ASSESSING AND TREATING PATIENTS WITH IMPULSIVITY, COMPULSIVITY, AND ADDICTION NURS 6630
Sample Answer for ASSESSING AND TREATING PATIENTS WITH IMPULSIVITY, COMPULSIVITY, AND ADDICTION NURS 6630 Included After Question
Impulsivity, compulsivity, and addiction are challenging disorders for patients across the life span. Impulsivity is the inclination to act upon sudden urges or desires without considering potential consequences; patients often describe impulsivity as living in the present moment without regard to the future (MentalHelp.net, n.d.). Thus, these disorders often manifest as negative behaviors, resulting in adverse outcomes for patients. For example, compulsivity represents a behavior that an individual feels driven to perform to relieve anxiety (MentalHelp.net, n.d.). The presence of these behaviors often results in addiction, which represents the process of the transition from impulsive to compulsive behavior.
In your role as the psychiatric nurse practitioner (PNP), you have the opportunity to help patients address underlying causes of the disorders and overcome these behaviors. For this Assignment, as you examine the client case study in this week’s Learning Resources, consider how you might assess and treat clients presenting with impulsivity, compulsivity, and addiction.
Reference: MentalHelp.net. (n.d.). Impaired decision-making, impulsivity, and compulsivity: Addictions’ effect on the cerebral cortex. https://www.mentalhelp.net/addiction/impulsivity-and-compulsivity-addictions-effect-on-the-cerebral-cortex/
Resources
Be sure to review the Learning Resources before completing this activity.
Click the weekly resources link to access the resources.
WEEKLY RESOURCES
Learning Resources
- Kelly, J. E., & Renner, J. A. (2016). Alcohol-Related disorders. In T. A. Stern, M. Favo, T. E. Wilens, & J. F. Rosenbaum. (Eds.), Massachusetts General Hospital psychopharmacology and neurotherapeutics (pp. 163–182). Elsevier.
- Renner, J. A., & Ward, N. (2016). Drug addiction. In T. A. Stern, M. Favo, T. E. Wilens, & J. F. Rosenbaum. (Eds.), Massachusetts General Hospital psychopharmacology and neurotherapeutics (pp. 163–182). Elsevier.
- Substance Abuse and Mental Health Services Administration. (1999). Treatment of adolescents with substance use disorders: Treatment improvement protocol series
Links to an external site., no. 32. http://www.ncbi.nlm.nih.gov/books/NBK64350/
- Chapter 1, “Substance Use Among Adolescents”
- Chapter 2, “Tailoring Treatment to the Adolescent’s Problem”
- Chapter 7, “Youths with Distinctive Treatment Needs”
University of Michigan Health System. (2016). Childhood trauma linked to worse impulse control. Journal of Psychosocial Nursing & Mental Health Services
Links to an external site., 54(4), 15.
Grant, J. E., Odlaug, B. L., & Schreiber, L. N. (2014). Pharmacological treatments in pathological gambling. British Journal of Clinical Pharmacology
Links to an external site., 77(2), 375–381. https://doi.org/10.1111/j.1365-2125.2012.04457.x
Hulvershorn, L. A., Schroeder, K. M., Wink, L. K., Erickson, C. A., & McDougle, C. J. (2015). Psychopharmacologic treatment of children prenatally exposed to drugs of abuse. Human Psychopharmacology
Links to an external site., 30(3), 164–172. https://doi.org/10.1002/hup.2467
Loreck, D., Brandt, N. J., & DiPaula, B. (2016). Managing opioid abuse in older adults: Clinical considerations and challenges. Journal of Gerontological Nursing
Links to an external site., 42(4), 10–15. https://doi.org/10.3928/00989134-20160314-04
Salmon, J. M., & Forester, B. (2012). Substance abuse and co-occurring psychiatric disorders in older adults: A clinical case and review of the relevant literature. Journal of Dual Diagnosis
Links to an external site., 8(1), 74–84. https://doi.org/10.1080/15504263.2012.648439
Sanches, M., Scott-Gurnell, K., Patel, A., Caetano, S. C., Zunta-Soares, G. B., Hatch, J. P., Olvera, R., Swann, A. C., & Soares, J. C. (2014). Impulsivity in children and adolescents with mood disorders and unaffected offspring of bipolar parents. Comprehensive Psychiatry
- Links to an external site., 55(6), 1337–1341. https://doi.org/10.1016/j.comppsych.2014.04.018
- U.S. Food & Drug Administration. (n.d.). Drugs@FDA: FDA-approved drugs
- Links to an external site.. https://www.accessdata.fda.gov/scripts/cder/daf/index.cfm
Links to an external site.
