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Question 8#

A 42-year-old banker sees you as a new patient. He states that he is healthy and takes no regular medications. His examination is normal except for a blood pressure of 150/94. When questioning him about alcohol use, he admits that he goes out drinking with friends about two Saturdays each month to relieve stress. At these times he will often have 8 to 10 mixed alcohol drinks. He and his wife have recently had several arguments about this habit, and she has threatened to divorce him if he doesn’t change his ways. Despite this, he has been unable to change. On one occasion he was arrested for driving while intoxicated. Nonetheless, he has continued to be successfully employed, has never been hospitalized for an alcohol-related problem, and has never had symptoms of alcohol withdrawal.

Which of the following statements is true regarding treatment of this patient? 

A. Advice from a physician to reduce his alcohol consumption is likely to be successful
B. The patient should be advised that complete abstinence from alcohol and referral to a mutual aid group is the best strategy in treating his alcohol use disorder
C. Abstinence from alcohol may necessitate treatment of his blood pressure because he is currently using alcohol to treat stress
D. Medications for alcohol dependence are not usually helpful
E. The fact that this patient has had no symptoms of alcohol dependence proves that he does not abuse alcohol

Correct Answer is B

Comment:

This patient has an alcohol use disorder, which is defined as a maladaptive pattern of alcohol use causing clinically significant impairment or distress. Men who consume more than 14 drinks per week or 4 drinks on any one day, and women who consume more than 7 drinks per week or more than 3 drinks on any one day are at risk for this disorder. This patient has had significant marital discord, has been unable to cease alcohol use, and has had an arrest for driving while intoxicated. All of these indicate that the patient has clinically significant impairment from alcohol abuse. Alcohol use disorder may or may not be accompanied by alcohol dependence, which is characterized by symptoms and signs of alcohol withdrawal during periods of abstinence. Patients with alcohol use disorder are usually unable to limit the amount of alcohol that they consume, and therefore complete abstinence from alcohol is recommended. Mutual help groups (such as Alcoholics Anonymous) as well as medications (such as acamprosate and naltrexone) can be helpful in maintaining abstinence. Physician advice alone is usually unsuccessful. Alcohol use disorder is frequently accompanied by other psychiatric disorders such as depression. Alcohol use disorder can aggravate hypertension; blood pressure will improve with abstinence. Current understanding of alcohol use disorder suggests that there is a genetic tendency to this illness.