Mr. Hake returns again to your office. He has been sober for nearly 6 weeks, is seeing his counselor 3 days a week and has been staying at home the rest of the time. He states that he is committed to sobriety but he feels he needs more help and sometimes is nervous about leaving his house due to temptation as he lives very close to the tavern at which he typically drank. He says that his daughter is supportive but he only sees her on the weekends since she lives on the outskirts of town.
What should you do next?
a. Ask him more about the treatment program he is enrolled in
You should do this no matter what so you can understand the type of treatment he is receiving. Does he see an MD occasionally? If so, is he on any new medication that you need to know about? How long will he be in therapy? Who can he call if or when he relapses? Can you contact his treatment team to discuss his care directly with them? Knowing the answers to these questions can help you care for the chronic disease of alcohol dependence.
b. Congratulate him on his success so far and encourage follow-up with his counselor
This may be the best course of action if you find that he is enrolled in a comprehensive treatment program that provides him with education, support of professionals & peers and access to a prescribing provider if he needs one.
c. Discuss starting a medication to maintain sobriety
Some treatment programs do not provide access to a prescribing provider and, therefore, no one to prescribe medications to support and maintain abstinence. If this is an option you are considering for Mr. Hake’s treatment, you need to know if this responsibility will fall to you or an addition specialist. Then you need to discuss the risks and benefits of such medications and determine his level of interest in this therapy before proceeding further.
d. Prescribe diazepam for anxiety and agoraphobia
“Co-addiction” with benzodiazepines is possible in patients already battling alcohol dependence. These medications should be used very sparingly, if at all, in these patients. Other medications should be considered if treating anxiety or depression.