Note: To access the following medications, use the Drugs@FDA resource. Type the name of each medication in the keyword search bar. Select the hyperlink related to the medication name you searched. Review the supplements provided and select the package label resource file associated with the medication you searched. If a label is not available, you may need to conduct a general search outside of this resource provided. Be sure to review the label information for each medication as this information will be helpful for your review in preparation for your Assignments.
- naltrexone (revia/vivitrol)
- naloxone
- acamprosate
- disulfiram
Note: This case study will serve as the foundation for this week’s Assignment.
- Lupi, M., Martinotti, G., Acciavatti, T., Pettorruso, M., Brunetti, M., Santacroce, R., Cinose, E., Di Iorio, G., Di Nicola, M., & Di Giannantonio, M. (2014). Pharmacological treatments in gambling disorder: A qualitative review. Biomed Research International, 2014
Links to an external site.. https://doi.org/10.1155/2014/537306
To prepare for this Assignment:
- Review this week’s Learning Resources, including the Medication Resources indicated for this week.
- Reflect on the psychopharmacologic treatments you might recommend for the assessment and treatment of patients requiring therapy for impulsivity, compulsivity, and addiction.
The Assignment: 5 pages
Examine Case Study: A Puerto Rican Woman With Comorbid Addiction. You will be asked to make three decisions concerning the medication to prescribe to this client. Be sure to consider factors that might impact the client’s pharmacokinetic and pharmacodynamic processes.
At each decision point, you should evaluate all options before selecting your decision and moving throughout the exercise. Before you make your decision, make sure that you have researched each option and that you evaluate the decision that you will select. Be sure to research each option using the primary literature.
Introduction to the case (1 page)
- Briefly explain and summarize the case for this Assignment. Be sure to include the specific patient factors that may impact your decision making when prescribing medication for this patient.
Decision #1 (1 page)
- Which decision did you select?
- Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
- Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
- What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).
- Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.
Decision #2 (1 page)
- Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
- Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
- What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).
- Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.
Decision #3 (1 page)
- Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
- Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
- What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).
- Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.
Conclusion (1 page)
- Summarize your recommendations on the treatment options you selected for this patient. Be sure to justify your recommendations and support your response with clinically relevant and patient-specific resources, including the primary literature.
Note: Support your rationale with a minimum of five academic resources. While you may use the course text to support your rationale, it will not count toward the resource requirement. You should be utilizing the primary and secondary literature.
Reminder : The College of Nursing requires that all papers submitted include a title page, introduction, summary, and references. The Sample Paper provided at the Walden Writing Center provides an example of those required elements (available at https://academicguides.waldenu.edu/writingcenter/templates/general#s-lg-box-20293632). All papers submitted must use this formatting
By Day 7
Submit your Assignment.
submission information
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- To submit your completed assignment, save your Assignment as WK10Assgn1_LastName_Firstinitial
- Then, click on Start Assignment near the top of the page.
- Next, click on Upload File and select Submit Assignment for review.
