| Course | NUR-7632 Advanced Assessment, Differential Diagnosis, and Management of Psychiatric Disorders Adult Population, Part A |
|---|---|
| Module | Module 6 |
| Paper type | Case analysis: adult alcohol use disorder |
| Length | About 1,069 words, 6 pages |
| Format | APA 7 student paper |
| School | Thomas Edison State University |
| Program | M.S. in Nursing, Psychiatric Mental Health Nurse Practitioner |
| Updated | October 2026 |
Free sample paper for NUR 7632 Module 6
An Arrest on Route 24: AUDIT Screening, Safe Withdrawal and Naltrexone for a 52-Year-Old Real Estate Agent
Student Name
M.S. in Nursing, Psychiatric Mental Health Nurse Practitioner, Thomas Edison State University
NUR-7632: Advanced Assessment, Differential Diagnosis, and Management of Psychiatric Disorders: Adult Population, Part A
Mentor Name
Month Day, Year
An Arrest on Route 24: AUDIT Screening, Safe Withdrawal and Naltrexone for a 52-Year-Old Real Estate Agent
The Night of the Closing
Diane, an invented patient, is 52 and has sold houses in Morris County for twenty years. Three weeks ago she was stopped on Route 24 after a client dinner with a blood alcohol level of 0.14 and charged with driving while intoxicated. Her license is suspended and the court has ordered an evaluation. She tells the story without much distress at first, describing the arrest as bad luck.
A careful history tells more. She drinks a bottle of wine most evenings and more on weekends, has tried twice to cut down and failed, hides empty bottles from her husband and has missed two morning showings in the past month. In the mornings her hands shake until she has coffee, and twice she has had a glass of wine before noon "to settle." Her mother drank heavily. She takes lisinopril for high blood pressure and has no history of seizures or withdrawal delirium.
Her husband, reached by phone with her consent, adds that she has fallen asleep on the couch most nights for a year and that their adult daughter has stopped bringing the grandchildren on weekends. Diane had not known about the second point and is visibly shaken by it. This is the moment the visit turns, and she asks for the first time what treatment would involve.
Screening and Diagnosis
Saunders et al. (1993) built the Alcohol Use Disorders Identification Test from a World Health Organization project in six countries, choosing ten items from a 150-item interview given to 1,888 people attending primary care. The ten questions ask about quantity and frequency, dependence and drinking-related harm, each scored from 0 to 4 for a total out of 40. Among people diagnosed with hazardous or harmful drinking, 92 percent scored 8 or more, and 94 percent of those without such drinking scored below 8.
Diane scores 24, well above the level that suggests dependence. The interview confirms alcohol use disorder in the severe range: she drinks more than she intends, cannot cut down, craves alcohol, neglects work, keeps drinking despite problems with her marriage, drives after drinking and has tolerance and morning withdrawal. Her liver tests show a raised gamma-glutamyl transferase, and her blood count shows large red cells, both common with heavy drinking. Her PHQ-9 is 9, and her low mood is followed rather than treated at once, since it often lifts after several weeks without alcohol.
Planning a Safe Withdrawal
Her morning tremor and drinking to settle it mean withdrawal must be planned. With no past withdrawal seizures or delirium, no serious medical illness and a husband who can stay with her, withdrawal at home is judged reasonable. A nurse checks her daily for five days using a standard withdrawal scale, and a short, fixed tapering course of a long-acting benzodiazepine is prescribed, with her husband holding the pills. Thiamine is started to protect against a brain disorder caused by its deficiency. She is told to go to the emergency department if she becomes confused, sees things or has a seizure.
Choosing a Medicine
Jonas et al. (2014) reviewed 122 randomized trials and one cohort study with 22,803 participants to compare medicines for alcohol use disorder in outpatient care. Acamprosate and oral naltrexone at 50 mg a day both reduced return to any drinking, with about 12 people needing acamprosate and 20 needing naltrexone for one to benefit, and naltrexone also reduced return to heavy drinking, with about 12 people needing treatment. In head-to-head trials, the two did not differ clearly. Disulfiram did not show a benefit in well-controlled trials.
