Alcoholic Hepatitis: Models and Treatment

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Table of Contents

Introduction
Background Information of Alcoholic Hepatitis
Evaluation of Models
Needs of the Patient
Treatment Plan
Conclusion
References

Introduction

Diseases have a negative impact on our socio-economic well- being. Treatment sometimes does not entail chemotherapy alone but other interventions that require patients to abandon unhealthy habits. Healthcare providers use behavioral models to ensure the success of other medical interventions such as physical activity, drug, and alcohol recovery sessions. Doctors use a combination of chemotherapy and other medical interventions in the treatment of alcoholic hepatitis. Therefore, this essay examines the case study of alcoholic hepatitis with a view of evaluating models of health promotion and disease prevention, identifying client needs, and creating a treatment plan.

Background Information of Alcoholic Hepatitis

Alcoholic hepatitis is a clinical syndrome whose symptoms include jaundice and failure of the liver due to prolonged overindulgence in alcohol consumption (Thursz et al., 2015). The severity of the disease is determined using the Maddrey’s discriminant formula, which classifies patients having values of 32 and above as having severe forms of the disease. Patients with severe hepatitis have 30-40% chance of succumbing to the disease (Singal, Kamat, Gores, & Shah, 2014). Alcoholic hepatitis is a form of alcoholic liver disease (ALD) coupled with liver cirrhosis (Basra & Anand, 2011). In the prophylaxis of the disease, prednisolone and pentoxifylline are the most widely used pharmacological agents with empirical evidence indicating that they have disparate results in the management of the severe form of the disease (Thursz et al., 2015). Pentoxifylline does not increase survival of patients with alcoholic hepatitis while Prednisone reduces death by 28 days; however, with no significant change after 3 and 12 months, respectively. The cause of the disparity is still under investigation.

Evaluation of Models

The major strides made in medical research made in the 20^th century have resulted in decreased infant, child, and maternal deaths. Longevity has a positive impact on the social and economic well-being of most countries. The approach employed in combating diseases is that of treating each disease individually using behavioral models, which play a key role in the effective management of diseases. John’s relapse with alcohol abuse is the causative factor for alcohol hepatitis. Therefore, imperative in his treatment and recovery are the trans-theoretical, health belief and relapse prevention models.

The trans-theoretical model holds that for people to embrace healthy behaviors and abandon bad ones, they have to undergo different stages that entail pre-contemplation, contemplation, preparation, action, and maintenance (Howard, Schembre, Motl, Dishan, & Nigg, 2013). The health belief model avers that a patient’s perception of disease threat and benefits of a given intervention must override the impediments to the same intervention if a patient is ever to adopt a new treatment. The key concepts of the model include perceived susceptibility and severity, supposed merits of an action, potential impediments to an action, motivation to an action, and self-efficacy by setting tenable behavioral objectives (Orji, Vassileva, & Mandryk, 2012).

The relapse prevention models hold that persons commencing physical activities may need interventions that make them expect factors that contribute to relapse (Hendershot, Witkiewitz, George, & Marlatt, 2011). Key concepts of this model include skills acquisition via training, mindset reframing and lifestyle re-adjustments. The major aims of the relapse prevention concepts are to prepare a patient psychologically for an eventuality of re-encountering the same challenges that made the patient engage in unhealthy behavior. A secondary exposure will not have the same impact as the initial one, and so, a person is better equipped to tackle them.

Though these behavioral models seem appropriate, they are not without downsides. The health belief model does not consider attitudes and beliefs that motivate a patient to embrace a health behavior. The model also does not take into account habitual behaviors that inspire the decision to pursue recommended activities. Furthermore, the model assumes that motivations to act are common, and thus, it holds that health actions are the main objectives of health promotion. The trans-theoretical model overlooks the social context in which change occurs. Moreover, the model has no predefined period for each phase, and it assumes people make rational decisions, which in most cases is not true. The relapse prevention model has the demerit of assuming that the interventions employed will introduce the person to potential causes of relapse.

Needs of the Patient

Predicating on the behavioral models above, it is highly likely the patient’s relapse into alcoholism and drug abuse emanates because of a failure to maintain abstinence from drugs and alcohol. A plausible explanation for this could be that the patient experiences stress. The stress systematically creates a carefree attitude, which makes the patient trivialize the effects of drug abuse and alcohol, and the subsequent consequences. The stress also creates a sense of hopelessness, which makes the patient prone to relapse for he feels that his life is useless, and he has everything to lose.

The confession that his job is at stake and the fact that his wife is about to abandon him confirm that he is a deeply worried man who is already on the verge of depression. Furthermore, stress makes the patient develop withdrawal attitude, probably due to disillusionment. Evidently, John does not easily disclose information about his personal life to people because he probably does not see the benefits of disclosure. The overall contribution of stress in John’s life is that it has left him a shell of a man.