Rubric
NURS_6630_Week10_Assignment1_Rubric
| NURS_6630_Week10_Assignment1_Rubric | ||||||
| Criteria | Ratings | Pts | ||||
| This criterion is linked to a Learning Outcome Introduction to the case (1 page)Briefly explain and summarize the case for this Assignment. Be sure to include the specific patient factors that may impact your decision making when prescribing medication for this patient. |
|
10 pts | ||||
| This criterion is linked to a Learning Outcome Decision #1 (1–2 pages)• Which decision did you select?• Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.• Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.• What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).• Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples. |
|
20 pts | ||||
| This criterion is linked to a Learning Outcome Decision #2 (1–2 pages)• Which decision did you select?• Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.• Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.• What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).• Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples. |
|
20 pts | ||||
| This criterion is linked to a Learning Outcome Decision #3 (1–2 pages)• Which decision did you select?• Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.• Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.• What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).• Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples. |
|
20 pts | ||||
| This criterion is linked to a Learning Outcome Conclusion (1 page)• Summarize your recommendations on the treatment options you selected for this patient. Be sure to justify your recommendations and support your response with clinically relevant and patient-specific resources, including the primary literature. |
|
15 pts | ||||
| This criterion is linked to a Learning Outcome Written Expression and Formatting – Paragraph Development and Organization: Paragraphs make clear points that support well-developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused—neither long and rambling nor short and lacking substance. A clear and comprehensive purpose statement and introduction are provided that delineate all required criteria. |
|
5 pts | ||||
| This criterion is linked to a Learning Outcome Written Expression and Formatting – English writing standards: Correct grammar, mechanics, and proper punctuation |
|
5 pts | ||||
| This criterion is linked to a Learning Outcome Written Expression and Formatting – The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, parenthetical/in-text citations, and reference list. |
|
5 pts | ||||
| Total Points: 100 | ||||||
A Sample Answer For the Assignment: ASSESSING AND TREATING PATIENTS WITH IMPULSIVITY, COMPULSIVITY, AND ADDICTION NURS 6630
Title: ASSESSING AND TREATING PATIENTS WITH IMPULSIVITY, COMPULSIVITY, AND ADDICTION NURS 6630
Alcohol use disorder contributes a significant proportion of the mental disorder substance use disorder which often occurs as a consequence of maladaptation to pressures in life. Alcohol use disorder co-occurrence with gambling disorder is increasing in prevalence over the years. Each disorder is a known predisposing factor for the other. There is a greater predisposition to morbidity and mortality than when the disorders occur separately (Atkinson, 2018). The purpose of this paper is to discuss the management of this patient in line with pharmacotherapy and psychotherapy, the expectations during and after treatment, and the ethical considerations during management.
Introduction to the Case
This week’s case study discusses a 53-year-old Puerto Rican female Mrs. Perez who has had alcohol use disorder for more than 25 years and has been part of Alcoholic Anonymous though intermittently. Her alcohol use has deteriorated over 2 years since a casino was opened close to her home. She also reports spending huge sums of money on gambling and her alcohol consumption also increases during gambling sprees. She also reports an increase in the frequency of smoking cigarettes over the past 2 years. She has gained 7lb. In her mental state exam, she is alert and oriented with clear speech. She cannot maintain appropriate eye contact and is avoidant. Her subjective mood is sad and her impulse control is impaired. She has no hallucinations, no involuntary stereotyped movements, no suicidal ideations, and her insight and judgment are intact. Her diagnosis is gambling disorder co-occurring with alcohol use disorder. In this case, decision-making in treatment is influenced by the goal of therapy, treatment duration, the dosage of the drug, socioeconomic status of the patient, gender, the individual drug pharmacokinetics, side effects, and toxicity profile. The purpose of this paper is to discuss the management of this patient in line with pharmacotherapy and psychotherapy, the expectations during and after treatment, and the ethical considerations during management.
Decision 1
Naltrexone 380mg Intramuscularly every 4 weeks.
Why did you select this decision?
Naltrexone is considered one of the first-line drugs in the management of alcohol use disorder. Naltrexone is highly efficacious in the prevention of relapse and reduction in heavy consumption of alcohol. It has also been found to have an average efficacy in the promotion of total abstinence in alcohol use disorder patients (Kedia et al., 2022). According to the American Psychiatry Association, naltrexone proves to have modest efficacy in the treatment of alcohol use disorder with few side effects. The extended-release intramuscular naltrexone greatly improves the adherence to medication by reducing the pill burden and limiting the dose to one monthly injection (Edelman et al., 2018). Naltrexone has also been shown to extinguish the urge to gamble (Kraus et al., 2020). These reasons make Naltrexone the most appropriate in Mrs. Perez’ management.
Why did you not select the other two options provided in the exercise?
