His roommate reports finding alcohol bottles and drug paraphernalia in their shared room. Jordan admits to daily alcohol consumption and intermittent use of marijuana and Adderall, which he originally used to stay awake during exams. He states he wants to feel better.

Jordan states that he started drinking socially at age 16 but began drinking more heavily when he entered college. During high-stress periods such as midterms and finals, he would use non-prescribed Adderall to improve concentration. He denies intravenous drug use but admits to frequent binge drinking and occasional cannabis use to “take the edge off.” He reports frequent blackouts, missed assignments, and strained family relationships. Jordan appears disheveled, with mild tremors in both hands. His speech is pressured, and mood is described as “numb.” Affect is flat. Insight and judgment appear impaired. He denies suicidal ideation but states, “Sometimes I don’t care if I wake up or not.”

Questions:

1. What is the most appropriate next step in management for Jordan?
A. Immediate inpatient detoxification
B. Arrest and disciplinary action
C. Referral to outpatient substance use treatment
D. Prescribe benzodiazepines for anxiety

2. What is a common sign of alcohol withdrawal Jordan might experience?
A. Euphoric mood
B. Tactile hallucinations
C. Mydriasis
D. Bradycardia

3. Jordan’s statement “I don’t care if I wake up or not” should prompt which of the following actions?
A. Immediate psychiatric hospitalization
B. Suicide risk assessment
C. Reassure him and schedule a follow-up
D. Ignore unless he mentions suicide directly

Answers:

1. C - Jordan is medically stable and shows motivation for change. Outpatient treatment with behavioral therapy is the recommended first step.

2. B - Alcohol withdrawal can cause tactile hallucinations (“bugs crawling on skin”), tremors, and seizures

3. B - Passive suicidal ideation warrants a thorough suicide risk assessment, especially in the context of substance use and impaired judgment.