Alcoholism Case Study

Alcoholism Case Study

The expansion in the use of directly observed therapy (DOT) in the United States was followed by dramatic decreases in multidrug-resistant tuberculosis and the return of overall trends in case rates to the steady decline of previous decades (Burman and Reves, 2004). As I provide my personal opinions as a caseworker providing DOT to Lisa, I will begin my quest through current definitions of directly observed therapy (DOT) and research, most important priorities of Lisa's treatment plan, my personal views of alcoholism as a disease, and finally arriving on how I would address the primary problems (alcohol and tuberculosis) when working directly with Lisa.

Tuberculosis is a very serious health problem with two million people dying each year, mostly in low-income countries (Volmink and Garner, 2001). Effective drugs for tuberculosis are available but the problem still exists. People with tuberculosis should take the drugs for at least six months, but many do not adhere to their course of treatment (2001). For this reason, services for people with tuberculosis often use different approaches to encourage people to complete their course of treatment such as directly observed therapy, commonly known as DOT (2001).

In DOT, a health care worker watches the patient swallow his prescribed TB medications (1997). This leads to reductions in treatment failure, relapse and drug resistance (1997). DOT can take place in the office, clinic, or in the community and can be used alone or with other measures (2004). The success rates of DOT are high providing many benefits to the individual.

In working with Lisa, whom suffers from a dual diagnosis of alcoholism and tuberculosis, I would have done a few things differently. When researching directly observed therapy and all that it entails, I learned that the caseworker should be present when individuals ingest the medication; have the ability to problem solve, facilitate and empathize with individuals; and should build rapport and trust with individuals (1997).

In the case with Lisa, the caseworker waited until Lisa missed three doses of medication before she could track her down. I think it is important to get information about family and friends when making the initial contact with the individual in efforts of contacting the individual during an emergency or crisis. I also would have attempted to get written permission from Lisa in order to speak with her sister or any other close relatives and friends explaining to them what directly observed therapy was about. This could have given Lisa the support that she needed. The caseworker stated that she would give Lisa bus passes to get to the alcohol treatment center. I would have volunteered to take Lisa to ensure compliance. Although there were things that I would have done differently than Lisa's caseworker, there were some things that I would have kept the same.

I liked how she was able to empathize with Lisa. She stated that she understood how Lisa feels and was able to make recommendations as to how Lisa could improve her current situation. I also liked the idea that she brought along Lisa's favorite juice to take with her medication. This shows that the caseworker had actually noticed the things Lisa likes and was making effort to build a rapport. Addressing the alcohol abuse was commendable because this was causing Lisa to be depressed and non-compliant with her medication, however I would have addressed the issue much earlier.

I think in order to effectively treat tuberculosis; the alcoholism has to be addressed also. During initial contact, tuberculosis and directly observed therapy should be explained extensively. I would have informed Lisa of the consequences of not taking her medication along with the benefits. I would set up an appointment with an alcohol treatment program the same day. I would gather information about relative and friends as well as getting a confidentiality release signed, allowing me to speak with theses individuals. I would set up a time that I could be able do activities in which Lisa enjoys in efforts of building a rapport. I would put in place several motivational tools such as gift cards or food vouchers in order to keep Lisa motivated throughout the six months. I would create a calendar that lists each appointment day and time to use as a reminder for Lisa.

I agree that alcoholism is a disease. Like many other diseases, it has a generally predictable course, has recognized symptoms, and is influenced by both genetic and environmental factors that are being increasingly well defined (Gans, 2007). Alcoholism should not be judged as a problem of willpower, misconduct, or any other unscientific diagnosis (Hobbs, 1998). The problem must be accepted for what it is, a biopsychosocial disease with a strong genetic influence, obvious signs and symptoms, a natural progression and a fatal outcome if not treated (1998). In the past, the medical field and public have accepted smoking as an addictive disease which has reduced the rates of nicotine use in the United States (1998). Through similar interventions, I believe we can reduce the rate of alcohol abuse throughout the country.

The term dual diagnosis is often used interchangeably with the terms co-morbidity, co-occurring