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

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

 

Gambling and alcohol abuse are two of the most common mental health issues that psychiatric mental health nurse practitioners (PMHNP) encounter in their practice. PMHNP works to assist patients with gambling and alcohol abuse disorders in overcoming their addiction and leading a normal life. As such, this article will analyze a case study of a patient who has been diagnosed with gambling and alcohol use disorders. Maria Perez, 53, is a Puerto Rican female who presented to the clinic with an uncomfortable problem. The client admits to a history of alcoholism dating all the way back to her father’s death during her adolescent years. She has struggled with alcohol since her twenties and is a member of Alcohol Anonymous on an as-needed basis. The client stated that she has been having problems sustaining sobriety since a casino opened near her home. Perez has been gambling with a friend at a casino and enjoys drinking wine to help her relax during high-stakes games.

Her drinking habits have inclined her to engage in irresponsible gambling. Additionally, the client has smoked cigarettes for the last two years and is concerned about the impact on her health. Additionally, the client reported gaining more than 7 pounds over her normal 115-pound weight. The individual underwent a mental status examination. The assessment revealed that the client is oriented and aware, suitably dressed for the occasion, speaks clearly, objectively, and coherently, and avoids eye contact. Additionally, the examination revealed that the customer lacked any notable mannerisms, ticks, or gestures. The client’s mood was depressed, with no hallucinations, delusions, paranoia, or suicidal or homicidal ideas.

Decision Point One

Selected Decision

Administer Vivitrol (naltrexone) injection, 380 mg intramuscularly in the gluteal region every 4 weeks.

Reason for Selection

Vivitrol was selected as the first line of treatment because it works as a competitive antagonist of alcohol receptors, making it suitable for addiction management. The inhibition of alcohol receptors minimizes craving for alcohol, hence, improvement in abuse behaviors (Stahl, 2013). The inhibition of the alcohol receptors also reduces the perceived thirst for alcohol by the patient (Holt & Tobin, 2018). Patients who take alcohol but are in the process of overcoming their addiction problems may also use naltrexone. Naltrexone facilitates the systematic disuse of alcohol by the patients (Leighty & Ansara, 2019). Assignment: Assessing and Treating Patients With Impulsivity, Compulsivity, and Addiction

Why Other Options were not Selected

Antabuse (disulfiram) 250 mg orally daily and Campral (acamprosate) 666 mg orally three times a day were not selected because they are recommended for use in patients that have stopped alcohol intake (Stahl, 2013). The medications were also likely to predispose the patients to side effects such as nausea and tachycardia with the administration of disulfiram (Shirley et al., 2021). Since the patient has not abstained from alcohol abuse, the above options were not selected to ensure safety and quality in the care given.

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Expectations

The above decision was made with the expectation of ensuring the reducing in symptoms of alcohol addiction being experienced by the

Assignment Assessing and Treating Patients With Impulsivity, Compulsivity and Addiction

Assignment Assessing and Treating Patients With Impulsivity, Compulsivity and Addiction

client. The decision also aimed at promoting the systematic desensitization of alcohol desires that the patient was experiencing (Stern et al., 2015). It was anticipated that the administration of naltrexone would result in improved tolerability and abstinence of the patient from alcohol abuse (Wightman et al., 2018). Assignment: Assessing and Treating Patients With Impulsivity, Compulsivity, and Addiction

Impact of Ethical Considerations on Treatment Plan and Communication with the Client

Ethical considerations such as benevolence and non-maleficence informed the treatment plan. The PMHNP aimed at ensuring that the use of naltrexone would result in minimal harm and side effects to the client (Loreck David et al., 2016). The ethical aspect of informed consent would also influence the care given to the patient (Ellis, 2017). For example, the PMHNP was expected to seek informed consent prior to implementing the care plan to minimize ethical and legal issues related to the care given to the patient. Seeking informed consent ensures the protection of the rights of the patient to informed care. It also promotes patient autonomy, as he has the decision to accept or decline the available treatment interventions (Stern et al., 2015).

Decision Point Two

Selected Decision

Refer the client to counselor to address gambling issues.

Reason for Selection

The administration of naltrexone was effective in causing moderate improvement in the management of alcohol addiction and abuse by the client. The client however reported to engaging in severe gambling when she visits the casino. An effective intervention at this stage would therefore be referring the patient to the counselor for assistance in managing gambling issues. The FDA has not approved any drug for use in management of gambling issues (Grant et al., 2014). As a result, non-pharmacological interventions such as counseling are recommended. Counseling will enable the client to learn about the effective ways of overcoming gambling behaviors and coping up with her problem (Lee et al., 2021). The use of counseling interventions such as group therapy and cognitive behavioral therapy will equip the client with knowledge and skills needed in the management of anxiety. Assignment: Assessing and Treating Patients With Impulsivity, Compulsivity, and Addiction

Why Other Options were not Selected

The decisions to add valium (diazepam) 5 mg orally TID/PRN/anxiety and add Chantix (varenicline) 1 mg orally BID were not selected in the case study. The administration of valium was likely to increase the rise of side effects such as sedation, memory problems, tiredness, and drowsiness that were likely to affect the adherence to treatment (Sychla, Gründer, & Lammertz, 2017). The decision to add Chantix was also not selected because the administration of naltrexone had led to moderate improvement in symptoms of addiction in the client (Echeburúa & Amor, 2021). Augmenting the treatment is therefore not recommended.

