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Assignment: Management of Impulsivity, Compulsivity and Addiction

Assignment: Management of Impulsivity, Compulsivity and Addiction

 

Compulsivity together with impulsivity are compulsive behaviors initiated by the brain and are linked to addiction or substance abuse disorder. In many cases, individuals diagnosed with impulsivity develop cravings to behavior without considering the negative impacts of their actions (Stahl & Grady, 2012). However, not all consequences of impulsivity results in negativity. In contrast, compulsivity refers to a behavior that an individual is compelled to undertake in order to resolve the feelings of anxiety related inaction to a given craving.  After executing a compulsive behavior, an individual enjoys a sense of relief to restore comfort and alleviate anxiety. Both impulsivity and compulsivity behaviors manifest in people suspected of addiction, and this necessitates a psychiatric nurse to assess clients in order to confirm or rule out their presence in a patient (Tuschman, 2013).

The establishment of a treatment plan for patients with impulsivity and compulsivity is preceded by the formulation of a diagnosis in a patient who manifests unacceptable behaviors. The present article delves into an analysis of a 53-year old woman who has been diagnosed with alcohol abuse together with gambling disorders. Research articles indicate that alcohol abuse disorder and gambling are a manifestation of compulsivity and impulsivity which necessitates an intervention plan that involves pharmacological or non-pharmacological approaches. A treatment plan founded on the present case study will be determined by factors, which include proper selection of drugs, dosage, and route of administration and the time of use. Moreover, decisions on the choice of a specific prescription drug depend on the pharmacodynamics as well as the pharmacokinetics and the ethical considerations.  Therefore, the purpose of the present paper is to examine the case study of the above woman and the necessary pharmacological interventions to address her gambling disorder.

Decision Point One

Selected Decision

“Administer Naltrexone (Vivitrol) injection of 380 mg intramuscularly (IM) in the gluteal region for 4 weeks” (Laureate Education, 2016c).

Reasons for the Choice of the Above Medication

Vivitrol is an effective prescription medication for the treatment of alcohol addiction. The drug works using the principle of binding to opiate receptors so as to antagonistically alter the actions of opiate neurotransmitters which are released by alcohol. Studies by Keurhorst et al. (2014) illustrate that Naltrexone is a drug of choice in the management of alcohol abuse because it quickly reaches peak plasma concentration, which occurs 2 hours immediately after the administration of the therapy and has extended release properties of 2-3 days. According to Anderson et al. (2014), the plasma concentration for the drug often starts to indicate a lower peak after seven days of administration. The premise enables the drug to achieve a constant therapeutic blood level throughout the four weeks, and this helps the body system to avoid daily peaks as well as troughs caused by the medication (Stahl, 2013). This approach ensures that patients remain compliant to the administered medications.

The FDA states that Campral can only be indicated for patients to maintain alcohol abstinence as well as applied in multidisciplinary therapy, which is far from the case in the current case. Disulfiram, on the other hand, can only be administered to enforce a sobriety state for a patient awaiting psychotherapeutic or supportive treatment. In addition, patients in either of the medications are likely to develop compliance issues due to the oral route of administration; something that does not affect Naltrexone. Therefore, Naltrexone administration is supported by a bundle of evidence for patients with compulsive alcohol use disorder.

Expected Results

Naltrexone is a medication primarily indicated for the treatment of alcohol-abuse disorder. The drug provides a steady relief after seven days of administration. Based on this, patients on the medication are anticipated to begin alcohol abstinence and the reduction of impulsivity after the first week of therapy. With this expectation, the patient should be healed from the addiction after four weeks of consistent use of the medication.

The Distinction between Expected Results and the Actual Results

On reporting to the care facility on the fourth week, the patient confirmed a positive behavior on alcohol use. She affirmed that during the treatment period with the Naltrexone medication, her craving for alcohol use had ceased to exist. Nonetheless, as much as the patient does not attend the casino as much as she used to, she still indulges in occasional gambling. Moreover, she still finds solace in smoking and has begun to develop anxiety (Garrison et al., 2018). This behavioral pattern indicates that Naltrexone is primarily used as a therapy for the management of compulsive alcohol use and gambling – to a less extent.

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Decision Point Two

Selected Decision

“The patient was to be referred to a professional counselor to resolve gambling habit” (Laureate Education, 2016c).

Reasons for the Above Selection

Now that the patient’s alcohol addiction is resolved, it will be important to provide psychological therapy to address gambling

Assignment Management of Impulsivity, Compulsivity and Addiction

Assignment Management of Impulsivity, Compulsivity and Addiction

habits. A decision made to refer Mrs. Perez (the client) to a professional counselor is a positive move to offer support on positive behavior change. Even though the patient reported anxiety, prescribing diazepam implies that her co-morbid habit of gambling will not be resolved (Bartley & Bloch, 2013). Moreover, Chantix (Varenicline) of 1 mg orally BID (Laureate Education, 2016c) will not be adopted during the therapy since it can only treat the smoking behavior whereas the primary concern herein is the management of the gambling disorder. As such, referring the client to a professional counselor will assist in the development of coping mechanisms against gambling.

