Instructor Manual for Psychiatric Mental Health Nursing Concepts of Care in Evidence-Based Practice 8th Edition by Mary C. Townsend

What is the chief complaint? (In the client’s own words, and report of others)
Initially the client denies there is a problem and says alcohol is part of doing business. Lois (client’s wife) begins to worry there is a problem with alcohol when his behavior at social events is embarrassing and he has physical symptoms (liver enlargement) but continues to drink.

Based on the above information, and a close viewing of the movie, what questions would arise during history taking? What are some possible answers? You might base your questions on:
History of the client’s illness
Psychosocial history
Family history or dynamics
How much and how often do you drink alcohol?
Has anyone ever been concerned about your behavior while drinking?
Have you been told by a physician that your health is affected by alcohol?
Have you tried to cut down or avoid alcohol for any significant period? What were the results of those attempts?
Is there a history in your family of anyone using alcohol or other drugs?
How is your relationship with your wife? Do you have discussions or disagreements about your alcohol use?

What other observations do you have about the client’s behavior?
Bill denies that alcohol has been a problem for many years. He makes excuses for drinking (e.g., “It’s part of my business”). His drinking takes priority over important life events (e.g., Lois having a miscarriage). He makes promises to quit that he doesn’t keep. He injures himself (e.g., running into tree) when intoxicated. Eventually, he is not working at all, stays home all day in his bathrobe, appears disheveled, hides liquor around the house, and is socially isolated from friends and family.

In your opinion, is the diagnosis discussed above correct?
Yes. Bill demonstrates behaviors that match all of the DSM-IV-TR criteria.

What DSM-IV-TR criteria support (or negate) this diagnosis?
All of them

What treatment plan would you outline?
Participation in treatment program to deal with acceptance of alcoholism; need for abstinence; insecurities, anxiety, and discomfort around people; relationship with wife; ongoing participation in AA support group; Al-Anon participation for Lois.

With what expected outcomes?
 Bill will abstain from alcohol or other drugs.
 Bill will maintain an open, sharing relationship with wife.
 Bill will have ability to cope with life problems and emotions without alcohol.