Expectations

The above decision was made with the expectation of facilitating the effective management of the gambling problem being experienced by the client. It was also expected that the client would be assisted to identify effective strategies for managing her gambling problem. The decision was also made with the aim of improving the effectiveness of the pharmacological interventions used in addiction management (Pickering et al., 2020). Assignment: Assessing and Treating Patients With Impulsivity, Compulsivity, and Addiction

Impact of Ethical Considerations on Treatment Plan and Communication with the Client

The ethical consideration of promoting privacy and confidentiality of patient data would influence the selection of treatment plans at this phase. PMHNP is expected to seek informed consent from the client prior to sharing her information with other healthcare providers (Ellis, 2017). PMHNP is also expected to promote patient’s right to autonomous care by educating her about the aims of the selected treatment interventions.

Decision Point Three

Selected Decision

Explore the issue that Mrs. Perez is having with her counselor, and encourage her to continue attending the Gamblers Anonymous meetings.

Reason for Selection

The use of counseling services appears to have been effective for the client. For example, the client returned after 4 weeks reporting that the anxiety she had been experiencing was gone. She also reported that she has started attending Gamblers Anonymous group and has been participating in self-expression to seek the support that she needs. An effective intervention at this step would be to encourage the client to continue seeing her current counselor and continue with the Gamblers Anonymous group (Echeburúa & Amor, 2021). There is the need for the PMHNP to obtain information from the client on the factors that contributed to her dissatisfaction with the care given by her counselor (Kelly & Renner, 2016). The information obtained from her will be used to implement effective interventions that would strengthen the relationship between her and the counselor (Lee et al., 2021). There is also the need to refer the client to the smoking cessation clinic to be assisted on the management of her health problem of smoking cigarette.

Why Other Options were not Selected

The decision to encourage Mrs. Perez to continue seeing her current counselor and continue with Gamblers Anonymous group was not selected because a strained relationship between her and the counselor could affect client’s participation and increase the risk of relapse (Heinz, Romanczuk-Seiferth, & Potenza, 2019). The decision to discontinue vivitrol and encourage Mrs. Perez to continue seeing her counselor and participating in the Gamblers Anonymous group was not selected because it would result in symptom relapse (Wightman et al., 2018).

Expectations

The above decision was made with the aim of adopting interventions to improve the relationship between the counselor and the client. The decision also aimed at ensuring continued improvement in the adoption of positive behaviors against gambling by the client. It was also expected that the client would adopt sustainable interventions to manage her addiction problems (Holt & Tobin, 2018).

Impact of Ethical Considerations on Treatment Plan and Communication with the Client

The ethical principle of informed consent influenced the selection of the above decision. The patient has a right to participate or not in a treatment program. Obtaining information about the factors affecting the relationship between her and the counselor would therefore improve the interventions used to facilitate recovery process. The other ethical consideration is privacy and confidentiality of data (Ellis, 2017). The PMHNP should ensure that the client’s data is protected from unauthorized access, hence, data integrity. Assignment: Assessing and Treating Patients With Impulsivity, Compulsivity, and Addiction

Conclusion

Gambling and alcohol abuse disorder affects a significant proportion of people globally. Gambling and alcohol abuse disorder affect the social and occupational functioning of a patient. The increased dependence on alcohol and engagement in addictive gambling behaviors hinders one’s ability to contribute optimally to self and community development. The administration of naltrexone to the patient was an effective decision in the case study (Stahl, 2013). Naltrexone proved effective in managing the client’s alcohol addiction and abuse problem, leading to her improved social and occupational functioning. Naltrexone also facilitated the gradual cessation of alcohol abuse by the client (Holt & Tobin, 2018). Counseling was also found effective in managing the gambling problem being experienced by the client. Accordingly, counseling provided the client with knowledge and skills that are needed in coping up with addiction problems including gambling. The client also participated in social support groups such as Gamblers Anonymous group to learn from others about the effective ways of overcoming gambling. The relationship between the client and the healthcare provider is important for optimal behavioral and lifestyle modification in case management. As a result, it was important to examine the factors that contribute to the poor relationship between the client and her counselor to inform improvement interventions in managing the client (Echeburúa & Amor, 2021). Based on the above analysis, I believe that I made ethical decisions in determining the treatment needs and options for the client in the case study.