The COMBINE trial tested these medicines in practice. Anton et al. (2006) randomly assigned 1,383 recently abstinent adults with alcohol dependence at 11 U.S. sites to naltrexone, acamprosate, both or placebos, each with medical management, with or without a structured behavioral intervention, for 16 weeks. Those given naltrexone with medical management, the behavioral intervention with medical management, or both had more days without drinking than those given placebo pills and medical management alone, and naltrexone lowered the risk of a heavy drinking day. Acamprosate showed no clear effect in that trial.
Naltrexone is started after withdrawal ends. Her liver tests are raised but under three times normal, so it can be used with checks at one and three months. She is told that naltrexone blocks opioid pain medicines, so she should carry a card and tell any surgeon or dentist, and that it lowers the pull of drinking rather than making her sick if she drinks.
| Option | Evidence | Fit for Diane |
|---|---|---|
| Naltrexone | Reduced heavy drinking in review and COMBINE | Chosen; liver tests watched |
| Acamprosate | Reduced any drinking in review; no effect in COMBINE | Alternative if naltrexone not tolerated |
| Disulfiram | No benefit in blinded trials | Not chosen |
| Medical management | Effective with naltrexone in COMBINE | Monthly visits |
| Counseling | Effective alone in COMBINE | Weekly sessions |
Counseling and Support
Medical management visits each month check her drinking, side effects and liver tests and encourage her to keep going. Weekly counseling with a cognitive behavioral approach helps her plan for client dinners, where the risk is greatest, with a ready answer and a non-alcoholic drink. Mutual help groups are offered, and she chooses a group for women in recovery. Her husband is invited to a session, with her agreement, to talk about the hiding and the trust it cost.
The Court and Her Work
The court-ordered evaluation is completed with her consent, and her progress reports go only where she authorizes. The state's intoxicated driver program and the ignition interlock rules are reviewed. Her work schedule is adjusted so that she avoids evening client dinners for the first three months, and she arranges for a colleague to drive her to showings until her license is restored.
Conclusion
Diane has severe alcohol use disorder, found with an AUDIT of 24 and confirmed criterion by criterion, with morning withdrawal and a raised liver enzyme. Her withdrawal is planned safely at home with daily checks. Naltrexone, chosen because it reduced heavy drinking in a large review and in COMBINE, is paired with medical management and weekly counseling. Her mood will be rechecked after four weeks without alcohol, her liver tests at one and three months, and her drinking at every visit, so the plan can change if the first medicine is not enough.
References
Anton, R. F., O'Malley, S. S., Ciraulo, D. A., Cisler, R. A., Couper, D., Donovan, D. M., Gastfriend, D. R., Hosking, J. D., Johnson, B. A., LoCastro, J. S., Longabaugh, R., Mason, B. J., Mattson, M. E., Miller, W. R., Pettinati, H. M., Randall, C. L., Swift, R., Weiss, R. D., Williams, L. D., & Zweben, A. (2006). Combined pharmacotherapies and behavioral interventions for alcohol dependence: The COMBINE study: A randomized controlled trial. JAMA, 295(17), 2003-2017. https://doi.org/10.1001/jama.295.17.2003
Jonas, D. E., Amick, H. R., Feltner, C., Bobashev, G., Thomas, K., Wines, R., Kim, M. M., Shanahan, E., Gass, C. E., Rowe, C. J., & Garbutt, J. C. (2014). Pharmacotherapy for adults with alcohol use disorders in outpatient settings: A systematic review and meta-analysis. JAMA, 311(18), 1889-1900. https://doi.org/10.1001/jama.2014.3628
Saunders, J. B., Aasland, O. G., Babor, T. F., de la Fuente, J. R., & Grant, M. (1993). Development of the Alcohol Use Disorders Identification Test (AUDIT): WHO collaborative project on early detection of persons with harmful alcohol consumption-II. Addiction, 88(6), 791-804. https://doi.org/10.1111/j.1360-0443.1993.tb02093.x
NUR 7632 Module 6 instructions, in plain terms
Substance use is one of the common adult mental health concerns named in the NUR-7632 catalog description, and as TESU shares the syllabus only after enrollment, the final module was planned as an alcohol use disorder case. Expect to start from a scored screen, walk through each diagnostic criterion to set the severity, assess withdrawal risk and choose a safe setting for it, pick a medicine from comparative evidence, describe the counseling that goes with it and plan follow-up with laboratory checks. Some sections ask for opioid use disorder with buprenorphine instead, or a case where alcohol and depression overlap. Check whether your directions want a named withdrawal scale, a motivational interviewing passage or a discussion of the legal side of a court-ordered evaluation, and fit the length to any page limit set there.
