Case Study: Multidisciplinary Management of Alcohol Addiction with Integrated Rehabilitation

Abstract

This case study presents a 38-year-old male with alcohol dependence disorder, managed through a structured inpatient detoxification program followed by multidisciplinary rehabilitation involving pharmacotherapy, cognitive-behavioral therapy (CBT), and family counseling. Early recognition, gradual withdrawal management, and psychosocial interventions resulted in sustained abstinence and improved quality of life. The case highlights the importance of individualized treatment planning, medication-assisted detoxification, and long-term psychological support in successful addiction recovery. Integrating medical, psychiatric, and social approaches ensures holistic patient rehabilitation and relapse prevention.

Introduction

Substance use disorders, particularly alcohol dependence, remain a major global public health concern, contributing to significant morbidity, mortality, and socioeconomic burden. Alcohol addiction is characterized by tolerance, withdrawal symptoms, and loss of control over consumption.
Comprehensive management requires a biopsychosocial model that addresses physiological dependence, psychological triggers, and environmental influences. Modern addiction treatment integrates pharmacotherapy, psychotherapy, and community support, emphasizing continuity of care. This case demonstrates how a coordinated multidisciplinary strategy combining medical stabilization, behavioral therapy, and family involvement achieves sustainable recovery.

Patient Information

Age / Gender: 38-year-old male
Occupation: Corporate sales executive
Marital Status: Married with one child
Medical History: Mild hypertension, gastritis
Psychiatric History: None
Family History: Paternal history of alcohol use disorder
Social History: Daily alcohol consumption for 10 years (approx. 180 mL/day), occasional smoker
Current Medications: Amlodipine 5 mg once daily
Chief Complaints: Tremors, irritability, insomnia, and craving for alcohol after attempting to quit

Clinical Findings

Symptoms:

• Hand tremors and restlessness

• Sweating, irritability, and poor concentration

• Sleep disturbances and intense craving for alcohol

Physical Examination:

• Temperature: 99°F

• Pulse: 104 bpm

• BP: 150/90 mmHg

• Mild hand tremors, anxiety, and diaphoresis

• No hepatic tenderness or jaundice observed

• Clinical Institute Withdrawal Assessment for Alcohol (CIWA-Ar): 18 (moderate withdrawal)

Timeline

Initial Presentation (March 2024):
Patient presented to outpatient psychiatry with symptoms of alcohol withdrawal 24 hours after last drink. Referred for inpatient detoxification.

Admission and Assessment (Day 1):
Comprehensive evaluation by psychiatry, internal medicine, and clinical psychology teams. Baseline investigations performed.

Detoxification Phase (Days 1–7):
Benzodiazepine-assisted detoxification initiated (chlordiazepoxide 50 mg tapering dose), thiamine supplementation, hydration, and monitoring for withdrawal complications.

Rehabilitation Phase (Weeks 2–6):
CBT sessions, group therapy, stress management, and family counseling initiated. Pharmacotherapy with naltrexone 50 mg/day started to reduce cravings.

Discharge (End of Week 6):
Patient discharged with stable mood, controlled cravings, and relapse-prevention plan.

Follow-Up (3 Months):
Maintained abstinence, resumed work, improved family interactions, and active participation in community support groups (AA meetings).

Diagnostic Assessment

Laboratory Findings:

• Liver Function Tests: Mildly elevated AST (60 IU/L), ALT (70 IU/L)

• CBC, electrolytes, renal function: Within normal limits

• Blood Alcohol Level: Negative (on admission)

• ECG: Normal

Psychological Evaluation:

• DSM-5 Criteria: Met diagnostic criteria for Alcohol Use Disorder (severe type)

• Depression and Anxiety Screening: Mild depressive features, no psychosis

• Motivation Level: Stage of “Preparation” on Prochaska and DiClemente model

Risk Evaluation:

• Withdrawal Risk: Moderate (CIWA-Ar 18)

• Relapse Risk: High (due to occupational stress)

Therapeutic Intervention

Step 1 – Detoxification and Medical Stabilization

• Controlled benzodiazepine taper (chlordiazepoxide 50 mg → 10 mg over 7 days)

• Thiamine 100 mg IV daily for 3 days, followed by oral supplementation

• Proton pump inhibitor for gastritis prophylaxis

• Blood pressure managed with existing antihypertensive

• Daily clinical monitoring for withdrawal complications (delirium tremens, seizures)

Step 2 – Psychotherapy and Behavioral Modification

• Cognitive-Behavioral Therapy (CBT) for trigger identification and craving control

• Motivational Enhancement Therapy to strengthen readiness for change

• Stress management techniques (deep breathing, journaling, mindfulness)

• Family therapy sessions for relational support and accountability

Step 3 – Pharmacotherapy for Relapse Prevention

• Naltrexone 50 mg daily initiated after detox phase

• Advised abstinence from alcohol while on treatment

• Monitored for hepatic side effects and adherence

Step 4 – Rehabilitation and Social Reintegration

• Group therapy and Alcoholics Anonymous (AA) meetings

• Vocational counseling for stress management at workplace

• Regular psychiatric and psychological follow-up every 2 weeks for 3 months

Challenges Faced

• Withdrawal Severity: Managed using structured CIWA-Ar-guided tapering.