References

Echeburúa, E., & Amor, P. J. (2021). Psychological Management of Gambling Disorder With or Without Other Psychiatric Comorbidities. In N. el-Guebaly, G. Carrà, M. Galanter, & A. M. Baldacchino (Eds.), Textbook of Addiction Treatment: International Perspectives (pp. 929–942). Springer International Publishing. https://doi.org/10.1007/978-3-030-36391-8_65

Ellis, P. (2017). Understanding Ethics for Nursing Students. Learning Matters.

Grant, J. E., Odlaug, B. L., & Schreiber, L. R. N. (2014). Pharmacological treatments in pathological gambling. British Journal of Clinical Pharmacology, 77(2), 375–381. https://doi.org/10.1111/j.1365-2125.2012.04457.x

Heinz, A., Romanczuk-Seiferth, N., & Potenza, M. N. (2019). Gambling disorder. Cham, Springer.

Holt, S. R., & Tobin, D. G. (2018). Pharmacotherapy for alcohol use disorder. Medical Clinics, 102(4), 653–666. https://doi.org/10.1016/j.mcna.2018.02.008

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.

Lee, K., Kim, H., & Kim, Y. (2021). Gambling disorder symptoms, suicidal ideation, and suicide attempts. Psychiatry Investigation, 18(1), 88–93. https://doi.org/10.30773/pi.2020.0035

Leighty, A. E., & Ansara, E. D. (2019). Treatment outcomes of long-acting injectable naltrexone versus oral naltrexone in alcohol use disorder in veterans. Mental Health Clinician, 9(6), 392–396. https://doi.org/10.9740/mhc.2019.11.392

Loreck David, Brandt Nicole J., & DiPaula Bethany. (2016). Managing opioid abuse in older adults: clinical considerations and challenges. Journal of Gerontological Nursing, 42(4), 10–15. https://doi.org/10.3928/00989134-20160314-04

Pickering, D., Spoelma, M. J., Dawczyk, A., Gainsbury, S. M., & Blaszczynski, A. (2020). What does it mean to recover from a gambling disorder? Perspectives of gambling help service users. Addiction Research & Theory, 28(2), 132–143. https://doi.org/10.1080/16066359.2019.1601178

Shirley, D.-A., Sharma, I., Warren, C. A., & Moonah, S. (2021). Drug repurposing of the alcohol abuse medication disulfiram as an anti-parasitic agent. Frontiers in Cellular and Infection Microbiology, 11. https://doi.org/10.3389/fcimb.2021.633194

Stahl, S. M. (2013). Stahl’s essential psychopharmacology: neuroscientific basis and practical applications. Cambridge university press.

Stern, T. A., Fava, M., Rosenbaum, J. F., & Wilens, T. E. (2015). Massachusetts General Hospital Psychopharmacology. Elsevier Science Health Science.

Sychla, H., Gründer, G., & Lammertz, S. E. (2017). Comparison of clomethiazole and diazepam in the treatment of alcohol withdrawal syndrome in clinical practice. European addiction research, 23(4), 211-218. https://doi.org/10.1159/000480380

Wightman, R. S., Nelson, L. S., Lee, J. D., Fox, L. M., & Smith, S. W. (2018). Severe opioid withdrawal precipitated by Vivitrol®. The American Journal of Emergency Medicine, 36(6), 1128.e1-1128.e2. https://doi.org/10.1016/j.ajem.2018.03.052

Name:  Discussion Rubric

  Excellent

90–100

Good

80–89

Fair

70–79

Poor

0–69

Main Posting:

Response to the Discussion question is reflective with critical analysis and synthesis representative of knowledge gained from the course readings for the module and current credible sources.

40 (40%) – 44 (44%)

Thoroughly responds to the Discussion question(s).

Is reflective with critical analysis and synthesis representative of knowledge gained from the course readings for the module and current credible sources.

No less than 75% of post has exceptional depth and breadth.

Supported by at least three current credible sources.

35 (35%) – 39 (39%)

Responds to most of the Discussion question(s).

Is somewhat reflective with critical analysis and synthesis representative of knowledge gained from the course readings for the module.

50% of the post has exceptional depth and breadth.

Supported by at least three credible references.

31 (31%) – 34 (34%)

Responds to some of the Discussion question(s).

One to two criteria are not addressed or are superficially addressed.

Is somewhat lacking reflection and critical analysis and synthesis.

Somewhat represents knowledge gained from the course readings for the module.

Cited with fewer than two credible references.

0 (0%) – 30 (30%)

Does not respond to the Discussion question(s).