Expected Results

Following a four-week treatment, the client is expected to reduce her gambling habit. This will be evident in a reduction of the client’s trips to gambling points which, in overall sense, may diminish her impulsivity symptom to the behavior (Stahl, 2013). The psychologist will be required to apply the psychotherapeutic stratagems to reduce the patient’s compulsive behavior especially with regard to gambling. In essence, the approach aims at identifying gambling issues that lead to addiction, and the psychologist will develop counseling sessions to resolve the habit.

Differences between Expected Results and Actual Results

Following referral of the patient to a counselor, it was expected that she will make a second visit after four weeks. Besides, the PMHNP anticipated that the patient would reduce her compulsive gambling as well as remission in anxiety due to the counseling sessions. The addiction in gambling was one of the most important concerns in resolving behavioral pattern, and as such, a referral was made to a psychotherapist.

Further, the patient displayed a remarkable change in behavior four weeks later when she came back for follow-up visits to the clinic. She was achieving remission in the addictive habit of gambling. Besides, as opposed to attending counseling sessions, the client opted to join a gambler’s anonymous group within her locally where she received support against the habit (Fiori et al., 2015). Following these interventions, the client’s addictive behavior was resolved when she reported for the follow-up visit. In addition, she indicated that anxiety had receded. This was against the expectations of the client since the aim of the therapy was to address gambling but not anxiety. The surprise in anxiety treatment was based on the confidence she acquired from the support group when she resolved to quit her counseling sessions.

Decision Point Three

Selected Decision

“Assess the challenges that counselor faces while providing therapy to Mrs. Perez and encourage the patient to continue with her Gamblers Anonymous Meetings” (Laureate Education, 2016c).

Reasons for the Above Selection

It is apparent that there is a problem with the counselor, especially on how she handles Mrs. Perez. Thus, now that the client finds the local gambler’s anonymous group effective in resolving her habit, she should be encouraged to continue with the sessions.  Meanwhile, the PMHNP nurse needs to assess the challenges between the psychiatrist counselor and the client so as to find a solution that will encourage the patient to resume her sessions (Stahl, 2014b). However, the counselor is under no obligation to compel Mrs. Perez to attend counseling sessions as this may compromise the patient’s healing process and she can relapse to her old habits. Nonetheless, the patient will continue to use the Vitriol medication even after four weeks as a prevention of a relapse.

Expected Results

The nurse practitioner should educate the patient about the benefits of counseling to enable her to resume the sessions with her therapist. Besides, since the FDA does not approve a specific prescription therapy for gambling, the client must be convinced to restart her counseling sessions as evidence affirms its effectiveness in solving the habit (West & Brown, 2013). In addition, the problem related to smoking cessation is likely to feature in the intervention strategy aimed at managing addictions. It is anticipated that after 12 weeks, the quality of life for the patient will have improved due to the treatment of the compulsive behavior.

Differences between Expected Results and Actual Results

The option to inform the client on the need to attend the local gambler’s anonymous group sessions while encouraging her to consider revisiting her counseling sessions conforms to the standard procedure in managing addiction (Stahl & Grady, 2012). As aforementioned, counseling is an evidence-based approach in addressing gambling addiction, and the patient should be guided to resume the therapy. However, caution must be taken to avoid forcing the client to attend the sessions as this may compromise the steps that have been made by the client. Moreover, the patient may lack interest in other intervention programs which can result in relapse.

Impact of Ethics on Intervention

FDA does not clearly define gambling habits and compulsive alcohol use in terms of treatment. As such, there are no specific medications to treat or manage the conditions. However, it is essential to embrace counseling as an alternative therapeutic strategy (Sharpley & Bitsika, 2014). Ethical considerations in the case study are also evident when the nurse practitioner made recommendations to the patient by taking into account her respect and dignity while encouraging her in the therapy options. Guided by this argument, the therapy approach was administered based on the moral and legal requirements of professional practice (Anderson et al., 2014). This was evident when the counsellor embraced the civil rights of the client and did not encourage her to attend counseling sessions that were not appealing to her. Furthermore, the nurse identified the need to give the patient liberty to participate in the gambler’s anonymous group sessions and therefore recognized the rights of the patient to refuse therapy.

Conclusion

Alcohol addictions and problematic gambling habits can have a negative impact on the life development of an individual. Thus, there is a need to formulate an intervention plan to resolve these compulsive behaviors. The selected therapy must be based on evidence to affirm its effectiveness in addressing the problem. The intervention approach must also follow the ethical and standard practice of care as stipulated in the FDA regulations. Clients should be encouraged to adhere to the medication regimen and make follow-ups with the nurse practitioners or health care providers to assist in the management of symptoms that might lead to a relapse.

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