleep disturbance, impaired
judgment, depression/anxiety, digestive, genitourinary, neuropsychiatric, relationship,
and job problems, to name a few.
4. Alcohol abuse is most easily defined as: when alcohol use leads to negative
consequences, you have a problem with alcohol (or any substance).
5. Some resources will distinguish between alcohol abuse and alcohol dependence with
abuse being a precursor to dependence.
6. When a person has been identified as having a problem with alcohol remember to
remind them to watch for hidden alcohol and to buy alcohol free products, e.g.
mouthwash, breath spray, cough syrup, etc.
7. When confronting a patient about their alcohol abuse it is important to speak to them
about your concerns in a non-judgmental and assertive way. Watch your voice tone
and posture, remaining non-judgmental is crucial, especially if your own family history
leaves you wanting to judge.
8. Most patients when initially confronted will deny, minimize their alcohol/drug use. Use
objective and educational information to convey the logical, natural consequences of
their behavior.
9. If a patient is ready to accept help, be sure to have resources at your fingertips to
offer the information, and encourage them to get help immediately. AA has meetings
every day in many locations.
10. If a patient plans to attend AA/NA educate them that they may need to attend a
couple of different meetings to find a group they connect with. There are smoking,
non-smoking, male, female groups, and open/closed meetings. Closed meetings are
only for recovering alcoholics. If you attended a meeting in med school, as part of a
class, that was an open meeting.
RESOURCES:
1.
2.
3.
http://www.mayoclinic.com/health/alcoholism
http://www.aca-usa.org information plus programs by area
http://www.alcoholicsanonymous.org (AA Central Office Ph# for Franklin Co.=
614/253-8501 or 800/870-3795 for meeting locations/times.)
4. Narcotics Anonymous for Franklin Co. – 614/252-1700.
5. http://www.projectcork.org/clinical_tools , 10 different screening tests, including
CAGE, MAST, Brief MAST some for ETOH and for other drugs; gives scoring.
6. Enoch, Mary-Anne and David Goldman. Problem Drinking and Alcoholism: Diagnosis
and Treatment, American Family Physician, Feb. 1, 2002. Good article, plus patient
handout. (http://www.findarticles.com/p/articles/mi_m3225 )
7. http://www.drugabuse.gov
8. Drugs of Abuse

Acid/LSD
Inhalants

Marijuana
Steroids (Anabolic)

Methamphetamine
Alcohol

PCP/Phencyclidine
Club Drugs

Prescription Medications
Cocaine

Smoking/Nicotine
Ecstasy/MDMA
8.
Heroin
NIDA Sites (NIDA also has educational resources available in Spanish as well)

backtoschool.drugabuse.gov

smoking.drugabuse.gov

hiv.drugabuse.gov

marijuana-info.org

clubdrugs.gov

steroidabuse.gov

teens.drugabuse.gov

inhalants.drugabuse.gov