Analysis of the case shows that the mind-body connection of the patient is weak. The weakness is attested by the fact that the client is physically weak for he lost much weight. Moreover, John is mentally feeble because he has relapsed into heroin and alcohol use. The effects of heroin and alcohol put the patient in a mental state that makes him forget his problems transiently and neglect his bodily needs such as food and exercise. After the effects of drugs and alcohol wear off, the client then faces the realities of life again. Over consumption of alcohol also has the far-reaching effect of damaging his liver resulting in jaundice and alcoholic hepatitis. Alcoholic hepatitis disease wears the body down contributing to the overall state of the malaise of the patient. Physical and mental states are inextricable and collectively contribute to overall well-being.

Treatment Plan

In light of the above discussions, the patient needs alcohol and drug therapy sessions, immediate chemotherapy for hepatitis, treatment of flu and swollen thyroid glands, anti-depressants and stress counseling sessions, and exercise, in this order. The treatment plan, captured in the table below, will aid in the achievement of these interventions.

Table 1: Treatment Plan

Activity

Alcohol and drug therapy sessions

In charge

Venue

Start

End

Overall objective

Chemotherapy for hepatitis

Drug

Dose

Provider

Progress

Prednisolone

1x daily

Treatment of flu and swollen thyroid glands

Drug

Dose

Provider

Progress

Stress management sessions

Anti-depressant; Prozac, 20mg,1x 1
Stress management: stress counselling sessions

Exercise

Recommended; jogging, calisthenics and aerobics

The treatment plan is appropriate in that it ensures the respective healthcare providers meet the patient’s needs. It does so by identifying ways of fulfilling each of the needs. Alcohol and drug abuse therapies will ensure that John abstains from drug and substance abuse, which have contributed to his poor health. Treatment for swollen thyroid glands is to ensure the patient is in the right physical state to pursue exercises and counseling sessions. The stress management session is for alleviating stress in a bid to return the patient to normalcy. Physical exercises will keep the patient healthy and contribute immensely to stress alleviation. Physical exhaustion has a way of deviating a person’s thoughts from everyday worries. However, exercises must go hand-in-hand with healthy feeding habits. Cumulatively, the needs will contribute to the patient’s overall well-being.

Table 2 Steps and goals

Patient’s details:			Doctor’s details:
Name: John Doe			Name:
Medical aid number: 3425678			Medical aid number:
Date of Birth:			Date of Birth:
Medication (s):	Dose:	Frequency:				Indication:
Prednisone	20mg	1 x a day				Alcoholic hepatitis
Diagnosis: The patient has alcoholic hepatitis and jaundice, which is a potent sign for damaged liver, due to his history of alcohol abuse.
Long-term goals: Ameliorate alcoholic hepatitis and manage stress.
Short term goals: Therapy for drug and alcoholStress counselling sessions.	Steps Stop alcohol use Substance and drug abuse counselling. Antidepressants Physical exercise	Start date:		End date:		Date achieved:
Review date:	Progress:
Patient’s signature
Health care Provider’s name, signature and title:					Date:

Conclusion

The successful management of diseases requires careful planning to ensure health care providers meet the patients’ needs. The analysis of case study shows that the treatment and recovery process of John requires chemotherapy and counseling. Moreover, the case study shows that planning of treatment requires the application of the models of health promotion and disease prevention such as the trans-theoretical model, health belief model, and relapse prevention model. Overall, treatment plan plays a vital role in the treatment and recovery process of John.

References

Basra, S., & Anand, B. (2011). Definition, epidemiology and magnitude of alcoholic hepatitis. World Journal of Hepatology, 3(5), 108-113.

Hendershot, C., Witkiewitz, K., George, W., & Marlatt, G. (2011). Relapse prevention for addictive behaviors. Substance Abuse Treatment, Prevention, and Policy, 6(17), 1-17.

Howard, C., Schembre, S., Motl, R., Dishan, R., & Nigg, C. (2013). Does the Trans-theoretical Model of Behavior Change Provide a Useful Basis for Interventions to Promote Fruit and Vegetable Consumption? American Journal of Health Promotion, 27(6), 351-357

Orji, R., Vassileva, J., & Mandryk, M. (2012). Towards an Effective Health Interventions Design: An Extension of the Health Belief Model. Online Journal of Public Health Informatics, 4(3), 1-32.

Singal, K., Kamat, P., Gores, G., & Shah, V. (2014). Alcoholic Hepatitis: Current Challenges and Future Directions. Clinical Gastroenterology and Hepatology, 12(4), 555-564.

Thursz, R., Richardson, P., Allison, M., Austin, A., Bowers, M., Day, C.,… Forrest, E. (2015). Prednisolone and Pentoxyfylline for Alcoholic Hepatitis. The New England Journal of Medicine, 372(16), 19-28.

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