No appropriate clinical management for alcohol dependence or alcohol abuse

Alcohol Use Disorder - Inability to obtain appropriate clinical management for alcohol dependence and alcohol abuse Factor

• Abstinence from drinking alcohol is the only effective treatment for alcohol dependence or alcohol abuse.  Therefore, it is important that once the alcohol dependence or alcohol abuse is identified, support and treatment be offered to allow this to occur.  This involves identification and treatment of any underlying medical, psychiatric, or social condition which may have led to the alcohol dependence or alcohol abuse.
• However, in all circumstances where alcohol dependence or alcohol abuse has been diagnosed, and the patient is prepared to undergo treatment, the following 3 initial steps are advised:

1.      Thorough physical examination to evaluate organ systems likely to be affected by alcohol consumption, including evidence of liver damage, gastrointestinal bleeding, cardia arrhythmia, and glucose or electrolyte imbalance.

2.      Provision of adequate nutrition, rest, and oral multiple B vitamins including thiamine for at least one week during the withdrawal stage.

3.      Alleviation of CNS (Central Nervous System) symptoms (tremor and elevated pulse) of alcohol withdrawal by administering another CNS depressant (benzodiazepines preferred), the dosage of which is gradually reduced over a number of days.  Antipsychotic medications are sometimes indicated.

• Institution of a supportive review programme following detoxification - rehabilitation, psychotherapy, counselling – with all recovering alcoholics encouraged to attend Alcoholics Anonymous.
• The characteristics of the patient predict outcome more than any specific attribute of a treatment programme.

Last reviewed for CCPS 9 September 2009.

Preliminary questions [26368]

11109  the condition under consideration has been accepted on the basis of inability to obtain appropriate clinical management for the condition under consideration.

7066     there is some evidence that an inability to obtain appropriate clinical management for the condition under consideration may be a factor in the worsening of the condition under consideration.

7334     the clinical onset of the condition under consideration occurred after the end of the veteran's last period of VEA service.

7335     the condition under consideration permanently worsened.

7378     the veteran was unable to obtain appropriate clinical management for the condition under consideration at some time.

7379     the inability to obtain appropriate clinical management for the condition under consideration contributed to the clinical worsening of the condition under consideration.

11234   the veteran has established the causal connection between the inability to obtain appropriate clinical management for the condition under consideration and VEA service for the clinical worsening of the condition under consideration.

11235  the veteran has established the causal connection between the inability to obtain appropriate clinical management for the condition under consideration and operational service for the clinical worsening of the condition under consideration.

or

11236  the veteran has established the causal connection between the inability to obtain appropriate clinical management for the condition under consideration and eligible service for the clinical worsening of the condition under consideration.

Clinical worsening and operational service [11235]

7384     the veteran was unable to obtain appropriate clinical management for the condition under consideration, which contributed to the clinical worsening of the condition under consideration, during operational service.

21084 the veteran was unable to obtain appropriate clinical management for the condition under consideration, which contributed to the clinical worsening of the condition under consideration, during operational service, as a causal result of operational service.

7387     the veteran's inability to obtain appropriate clinical management for the condition under consideration during operational service was due to the veteran's serious default, wilful act or serious breach of discipline.

or

7389     the veteran was unable to obtain appropriate clinical management for the condition under consideration, which contributed to the clinical worsening of the condition under consideration, because of an illness or injury which is identifiable.

7390     the identified illness or injury which prevented the veteran from obtaining appropriate clinical management for the condition under consideration is causally related to operational service.

7392     the clinical onset of the condition under consideration occurred prior to that part of operational service to which the identified illness or injury that prevented the veteran from obtaining appropriate clinical management for the condition under consideration is causally related.

Clinical worsening and eligible service [11236]

7385     the veteran was unable to obtain appropriate clinical management for the condition under consideration, which contributed to the clinical worsening of the condition under consideration, during eligible service.

7386     the veteran was unable to obtain appropriate clinical management for the condition under consideration, which contributed to the clinical worsening of the condition under consideration, during eligible service, as a causal result of eligible service.

7388     the veteran's inability to obtain appropriate clinical management for the condition under consideration during eligible service was due to the veteran's serious default, wilful act or serious breach of discipline.

or

7389     the veteran was unable to obtain appropriate clinical management for the condition under consideration, which contributed to the clinical worsening of the condition under consideration, because of an illness or injury which is identifiable.

7391     the identified illness or injury which prevented the veteran from obtaining appropriate clinical management for the condition under consideration is causally related to eligible service.

7393     the clinical onset of the condition under consideration occurred prior to that part of eligible service to which the identified illness or injury that prevented the veteran from obtaining appropriate clinical management for the condition under consideration is causally related.