Assignment: Therapy for Clients with Impulsivity, Compulsivity and Addiction
Assignment Therapy for Clients with Impulsivity, Compulsivity and Addiction
Addiction is classified as a mental condition in the diagnostic and statistical manual of mental disorders (DSM-5). A person who is unable to either physically or psychologically stop engaging in a particular activity, consuming a specific substance, or getting involved in some kind of deep thoughts is said to be suffering from addiction (American Psychiatric Association, 2013). People with severe addiction often present with compulsivity and impulsivity. This paper will assess the therapeutic decisions that have been made when treating a 53-year-old Puerto Rican female patient with a co-morbid addiction comprising of alcohol use disorder and gambling disorder. Following the diagnosis of addiction, the psychiatric mental health professional (PMHNP) must identify and implement therapeutic interventions that will improve the existing symptoms.
A person who is unable to either physically or psychologically stop engaging in a particular activity, consuming a specific substance, or getting involved in some kind of deep thoughts is said to be suffering from addiction
The primary reason for choosing Naltrexone as the initial treatment option for Mrs. Perez is that it is one of the medications that have been approved by the FDA for the treatment of alcohol dependence. The drug is highly effective in preventing relapse in patients who are suffering from addiction (Loreck, Brandt, & DiPaula, 2016). The recommended route of administration of Naltrexone in intramuscular injection in the gluteal region.
250 mg of Antabuse (Disulfiram) given orally daily has not been considered because there is little evidence that it will reduce relapse rates in patients with addiction despite the fact that it has successfully been used in the past to treat alcoholism. The drug is also associated with negative side effects when used in patients with alcohol use disorder (Stahl, 2013). Again, although Campral (Acamprosate) is effective in treating alcohol dependence, it must be combined with counseling to generate the desired results (Stahl, 2014). Therefore, these two decisions are considered inappropriate in the current scenario.
Outcomes
The PMHNP is expecting to observe positive changes in Mrs. Perez’s behaviors after four weeks. Precisely, her interest in gambling should reduce significantly. Again, the patient’s rate of cigarette use and alcohol consumption should also reduce (Grant, Odlaug, & Schreiber, 2014). Basically, Naltrexone is expected to reduce her urge for gambling and drug use. At the end of four weeks, some of the expected results have been achieved but not all. For instance, Mr. Perez has not tasted alcohol since she began to use the prescribed drugs and her rate of gambling has reduced. However, she still spends a lot of money at the casino if she visits and she is still consuming cigarettes. The patient has also developed anxiety which did not exist before.
Decision #2
Selected Decision
Refer to a counselor to address gambling issues
Reason for Selection
Counseling has been considered as the second decision option because it works well when combined with medications in addressing gambling addiction. The counselor should seek to understand and address the specific factors that are driving Mrs. Perez to engage in gambling (Grant, Odlaug, & Schreiber, 2014). Valium is used to treat alcohol withdrawal and anxiety. The drug has not been added to the current medication because the anxiety that Mrs. Perez is experiencing is just a mere side effect of the drug already administered and does not warrant treatment at this point. Again, although Chantix is effective in reducing cigarette addiction (Stahl, 2014), it has not been considered because it is highly necessary that gambling addiction is addressed first considering the fact that Mrs. Perez only enjoys smoking when she is playing at the slot machines.
Outcomes
At this point, the PMHNP expects that Mrs. Perez’s symptoms will improve even further. Precisely, she should not consume alcohol, should not go to the casino, should not smoke, and she should not experience anxiety (Grant, Odlaug, & Schreiber, 2014). The results of the counseling match what the PMHNP was expecting to achieve. On returning to the clinic in four weeks, Mrs. Perez has reported that her anxiety has completely disappeared. She has even started to attend gamblers anonymous meetings. However, Mrs. Perez does not like her counselor despite the fact that she is feeling supported in the group.
Decision #3
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
At this point, it is evident that Mrs. Perez is positively responding to treatment. In this respect, there is a great need that she
continues with the counseling sessions. A choice to explore issues that Ms. Perez has with her counselor has been made as it will help to build a strong patient-therapist relationship. As such, the patient will be able to continue with counseling (Sadock, Sadock, & Ruiz, 2014). Additionally, continuing with gambling anonymous meetings will help to address Mrs. Perez’s urge for gambling. Encouraging Mrs. Perez to continue with counseling is not an appropriate choice as this may make her boycott the counseling sessions. Furthermore, discontinuing Vivitrol is not an appropriate choice as this may cause an alcohol relapse (Stahl, 2013; Stahl, 2014).
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The PMHNP’s expectations at the third decision point resemble those at the second decision point. Specifically, Mrs. Perez should not consume alcohol, should not go to the casino, should not smoke, and she should not experience anxiety at the end of four weeks. Additionally, she should relate effectively with her counselor (Grant, Odlaug, & Schreiber, 2014).
The actual outcomes perfectly match what the PMHNP was expecting to achieve. On returning to the clinic in four weeks, Mrs. Perez has reported that she does not consume alcohol, does not go to the casino, does not smoke, and she does not experience anxiety. Additionally, her relationship with her counselor is really good. These results indicate that Naltrexone injection in combination with counseling is effective in treating patients with a co-morbid addiction comprising of alcohol use disorder and gambling disorder.
Ethical Considerations
Psychiatric mental health professionals must observe ethics and regulations that govern their profession whenever they are treating patients with gambling disorder and alcohol use disorder like Mrs. Perez. The ethical and legal considerations that have been made during communication and treatment include; respect for the patient’s autonomy by obtaining informed consent, maintaining politeness to strengthen the therapeutic relationship, and respecting the patient’s privacy rights (Sadock, Sadock, & Ruiz, 2014). These considerations have generated maximum therapeutic benefits for Mrs. Perez.
Conclusion
In summary, gambling addiction is classified as a mental disorder and should be addressed with a maximum level of professionalism. Treating the condition may present a big challenge to PMHNPs, especially if it co-occurs with other addictive disorders such as alcohol use disorder. However, it is possible to achieve positive health outcomes when appropriate therapeutic options are chosen and implemented.
Walden University Nurs 6630 – week 8 assignment
I want you to answer the questions given to you (decision points one, two, and three) before you click on the option. The answers will be based on your decisions made and patient outcomes during the decision tree. I am looking for an essay that is long enough to cover the topic BUT short enough to keep my interest. I do not need you to tell me the treatment options available to you – I am very familiar with the cases. Remember this is a Pharmacology class that incorporates Pharmacotherapy and not a class on diagnosing disease. I want you to tell me why you selected an option (why is it the best option- using clinically relevant and patient specific data) AND why you did not choose the other options (with clinically relevant and patient specific data).
At each decision point stop to complete the following:
Decision #1
Which decision did you select?
Why did you select this decision? Support your response with evidence and references to the Learning Resources. Be sure to provide rationale and clinical evidence why you DIDN’T select the other treatment choices available
What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
Explain any difference between what you expected to achieve with Decision #1 and the results of the decision. Why were they different?
Decision #2
Why did you select this decision? Support your response with evidence and references to the Learning Resources.
What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources. Be sure to provide rationale and clinical evidence why you DIDN’T select the other treatment choices available
Explain any difference between what you expected to achieve with Decision #2 and the results of the decision. Why were they different?
Decision #3
Why did you select this decision? Support your response with evidence and references to the Learning Resources.
What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources. Be sure to provide rationale and clinical evidence why you DIDN’T select the other treatment choices available
Explain any difference between what you expected to achieve with Decision #3 and the results of the decision. Why were they different?