Lacks depth or superficially addresses criteria.

Lacks reflection and critical analysis and synthesis.

Does not represent knowledge gained from the course readings for the module.

Contains only one or no credible references.

Main Posting:

Writing

6 (6%) – 6 (6%)

Written clearly and concisely.

Contains no grammatical or spelling errors.

Adheres to current APA manual writing rules and style.

5 (5%) – 5 (5%)

Written concisely.

May contain one to two grammatical or spelling errors.

Adheres to current APA manual writing rules and style.

4 (4%) – 4 (4%)

Written somewhat concisely.

May contain more than two spelling or grammatical errors.

Contains some APA formatting errors.

0 (0%) – 3 (3%)

Not written clearly or concisely.

Contains more than two spelling or grammatical errors.

Does not adhere to current APA manual writing rules and style.

Main Posting:

Timely and full participation

9 (9%) – 10 (10%)

Meets requirements for timely, full, and active participation.

Posts main Discussion by due date.

8 (8%) – 8 (8%)

Meets requirements for full participation.

Posts main Discussion by due date.

7 (7%) – 7 (7%)

Posts main Discussion by due date.

0 (0%) – 6 (6%)

Does not meet requirements for full participation.

Does not post main Discussion by due date.

First Response:

Post to colleague’s main post that is reflective and justified with credible sources.

9 (9%) – 9 (9%)

Response exhibits critical thinking and application to practice settings.

Responds to questions posed by faculty.

The use of scholarly sources to support ideas demonstrates synthesis and understanding of learning objectives.

8 (8%) – 8 (8%)

Response has some depth and may exhibit critical thinking or application to practice setting.

7 (7%) – 7 (7%)

Response is on topic and may have some depth.

0 (0%) – 6 (6%)

Response may not be on topic and lacks depth.

First Response:

Writing

6 (6%) – 6 (6%)

Communication is professional and respectful to colleagues.

Response to faculty questions are fully answered, if posed.

Provides clear, concise opinions and ideas that are supported by two or more credible sources.

Response is effectively written in standard, edited English.

5 (5%) – 5 (5%)

Communication is mostly professional and respectful to colleagues.

Response to faculty questions are mostly answered, if posed.

Provides opinions and ideas that are supported by few credible sources.

Response is written in standard, edited English.

4 (4%) – 4 (4%)

Response posed in the Discussion may lack effective professional communication.

Response to faculty questions are somewhat answered, if posed.

Few or no credible sources are cited.

0 (0%) – 3 (3%)

Responses posted in the Discussion lack effective communication.

Response to faculty questions are missing.

No credible sources are cited.

First Response:

Timely and full participation

5 (5%) – 5 (5%)

Meets requirements for timely, full, and active participation.

Posts by due date.

4 (4%) – 4 (4%)

Meets requirements for full participation.

Posts by due date.

3 (3%) – 3 (3%)

Posts by due date.

0 (0%) – 2 (2%)

Does not meet requirements for full participation.

Does not post by due date.

Second Response:
Post to colleague’s main post that is reflective and justified with credible sources.
9 (9%) – 9 (9%)

Response exhibits critical thinking and application to practice settings.

Responds to questions posed by faculty.

The use of scholarly sources to support ideas demonstrates synthesis and understanding of learning objectives.

8 (8%) – 8 (8%)

Response has some depth and may exhibit critical thinking or application to practice setting.

7 (7%) – 7 (7%)

Response is on topic and may have some depth.

0 (0%) – 6 (6%)

Response may not be on topic and lacks depth.

Second Response:
Writing
6 (6%) – 6 (6%)

Communication is professional and respectful to colleagues.

Response to faculty questions are fully answered, if posed.

Provides clear, concise opinions and ideas that are supported by two or more credible sources.

Response is effectively written in standard, edited English.

5 (5%) – 5 (5%)

Communication is mostly professional and respectful to colleagues.

Response to faculty questions are mostly answered, if posed.

Provides opinions and ideas that are supported by few credible sources.

Response is written in standard, edited English.

4 (4%) – 4 (4%)

Response posed in the Discussion may lack effective professional communication.

Response to faculty questions are somewhat answered, if posed.

Few or no credible sources are cited.

0 (0%) – 3 (3%)

Responses posted in the Discussion lack effective communication.

Response to faculty questions are missing.

No credible sources are cited.

Second Response:
Timely and full participation
5 (5%) – 5 (5%)

Meets requirements for timely, full, and active participation.

Posts by due date.

4 (4%) – 4 (4%)

Meets requirements for full participation.

Posts by due date.

3 (3%) – 3 (3%)

Posts by due date.

0 (0%) – 2 (2%)

Does not meet requirements for full participation.

Does not post by due date.

Total Points: 100

Name:  Discussion Rubric

 

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