Acamprosate offers an alternative to naltrexone in the case of a contraindication to naltrexone use. The three-times daily dose of 666mg of Acamprosate is high and often associated with severe side effects like suicidal ideations, anxiety, and tipping into major depression, especially for this patient whose subjective mood is already sad. Disulfiram is an FDA-approved second-line pharmacotherapy for alcohol use disorder (Stokes & Abdijadid, 2019). Disulfiram usage is marred with a lot of adverse effects ranging from confusion states, and convulsions, to death (Patel & Balasanova, 2021). Its use is restricted to patients who are highly motivated to cease alcohol use. Because of these serious side effects, disulfiram use is marred with non-adherence to therapy. For this particular patient, it may be used when the first-line therapy fails. There is no approved pharmacotherapy for gambling disorder hence there is a further need for patient counseling and cognitive behavioral therapy.
What were you hoping to achieve by making this decision?
After induction of treatment, it is expected that the patient will abstain completely from alcohol and there will be long periods before relapse. Reduced craving for alcohol and reduce total alcohol consumption during therapy (Fairbanks et al., 2020). Few adverse effects are expected as the long-acting slow release is effective at minimizing side effects. The patient is expected to be adherent to the medication as there is no pill burden and the injection is only once a month (Kedia et al., 2022). It is expected that the patient will continue smoking and gambling as these drugs do not treat gambling disorders.
How ethical considerations may impact the treatment plan and communication
The treatment of this patient is based on the four tenets of ethical considerations which include justice, non-maleficence, beneficence, and autonomy. Informed consent is important in patient care. The condition is explained to the patient and she is provided with the best treatment choices based on her condition. The side effects of each of the drug choices are explained to the patient (Davis, 2020). Continuous monitoring of these side effects and the well-being of the patient is mandatory. Preservation of patient confidentiality is essential.
Decision 2
Refer to a counselor to address gambling issues
Why did you select this decision?
Counseling is the mainstay of the management of gambling disorders. According to Atkinson et al (2018), psychotherapy is the most effective treatment of gambling disorder. The aspects of counseling may include gambling anonymous groups, cognitive behavioral therapy, and group therapy (Jonas et al., 2019). Pharmacotherapy only deals to reduce the co-morbidities associated with gambling disorder which in this case is alcohol use.
Why did you not select the other two options provided in the exercise?
Mrs. Perez’ anxiety is a direct consequence of gambling disorder. Psychotherapy is provides a higher efficiency in the management of anxiety than pharmacotherapy (Jonas et al., 2019). For this reason, diazepam will be ineffective. Diazepam is not an indicated treatment for gambling disorder. Diazepam would potentiate depression of the central nervous system. Varenicline is effective in aiding in quitting smoking as a nicotine replacement therapy when used alongside counseling as an adjunct therapy (Rigotti et al., 2022). However, it is important to maintain a monotherapy to prevent any drug-drug interactions.
What were you hoping to achieve by making this decision?
Following counseling, the patient’s anxiety is expected to be allayed. The gambling disorder and smoking are expected to have regressed and stopped after 12 weeks of counseling and cognitive behavioral therapy. With continuation and adherence to the monthly dose of naltrexone, the alcohol use disorder is expected to be distinguished with no withdrawal effects.
How ethical considerations may impact the treatment plan and communication
Counseling employs patient privacy and confidentiality to help build trust between the patient and the counselor. Competence and empathetic listening are vital values for a counselor (Palmer & Burrows, 2020). Informed consent is pivotal. The counselor must be registered under the professional body of counselors. Other tenets like justice, beneficence, and nonmaleficence still apply.
Decision 3
Explore the issue that the patient has with the counselor and encourage attendance of the Gamblers’ anonymous meetings.
Why did you select this decision?
The counseling sessions, however, the challenges ensued prove to have started working for this patient. The anxiety is resolved and she feels supported in the support group she joined. This is a worthwhile path that is proving efficacious in her management. There is a need to look into the issue that the patient holds against the counselor and resolve it if possible. If it is unresolvable, referral to another counselor would be the best course (Atkinson, 2018). This poor relationship would lead to default in therapy. Default in therapy may lead to reverting to gambling.
Why did you not select the other two options provided in the exercise?
