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Pharmacological agent(s) used to manage the substance of abuse

Cassidy is a 40-year-old female who is seeing you today for advice around alcohol consumption following encouragement by friends. Cassidy is currently separated from her husband and they have two children aged 8 and 10. She is working part time as an Assistant in Nursing and enjoys her job. With the exception of staying at home when the children were younger, she has always maintained employment. Cassidy has limited family support as she has one brother and both her parents are ageing and unable to help look after the children. Her family members are reported to be social drinkers, though her maternal grandfather was described as a ‘heavy drinker’.
Cassidy started drinking alcohol socially from the age of 16, with regular drinking (mainly on weekends) occurring 7 years ago, 12 months after the birth of her last child. For the past year, she has been drinking between 2 to 3 litres of wine across the week, with her alcohol consumption being heavier on the weekends and non-work days. On these days, her drinking is beginning to start around lunch time, stops when the school day ends and recommences when she is cooking tea. On work days, Cassidy begins drinking whilst cooking tea. On all nights, her drinking session usually does not end until she goes to bed. During your assessment, you note that Cassidy is concerned about: starting to be ‘snappy’ with the children; not being the mother she used to be; wanting to drink more; and finding it difficult to get up in the morning.

In 4 pages please discuss the pharmacology of all the usual pharmacological management options, for your chosen case scenario. In particular:

• What are the pharmacological agent(s) used to manage the substance of abuse?
• What is the pharmacology of the pharmacological agents used, paying particular attention to the pharmacokinetics and pharmacodynamics?
• What are the usual dosing schedules, including frequency and duration if applicable, for each pharmacological agent?
• What is the evidence of the efficacy of the pharmacological agents used?
• What are the precautions and/or adverse effects for each pharmacological agent that must be considered, and how can they be avoided or minimised?
Discuss how you might choose between different pharmacological management options, in particular how you might choose an option for the case scenario you have selected based on the pharmacology, safety and the efficacy of the pharmacological options available?

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