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

ASSESSING AND TREATING PATIENTS WITH IMPULSIVITY, COMPULSIVITY, AND ADDICTION NURS 6630 

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/ 

ASSESSING AND TREATING PATIENTS WITH IMPULSIVITY, COMPULSIVITY, AND ADDICTION NURS 6630 
ASSESSING AND TREATING PATIENTS WITH IMPULSIVITY, COMPULSIVITY, AND ADDICTION NURS 6630

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 

Required Readings 

  • 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  

Medication Resources 

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 

Required Media 

Note: This case study will serve as the foundation for this week’s Assignment. 

Optional Resources 

  • 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  

Links to an external site.. 

By Day 7 

Submit your Assignment.  

submission information 

Before submitting your final assignment, you can check your draft for authenticity. To check your draft, access the Turnitin Drafts from the Start Here area.  

  1. To submit your completed assignment, save your Assignment as WK10Assgn1_LastName_Firstinitial  
  1. Then, click on Start Assignment near the top of the page. 
  1. 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 to >8.0 pts  

Excellent Point range: 90–100 

The response accurately, clearly, and fully summarizes in detail the case for the Assignment…. The response accurately and clearly explains in detail the specific patient factors that impact decision making when prescribing medication for this patient. 

8 to >7.0 pts  

Good Point range: 80–89 

The response accurately summarizes the case for the Assignment…. The response accurately explains the specific patient factors that impact decision making with prescribing medication for this patient. 

7 to >6.0 pts  

Fair Point range: 70–79 

The response inaccurately or vaguely summarizes the case for the Assignment…. The response inaccurately or vaguely explains the specific patient factors that impact decision making with prescribing medication for this patient. 

6 to >0 pts  

Poor Point range: 0–69 

The response inaccurately and vaguely summarizes the case for the Assignment, or is missing…. The response inaccurately and vaguely explains the specific patient factors that impact decision making with 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 to >17.0 pts  

Excellent Point range: 90–100 

The response accurately and clearly explains in detail the decision selected…. The response accurately and clearly explains in detail why the decision was selected, with specific clinically relevant resources that fully support the decision selected…. The response accurately and clearly explains in detail why the other two responses were not selected, with specific clinically relevant resources that fully support the response…. The response accurately and clearly explains in detail the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that fully support the response…. The response accurately and clearly explains in detail how ethical considerations impact the treatment plan and communication with patients…. Examples provided fully support the decisions and responses provided. 

17 to >15.0 pts  

Good Point range: 80–89 

The response accurately explains the decision selected…. The response explains why the decision was selected, with specific clinically relevant resources that support the decision selected…. The response accurately explains why the other two responses were not selected, with specific clinically relevant resources that support the response…. The response accurately explains the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that support the response…. The response accurately explains how ethical considerations impact the treatment plan and communication with patients…. Examples provided support the decisions and responses provided. 

15 to >13.0 pts  

Fair Point range: 70–79 

The response inaccurately or vaguely explains the decision selected…. The response inaccurately or vaguely explains why the decision was selected, with specific clinically relevant resources that inaccurately or vaguely support the decision selected…. The response inaccurately or vaguely explains why the other two responses were not selected, with specific clinically relevant resources that inaccurately or vaguely support the response…. The response inaccurately or vaguely explains the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that inaccurately or vaguely support the response…. The response inaccurately or vaguely explains how ethical considerations impact the treatment plan and communication with patients…. Examples provided may support the decisions and responses provided. 

13 to >0 pts  

Poor Point range: 0–69 

The response inaccurately and vaguely explains the decision selected…. The response inaccurately and vaguely explains why the decision was selected, with specific clinically relevant resources that do not support the decision selected, or is missing…. The response inaccurately and vaguely explains why the other two responses were not selected, with specific clinically relevant resources that do not support the decision selected, or is missing…. The response inaccurately and vaguely explains the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that do not support the response, or is missing…. The response inaccurately and vaguely explains how ethical considerations impact the treatment plan and communication with patients, or is missing…. Examples provided do not support the decisions and responses provided, or is missing. 

 

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 to >17.0 pts  

Excellent Point range: 90–100 

The response accurately and clearly explains in detail the decision selected…. The response accurately and clearly explains in detail why the decision was selected, with specific clinically relevant resources that fully support the decision selected…. The response accurately and clearly explains in detail why the other two responses were not selected, with specific clinically relevant resources that fully support the response…. The response accurately and clearly explains in detail the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that fully support the response…. The response accurately and clearly explains in detail how ethical considerations impact the treatment plan and communication with patients…. Examples provided fully support the decisions and responses provided. 

17 to >15.0 pts  

Good Point range: 80–89 

The response accurately explains the decision selected…. The response explains why the decision was selected, with specific clinically relevant resources that support the decision selected…. The response accurately explains why the other two responses were not selected, with specific clinically relevant resources that support the response…. The response accurately explains the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that support the response…. The response accurately explains how ethical considerations impact the treatment plan and communication with patients…. Examples provided support the decisions and responses provided. 

15 to >13.0 pts  

Fair Point range: 70–79 

The response inaccurately or vaguely explains the decision selected…. The response inaccurately or vaguely explains why the decision was selected, with specific clinically relevant resources that inaccurately or vaguely support the decision selected…. The response inaccurately or vaguely explains why the other two responses were not selected, with specific clinically relevant resources that inaccurately or vaguely support the response…. The response inaccurately or vaguely explains the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that inaccurately or vaguely support the response…. The response inaccurately or vaguely explains how ethical considerations impact the treatment plan and communication with patients…. Examples provided may support the decisions and responses provided. 