Naltrexone use in the treatment of alcohol use disorder runs for a minimum of 6 months (Kedia et al., 2022). Discontinuation of naltrexone after 8 weeks of therapy is too soon and this may give room for relapsing to alcohol use disorder. If the patient continues visiting the counselor yet has an issue with her, it could prove detrimental to the course of therapy (DeAngelis, 2019). From this, it is key to aim at improving the patient-counselor relationship.
What were you hoping to achieve by making this decision?
Exploration of the issue with the counselor will fuel a positive interaction with the patient which in turn will improve the outcome of therapy (DeAngelis, 2019). The patient is also expected to stay in remission for the whole duration of therapy. There will be no adverse effects of the drugs.
How ethical considerations may impact the treatment plan and communication
The right of a patient to choose their counselor is important. Respecting the autonomy of the patient in decision-making is another important consideration (Davis, 2020). Maintenance of patient privacy and confidentiality of patient information is golden.
Conclusion
Co-occurrence of gambling disorder with alcohol use disorder is rising in prevalence as one is likely to tip a person into the other. This co-occurrence increases morbidity and mortality among these patients. This case study offers a perfect avenue for discussion of alcohol use disorder co-occurring with gambling disorder and cigarette smoking. The management is mainly based on pharmacotherapy and cognitive behavioral therapy. This patient displays binge alcohol drinking, smoking cigarettes, and spending excess money in her gambling endeavors. The first line of treatment for Alcohol use disorder co-occurring with a gambling disorder is naltrexone and acamprosate (Kedia et al., 2022). Combination therapy of naltrexone and cognitive behavioral therapy is highly efficacious in the management of this particular case (Jonas et al., 2019). Naltrexone is indicated to reduce alcohol cravings, minimize relapse, and abstain and it is also proven to greatly reduce the urge and the frequency of gambling sprees. The slow-release naltrexone greatly improves adherence. Acamprosate on the other hand has a limited advantage profile. It only promotes abstinence. Disulfiram is an FDA second line in the treatment of alcohol use disorder with limited use only in patients who aim at the complete cessation of alcohol use. Its adverse effects profile is severe ranging from light autonomic disturbances to commas and death (Stokes & Abdijadid, 2019). The pharmacotherapy of choice is greatly influenced by the goal of therapy, treatment duration, the dosage of the drug, socioeconomic status of the patient, the individual drug pharmacokinetics, side effects, and toxicity profile of the drug. The ethical considerations are based on justice, non-maleficence, beneficence, and autonomy. Informed consent, preservation of patient confidentiality, privacy, and respect for a patient’s decision is pivotal (Davis, 2020). The effective treatment of alcohol use disorder co-occurring with gambling disorder and cigarette smoking requires a wholesome treatment of the patient involving physical therapy and psychotherapy.
References
Atkinson, J. (2018). Commonalities in the Association of Behavioral Activation and Behavioral Inhibition with Problem Gambling and Alcohol Use in Young Adult College Students. Journal of Gambling Studies, 35(1), 125–141. https://doi.org/10.1007/s10899-018-9788-5
Davis, C. N. (2020). Guidelines and recommendations for training ethical alcohol researchers. Training and Education in Professional Psychology, 14(1), 52–59. https://doi.org/10.1037/tep0000257
DeAngelis, T. (2019, November 1). Better relationships with patients lead to better outcomes. Https://Www.apa.org. https://www.apa.org/monitor/2019/11/ce-corner-relationships
Edelman, E. J., Moore, B. A., Holt, S. R., Hansen, N., Kyriakides, T. C., Virata, M., Brown, S. T., Justice, A. C., Bryant, K. J., Fiellin, D. A., & Fiellin, L. E. (2018). Efficacy of Extended-Release Naltrexone on HIV-Related and Drinking Outcomes Among HIV-Positive Patients: A Randomized-Controlled Trial. AIDS and Behavior, 23(1), 211–221. https://doi.org/10.1007/s10461-018-2241-z
Fairbanks, J., Umbreit, A., Kolla, B. P., Karpyak, V. M., Schneekloth, T. D., Loukianova, L. L., & Sinha, S. (2020). Evidenced-Based pharmacotherapies for Alcohol Use Disorder. Mayo Clinic Proceedings, 95(9). https://doi.org/10.1016/j.mayocp.2020.01.030