• Craving Control: Addressed through pharmacotherapy and behavioral reinforcement.

• Occupational Stress: Managed through counseling and lifestyle modification.

• Family Strain: Reduced through structured family therapy and communication training.

Follow-Up and Outcomes

• 2 Weeks: No acute withdrawal symptoms; improved sleep and mood.

• 1 Month: Controlled cravings; began workplace reintegration.

• 3 Months: Maintained abstinence, improved relationships, normal liver function tests.

• 6 Months: Sustained recovery, active AA participant, stable psychosocial functioning.

Discussion

This case illustrates the effectiveness of a multidisciplinary, integrated approach in managing alcohol addiction. Combining medical detoxification, pharmacological support, and psychotherapeutic intervention addresses both physiological dependence and psychological conditioning.
Benzodiazepine-assisted detoxification minimizes withdrawal complications, while naltrexone effectively suppresses craving by blocking opioid receptors. CBT empowers patients to recognize high-risk situations and develop coping mechanisms.
Family involvement enhances treatment adherence, emotional stability, and relapse prevention. Long-term outcomes depend on structured follow-up, continued motivation, and community support participation.
Evidence supports that relapse rates drop by 40% when pharmacotherapy is combined with behavioral therapy, underscoring the synergy of medical and psychological strategies in addiction management.

Key Takeaways

• Early intervention and medical detoxification are essential for safe withdrawal.

• Pharmacotherapy (naltrexone, acamprosate) improves abstinence rates.

• Cognitive-behavioral therapy strengthens coping and relapse prevention.

• Family and community support play crucial roles in sustained recovery.

• Long-term follow-up ensures stability and reduces relapse risk.

Patient’s Perspective

“I didn’t realize how dependent I had become until I tried to quit. The first week was hard, but the doctors and counselors supported me through every step. Therapy helped me understand my triggers and rebuild trust with my family. I’ve been sober for six months now, and life finally feels balanced.”

Conclusion

This case underscores that successful addiction management requires an integrated medical and psychological framework. Detoxification alone is insufficient; sustained recovery hinges on long-term behavioral change, psychosocial support, and relapse prevention strategies. Addiction is a chronic, relapsing condition that affects both the brain’s neurochemistry and an individual’s emotional and social well-being. Thus, a comprehensive approach that combines pharmacological interventions—such as medication-assisted therapy (MAT) using agents like buprenorphine or naltrexone with cognitive-behavioral and motivational enhancement therapies is critical for lasting results.

A coordinated multidisciplinary team - psychiatrist, psychologist, physician, social worker, and family forms the cornerstone of effective rehabilitation. Each member plays a distinct yet complementary role: the psychiatrist addresses underlying psychiatric comorbidities such as depression or anxiety; the psychologist implements structured behavioral therapies; the physician manages withdrawal and physical health issues; the social worker facilitates reintegration into society; and the family provides emotional stability and accountability. This synergy not only accelerates recovery but also helps identify and address triggers that could lead to relapse.

By blending evidence-based therapy with patient-centered care, addiction treatment can transform lives, restoring health, dignity, and social function. Incorporating lifestyle modification, vocational training, mindfulness practices, and peer-support groups enhances resilience and self-efficacy. Technology-driven solutions like telepsychiatry and digital recovery tracking apps—can extend support beyond clinical settings, ensuring continuous engagement. Ultimately, addiction management must shift from crisis-based detoxification to a lifelong recovery model that prioritizes empowerment, community integration, and holistic wellness, turning vulnerability into sustainable strength.

References

1. National Institute on Drug Abuse (NIDA). (2023). Principles of Drug Addiction Treatment: A Research-Based Guide.

2. Anton RF, et al. (2006). Combined Pharmacotherapies and Behavioral Interventions for Alcohol Dependence. JAMA.

3. Soyka M, et al. (2017). Guidelines for Biological Treatment of Substance Use and Related Disorders. World J Biol Psychiatry.

4. Miller WR, Rollnick S. (2013). Motivational Interviewing: Helping People Change. Guilford Press.

5. NICE. (2022). Alcohol-Use Disorders: Diagnosis, Assessment, and Management.

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