Answer

Ewing’s (1984), CAGE (Cut down, Annoyed, Guilty, and Eye-opener) alcohol questionnaire could be used a screening tool for Ritchie. Assessments questions that could be derived from the CAGE alcohol questionnaire include the following (Johns Hopkins Medicine, 2021).

Questions

1. Have you ever felt or thought that you should cut down on your alcohol consumption (Ewing et al., 1984)?
2. Have you ever felt a sense of guilt or bad about your drinking (Ewing et al., 1984)?
3. Have you ever had a drink as a first-thing in the morning so as to get rid of hangover or to steady your nerves or act as an eye-opener (Ewing et al., 1984)?

Ritchie could not be asked if other people have annoyed him by criticizing his drinking since he states that his wife (Sandra) gets irritable and argumentative when he drinks (Ewing et al., 1984). 

Pharmacotherapy

            Three medications (disulfiram, acamprosate, and naltrexone) are available to help manage Ritchie’s cravings for alcohol since they are the only medications that have been approved by the U.S. Food and Drug Administration (Witkiewitz, Litten, & Leggio, 2019). Review Table 1 below.

Table 1: Comparison of Medications to Manage Alcohol Craving

Selected Medication: Naltrexone

            Naltrexone is described as the most effective medication for management of patients with craving for alcohol (Witkiewitz et al., 2019). Ritchie should be educated and informed that he will be taking 50 mg PO once per day together with food; since it has been demonstrated to be most effective if taken that way. Dosage can also include 50 mg once per day on week days and 100 mg OP on Saturdays or 100 mg PO once every other day (Prescribers’ Digital Reference (PDR), 2021).

Naltrexone therapy should be continued for about 3 to 6 months for it to be effective. Ritchie should not exceed maximum acceptable dosage of 150 mg per day PO. Assessment should be performed to include liver and kidney function. In case of severe hepatic function, naltrexone dosage should be increased by a 10-fold. Similarly, naltrexone dosages may need to be adjusted if Ritchie present with any form of renal impairment (PDR, 2021).

            Naltrexone is contraindicated if Ritchie has history of naltrexone hypersensitivity. Besides, in case he has hypersensitivity to nalmefene or naloxone; the drug will be contraindicated since they are similar structural properties to naltrexone (PDR, 202S1). Ritchie should be assessed and monitored since naltrexone is associated with increased risk suicide, depression, suicidal ideation, and attempted suicide (PDR, 2021). In addition, naltrexone causes other adverse effects such as peptide ulcer, atrial fibrillation, myocardial infarction, ejaculation dysfunction, constipation, thrombosis, and pulmonary embolism (PDR, 2021).

 Support Groups

            Ritchie should be referred to the Alcoholics Anonymous (AA) group in Tampa, Florida. The group can help Ritchie to work though shared issues as well as common concerns with a licensed counselor or group leader. The group allows for one to receive as well as give guidance and support for the continued sobriety while working with peers to overcome alcoholism (The Recovery Village and Alcohol Rehab, 2021). Al-Anon Family Groups (2020), is an available community resource for Sandra (Ritchie’s wife). Al-Anon Family Groups (2020) are meant for people who are concerned about the drinking behavior or others. Individual therapy would be appropriate for Ritchie so as to address psychosocial, physical, economic, and other issues that may influence his drinking behavior (Bradley et al., 2017).