Jonas, B., Leuschner, F., Eiling, A., Schoelen, C., Soellner, R., & Tossmann, P. (2019). Web-Based Intervention and Email-Counseling for Problem Gamblers: Results of a Randomized Controlled Trial. Journal of Gambling Studies. https://doi.org/10.1007/s10899-019-09883-8
Kedia, S. K., Ahuja, N., Dillon, P. J., Jones, A., Kumar, S., & Satapathy, S. (2022). Efficacy of Extended-Release Injectable Naltrexone on Alcohol Use Disorder Treatment: A Systematic Review. Journal of Psychoactive Drugs, 1–13. https://doi.org/10.1080/02791072.2022.2073300
Kraus, S. W., Etuk, R., & Potenza, M. N. (2020). Current pharmacotherapy for gambling disorder: a systematic review. Expert Opinion on Pharmacotherapy, 21(3), 287–296. https://doi.org/10.1080/14656566.2019.1702969
Palmer, K. M., & Burrows, V. (2020). Ethical and Safety Concerns Regarding the Use of Mental Health–Related Apps in Counseling: Considerations for Counselors. Journal of Technology in Behavioral Science. https://doi.org/10.1007/s41347-020-00160-9
Patel, A. K., & Balasanova, A. A. (2021). Treatment of Alcohol Use Disorder. JAMA, 325(6), 596. https://doi.org/10.1001/jama.2020.2012
Rigotti, N. A., Kruse, G. R., Livingstone-Banks, J., & Hartmann-Boyce, J. (2022). Treatment of Tobacco Smoking. JAMA, 327(6), 566. https://doi.org/10.1001/jama.2022.0395
Stokes, M., & Abdijadid, S. (2019, April 10). Disulfiram. Nih.gov; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK459340/
A Sample Answer 2 For the Assignment: ASSESSING AND TREATING PATIENTS WITH IMPULSIVITY, COMPULSIVITY, AND ADDICTION NURS 6630
Title: ASSESSING AND TREATING PATIENTS WITH IMPULSIVITY, COMPULSIVITY, AND ADDICTION NURS 6630
The case study examines Mrs. Perez, a 53-year-old Puerto Rican woman who seeks treatment at the clinic for her alcohol and gambling addictions. The patient indicates experiencing difficulties with alcohol use after the death of her father during her late adolescence. She has intermittently participated in Alcoholics Anonymous for over 25 years. Over the last couple of years, her need for gambling has intensified due to the establishment of the new “Rising Sun” casino near her residence. Consequently, she resorted to withdrawing more than $50,000 from her retirement savings in order to settle her mounting gambling obligations. Remarkably, she has managed to conceal this financial predicament from her spouse. Mrs. Perez displayed attentiveness and awareness during the mental status assessment, while her eye contact tended to avoid direct engagement. She expressed experiencing sadness, and her ability to regulate her impulses was compromised. Her presentation led to a diagnosis of a gambling problem and alcohol use disorder.
Various patient variables might influence the process of providing medicine for Mrs. Perez. The variables include her past alcohol and gambling dependency, increase in body weight, tobacco consumption, apprehensions about the detrimental impact of smoking on her well-being, and her recent withdrawal of $50,000 from her retirement fund to settle her gambling obligations. Additionally, one must also take into account her compromised ability to regulate impulses and her worries about anxiousness and thoughts of suicide when on Campral. These patient considerations emphasize the significance of tailored and comprehensive treatment strategies for persons grappling with addiction and the need for thoughtful deliberation when selecting a suitable drug choice. This paper provides a detailed analysis of the patient’s issues with gambling and alcohol use, as well as the therapy choices made to achieve favorable results.
Decision Point One
Selected Decision and Rationale
For the first choice, the chosen course of action was administering a Vivitrol (naltrexone) injection, with a dosage of 380 mg, into the gluteal area every four weeks. Mrs. Perez had experienced severe difficulties sustaining her sobriety as a result of her high-risk gambling behavior. Naltrexone is a pharmaceutical agent that inhibits the physiological responses of opioids, such as endorphins, which are generated during wagering and produce a gratifying sensation comparable to that of consuming alcohol (Kedia et al., 2022). According to studies, naltrexone may help people with gambling addictions by lowering their frequency of gambling and their impulse to gamble (Grant & Chamberlain, 2020). In addition, given Mrs. Perez’s alcohol use problem, naltrexone may assist her in maintaining sobriety by diminishing the enjoyable effects of alcohol intake. Naltrexone demonstrates efficacy in decreasing the frequency and quantity of alcohol intake among those afflicted with alcohol dependency (Ford & Håkansson, 2020).