13 to >0 pts  

Poor Point range: 0–69 

The response inaccurately and vaguely explains in detail the decision selected…. The response inaccurately and vaguely explains why the decision was selected, with specific clinically relevant resources that do not support the decision selected, or is missing…. The response inaccurately and vaguely explains why the other two responses were not selected, with specific clinically relevant resources that do not support the decision selected, or is missing…. The response inaccurately and vaguely explains the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that do not support the response, or is missing…. The response inaccurately and vaguely explains how ethical considerations impact the treatment plan and communication with patients, or is missing…. Examples provided do not support the decisions and responses provided, or is missing. 

 

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 to >17.0 pts  

Excellent Point range: 90–100 

The response accurately and clearly explains in detail the decision selected…. The response accurately and clearly explains in detail why the decision was selected, with specific clinically relevant resources that fully support the decision selected…. The response accurately and clearly explains in detail why the other two responses were not selected, with specific clinically relevant resources that fully support the response…. The response accurately and clearly explains in detail the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that fully support the response…. The response accurately and clearly explains in detail how ethical considerations impact the treatment plan and communication with patients…. Examples provided fully support the decisions and responses provided. 

17 to >15.0 pts  

Good Point range: 80–89 

The response accurately explains the decision selected…. The response explains why the decision was selected, with specific clinically relevant resources that support the decision selected…. The response accurately explains why the other two responses were not selected, with specific clinically relevant resources that support the response…. The response accurately explains the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that support the response…. The response accurately explains how ethical considerations impact the treatment plan and communication with patients…. Examples provided support the decisions and responses provided. 

15 to >13.0 pts  

Fair Point range: 70–79 

The response inaccurately or vaguely explains the decision selected…. The response inaccurately or vaguely explains why the decision was selected, with specific clinically relevant resources that inaccurately or vaguely support the decision selected…. The response inaccurately or vaguely explains why the other two responses were not selected, with specific clinically relevant resources that inaccurately or vaguely support the response…. The response inaccurately or vaguely explains the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that inaccurately or vaguely support the response…. The response inaccurately or vaguely explains how ethical considerations impact the treatment plan and communication with patients…. Examples provided may support the decisions and responses provided. 

13 to >0 pts  

Poor Point range: 0–69 

The response inaccurately and vaguely explains in detail the decision selected…. The response inaccurately and vaguely explains why the decision was selected, with specific clinically relevant resources that do not support the decision selected, or is missing…. The response inaccurately and vaguely explains why the other two responses were not selected, with specific clinically relevant resources that do not support the decision selected, or is missing…. The response inaccurately and vaguely explains the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that do not support the response, or is missing…. The response inaccurately and vaguely explains how ethical considerations impact the treatment plan and communication with patients, or is missing…. Examples provided do not support the decisions and responses provided, or is missing. 

 

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 to >13.0 pts  

Excellent Point range: 90–100 

The response accurately and clearly summarizes in detail the recommendations on the treatment options selected for this patient…. The response accurately and clearly explains a justification for the recommendations provided, including clinically relevant resources that fully support the recommendations provided. 

13 to >11.0 pts  

Good Point range: 80–89 

The response accurately summarizes the recommendations on the treatment options selected for this patient…. The response accurately explains a justification for the recommendation provided, including clinically relevant resources that support the recommendations provided. 

11 to >10.0 pts  

Fair Point range: 70–79 

The response inaccurately or vaguely summarizes the recommendations on the treatment options selected for this patient…. The response inaccurately or vaguely explains a justification for the recommendations provided, including clinically relevant resources that inaccurately or vaguely support the recommendations provided. 

10 to >0 pts  

Poor Point range: 0–69 

The response inaccurately and vaguely summarizes the recommendations on the treatment options selected for this patient, or is missing…. The response inaccurately and vaguely explains a justification for the recommendations provided, including clinically relevant resources that do not support the recommendations provided, or is missing. 

 

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 to >4.0 pts  

Excellent Point range: 90–100 

Paragraphs and sentences follow writing standards for flow, continuity, and clarity…. A clear and comprehensive purpose statement, introduction, and conclusion are provided that delineate all required criteria. 

4 to >3.5 pts  

Good Point range: 80–89 

Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time….Purpose, introduction, and conclusion of the assignment are stated, yet they are brief and not descriptive. 

3.5 to >3.0 pts  

Fair Point range: 70–79 

Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60%–79% of the time…. Purpose, introduction, and conclusion of the assignment is vague or off topic. 

3 to >0 pts  

Poor Point range: 0–69 

Paragraphs and sentences follow writing standards for flow, continuity, and clarity < 60% of the time…. No purpose statement, introduction, or conclusion were provided. 

 

5 pts 
This criterion is linked to a Learning Outcome Written Expression and Formatting – English writing standards: Correct grammar, mechanics, and proper punctuation  
5 to >4.0 pts  

Excellent Point range: 90–100 

Uses correct grammar, spelling, and punctuation with no errors. 

4 to >3.5 pts  

Good Point range: 80–89 

Contains a few (1 or 2) grammar, spelling, and punctuation errors. 

3.5 to >3.0 pts  

Fair Point range: 70–79 

Contains several (3 or 4) grammar, spelling, and punctuation errors. 

3 to >0 pts  

Poor Point range: 0–69 

Contains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding. 

 

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 to >4.0 pts  

Excellent Point range: 90–100 

Uses correct APA format with no errors. 

4 to >3.5 pts  

Good Point range: 80–89 

Contains a few (1 or 2) APA format errors. 

3.5 to >3.0 pts  

Fair Point range: 70–79 

Contains several (3 or 4) APA format errors. 

3 to >0 pts  

Poor Point range: 0–69 

Contains many (≥ 5) APA format errors. 

 

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 

Assignment 1: Assessing and Treating Patients With Impulsivity, Compulsivity, and Addiction 

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 

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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 

 

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