Patient's lifestyle choices

Your patient is still in pain due to his recent hospitalization. His overuse of pain medication shows you that he is in severe pain, he need more help. Still, his elevated liver enzymes makes it even harder to treat his pain. You may need to also refer and consult with a pain specialist. 

Apart from that, you ask your patient about his lifestyle choices, in your effort to figure out about other risk factors that may be affecting his liver function. Your patient reveals that he has trouble sleeping. His pain wakes him up at night, and he cannot fall back to sleep. He sometimes has 3 or 4 drinks at night to soothe his pain. And he also uses benzodiapines for his stress and to relax. You see now that put together all this medicines have an accumulative effect on his liver enzymes and be the reason for his recent hospitalization. 

You try to explain all this to your patient. Given the level of his health literacy your are not certain that he fully understands how risky his behaviour is. 

You start thinking you might need to refer him to a psychologist and/or psychiatrist for further consultation. Further monitoring of his liver function is required. You make sure you will have a follow up visit in a month. 

Finally, your patient says that one of his major problems is that he has lost his sleep. He gets up every morning feeling tired and depressed.