The administration of disulfiram was unnecessary, given that its deleterious effects were intended to deter alcohol consumption. The possible negative consequences, such as rapid or irregular heartbeats, low blood pressure, dizziness, severe headaches, and sudden skin reddening, might pose further risks to the patient’s overall health (Di Nicola et al., 2019). Hence, the recommended regimen for delivering Campral requires three doses per day, which raises the likelihood of patients failing to comply with the prescription and resulting in suboptimal adherence (Grant & Chamberlain, 2020).
Expected Outcome
It is expected that when the patient comes back to the clinic after taking naltrexone for four weeks, there will be a reduction in both the desire for alcohol and its use (Ventricelli & Peterson, 2021). Reducing alcohol use should lead to a restoration of her body mass to its natural state. Moreover, enhancing her capacity to control her impulses is expected to influence her overall well-being and satisfaction positively. She should reduce the frequency of her gambling activities.
Ethical Consideration
According to the code of ethics in the nursing profession, patient-centered care requires patients to actively participate in making decisions regarding their treatment (Koob, 2024). Therefore, it is critical to furnish the client with comprehensive information regarding each treatment alternative, encompassing their advantages and disadvantages, to enable them to make an informed decision.
Decision Point Two
Selected Decision and Rationale
As an additional intervention, upon evaluating the results of each of the three alternatives, it was determined that the most optimal course of action for Mrs. Perez was to recommend her to a counselor in order to tackle her gambling problems. The choice was made based on the client’s main worry, which is the gambling problem, and the possible advantages of receiving counseling with her existing pharmaceutical regimen. Studies have shown the efficacy of counseling and treatment in addressing gambling problems, namely via the use of cognitive-behavioral therapy and motivational interviewing (Kedia et al., 2022). Therapeutic counseling may assist the client in recognizing and dealing with the fundamental causes of their gambling behavior, acquiring effective strategies for managing it, and enhancing their belief in their ability to make positive changes and their desire to do so (Grant & Chamberlain, 2020). In addition, counseling may provide continuous assistance in sustaining abstinence and mitigating the likelihood of relapse (Ford & Håkansson, 2020).
Patients with a drug addiction problem should not be prescribed Valium since benzodiazepines, including Valium, have addictive properties (Di Nicola et al., 2019). Conversely, the use of Chantix was deemed unnecessary due to its association with heightened negative consequences when combined with naltrexone, such as anxiety, restlessness, sleeplessness, and dizziness (Grant & Chamberlain, 2020).
Expected Outcome
The patient is expected to have a reduction in symptoms of anxiety over the following month (Ventricelli & Peterson, 2021). The patient is anticipated to effectively manage their gambling behavior within the specified period by regularly attending and ultimately committing to treatment sessions focused on addressing gambling addiction. It is anticipated that the patient will give up gambling and smoking.
Ethical Consideration
According to Koob (2024), legal and ethical requirements require that the well-being and enjoyment of the patient should be given the utmost priority. To maximize patient satisfaction and build trust in the therapeutic method, it is essential to address all patient concerns, which may include anxiety, tobacco use, or gambling.
Decision Point Three
Selected Decision and Rationale
It was advised that Mrs. Perez’s counselor discussed the situation with her and strongly encouraged her to participate in Gamblers Anonymous meetings as the third course of action. The choice was made in light of the client’s admission that she did not like her counselor and the possible advantages of dealing with this matter and carrying on with Gamblers Anonymous. Studies have shown that establishing a favorable therapeutic connection between the individual receiving therapy and the therapist is crucial for achieving good treatment results (Kedia et al., 2022). Patients with a favorable rapport with their psychiatrist are more inclined to actively participate in therapy, experience a sense of being supported, and achieve advancements in their treatment objectives (Grant & Chamberlain, 2020). Hence, it is essential to resolve Mrs. Perez’s counselor’s matter to sustain her involvement in counseling and enhance her treatment results (Ford & Håkansson, 2020).