Inside the NUR 7632 Module 6 example
Diane's arrest after a client dinner and the fuller history behind it open the paper. Her AUDIT of 24 is read against the tool's development figures, and each diagnostic criterion she meets is named to rate severity. Liver tests, blood count and mood are reviewed. A home withdrawal plan with daily checks, a tapering course held by her husband and thiamine follows. The review of 122 trials and the COMBINE trial are reported with their numbers and their mixed results, and a five-row table compares options for her. Naltrexone is started with its liver checks and opioid warning. Counseling, mutual help, her marriage, the court and her work schedule are covered before a conclusion that sets dates for each recheck. Margin notes explain the criterion-based rating and the honest use of COMBINE.
Where the marks sit in the NUR 7632 Module 6 rubric
Graders of a drinking case reward an AUDIT or similar score, a diagnosis built from the criteria with a severity rating, a withdrawal plan that assesses risk and chooses a safe setting, a medicine chosen from comparative evidence and explained to the patient, counseling described in practical terms and follow-up with laboratory checks. Mentors credit papers that report mixed findings, such as acamprosate's result in COMBINE, rather than claiming every medicine works. Warning about opioid pain medicines with naltrexone is often noted as a mark of safe prescribing. Respecting consent when a court or employer is involved shows legal and ethical care. Waiting to treat low mood until the patient has been sober for several weeks shows sound judgment, and every source should be cited in APA style with page numbers and DOIs.
NUR 7632 Module 6 help: mistakes that cost marks
Students often jump to a medicine without planning withdrawal; assess the risk and say where and how it will be managed. Another frequent error is starting naltrexone without checking liver tests or warning about opioid pain medicines. Give the severity rating from the criteria, not from the screening score alone. Report COMBINE fairly, including what did not work. Do not treat low mood at once with an antidepressant before the patient has had some weeks without alcohol, unless the depression is severe. Describe the counseling, not just the referral, and plan for the situations where drinking is most likely. Writing a drinking case of your own? Forward the rubric, and the opening custom draft costs you nothing.
Write yours, or have the desk draft it
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NUR 7632 Module 6 questions, answered
Where can I find a free NUR 7632 Module 6 sample paper?
Diane's alcohol use disorder case, from her AUDIT of 24 to safe withdrawal and naltrexone with counseling, is on this page in full.
What AUDIT score indicates a drinking problem?
In the tool's development study, 92 percent of hazardous or harmful drinkers scored 8 or more; scores of 20 or more usually point to dependence.
Which medicine works best for alcohol use disorder?
Across 122 trials, acamprosate and naltrexone each cut the chance of any drinking again, with naltrexone also reducing heavy drinking; they did not clearly differ head to head.
What did the COMBINE study find?
Naltrexone or a behavioral intervention, each with medical management, increased days without drinking compared with placebo and management alone, while acamprosate showed no clear effect.
Can alcohol withdrawal be managed at home?
For people without past seizures or delirium, serious illness or unsafe homes, outpatient withdrawal with daily checks and a short medicine taper can be safe.