If the negative attitude of the patient toward her gambling counselor is disregarded, she will exhibit a lack of dedication to her treatment and will often skip appointments (Di Nicola et al., 2019). It is recommended to continue Vivitrol treatment for chronic alcoholism for a minimum of three months, indicating that discontinuing the medication at this juncture is unnecessary (Grant & Chamberlain, 2020).
Expected Outcome
It was anticipated that the client would have conveyed her issues to her counselor and actively engaged in treatment sessions during the next month (Ventricelli & Peterson, 2021). It is expected that she will successfully overcome her dependency on smoking and gambling throughout this period. Smoking should be reduced since it is associated with gambling, which needs regulation now.
Ethical Consideration
Recognizing and addressing any ethical concerns the patient may have about their counselor is essential to optimize treatment results and promote increased patient participation. Implementing this may improve the patient’s overall well-being and satisfaction. Before the patient consented to engage in the gambling sessions, it is essential to address her worries since she has the autonomy to make decisions about her well-being (Koob, 2024).
Conclusion
To address Mrs. Perez’s alcohol and gambling addictions, there was a blend of pharmaceutical and psychological therapies. The first decision was to deliver the Naltrexone (Vivitrol) injection, with a dosage of 380 mg, intramuscularly in the gluteal area every four weeks. The efficacy of Naltrexone in diminishing alcohol cravings and avoiding relapse among individuals diagnosed with alcohol use disorder (Kedia et al., 2022). The patient had a positive response to this treatment, with decreased alcohol intake and enhanced abstinence (Ford & Håkansson, 2020). To treat her gambling condition, it was recommended that she seek counseling to specifically target her gambling difficulties and strongly advised her to actively engage in Gamblers Anonymous meetings (Di Nicola et al., 2019). The client expressed a sense of being supported and actively involved in the Gamblers Anonymous group, which resulted in a reduction in her anxiety levels and an improvement in her gambling behaviors (Ventricelli & Peterson, 2021). Regarding the third choice point, it was proposed to investigate Mrs. Perez’s problem with her counselor and motivate her to attend Gamblers Anonymous gatherings (Grant & Chamberlain, 2020).
In summary, the integration of pharmaceutical and psychosocial therapies proved to be efficacious in addressing Mrs. Perez’s alcohol and gambling issues. Ethical issues were carefully considered throughout the treatment plan to preserve the patient’s autonomy and privacy. Acknowledging that each patient has distinct characteristics, treatment strategies should be customized to address their requirements and concerns (Koob, 2024). When making treatment decisions, clinicians must consider the patient’s medical background, other health conditions, personal preferences, and possible advantages and disadvantages of different therapy choices. Hence, continuous evaluation and adjustment of the treatment strategy are necessary for achieving favorable results.
References
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Ford, M., & Håkansson, A. (2020). Problem gambling, associations with comorbid health conditions, substance use, and behavioral addictions: Opportunities for treatment pathways. PLOS ONE, 15(1), e0227644. https://doi.org/10.1371/journal.pone.0227644
Grant, J. E., & Chamberlain, S. R. (2020). Gambling and substance use: Comorbidity and treatment implications. Progress in Neuro-Psychopharmacology and Biological Psychiatry, p. 99, 109852. https://doi.org/10.1016/j.pnpbp.2019.109852
Kedia, S., Ahuja, N., Dillon, P., Jones, A., Kumar, S., & Satapathy, S. K. (2022). Efficacy of Extended-Release Injectable Naltrexone on Alcohol Use Disorder Treatment: A Systematic Review. Journal of Psychoactive Drugs, 1–13. https://doi.org/10.1080/02791072.2022.2073300
Koob, G. F. (2024). Alcohol Use Disorder Treatment: Problems and Solutions. Annual Review of Pharmacology and Toxicology, 64(1), 255–275. https://doi.org/10.1146/annurev-pharmtox-031323-115847
Ventricelli, D., & Peterson, A. M. (2021). Substance use disorders. In Elsevier eBooks (pp. 759–768). https://doi.org/10.1016/b978-0-12-820007-0.00040-4