NURS 6630 Assessing and Treating Patients With Impulsivity, Compulsivity, and Addiction

Sample Answer for NURS 6630 Assessing and Treating Patients With Impulsivity, Compulsivity, and Addiction Included After Question

NURS 6630 Assessing and Treating Patients With Impulsivity, Compulsivity, and Addiction

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/

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

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· Next, from the Attach File area, click on the Browse My Computer button. Find the document you saved as “WK10Assgn+last name+first initial.(extension)” and click Open.

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A Sample Answer For the Assignment: NURS 6630 Assessing and Treating Patients With Impulsivity, Compulsivity, and Addiction

Title: NURS 6630 Assessing and Treating Patients With Impulsivity, Compulsivity, and Addiction

NURS 6630 Assessing and Treating Patients With Impulsivity, Compulsivity, and Addiction

Gambling and alcohol abuse are some of the mental health problems that psychiatric mental health nurse practitioners (PMHNP) face in their practice. PMHNP ensures that patients suffering from gambling and alcohol abuse disorders are assisted to overcome their addition and live a normal life. Therefore, this paper examines a case study of a patient that has been diagnosed with gambling disorder and alcohol use disorder. The patient is Maria Perez, a 53-year-old Puerto Rican female who came to the clinic with a complaint of an embarrassing problem. The client admitted having history of problems with alcohol since her father died during her teenage years. She has been struggling with alcohol since her 20’s and is involved with Alcohol Anonymous in on and off basis. The client reported to have difficulty in maintaining sobriety since the opening of a casino near her home. Perez has been gambling in the casino with her friend and enjoys drinking alcohol to calm her during high stake games. Her drinking behavior has predisposed her to reckless gambling. The client also has history of smoking cigarette for the last two years and is getting worried about its effects on her health. The client also reported to have gained more than 7 pounds of weight from her usual 115-pound weight. Mental status examination was administered to the client. The assessment showed the client to be oriented and alert, dressed appropriately for the occasion, has clear, goal directed and coherent speech and avoidance eye contact behaviors. The assessment also showed the client not to demonstrate any noteworthy mannerism, ticks or gestures. The mood of the client was sad with absence of hallucinations, delusions, paranoid, or suicidal and homicidal ideations.

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).

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.

Expectations

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

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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

NURS 6630 Assessing and Treating Patients With Impulsivity, Compulsivity, and Addiction
NURS 6630 Assessing and Treating Patients With Impulsivity, Compulsivity, and Addiction

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.

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).

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.

NURS 6630 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.

NURS 6630 Assessing and Treating Patients With Impulsivity, Compulsivity, and Addiction 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

The case study is about a 53-year-old Puerto Rican female who came to the clinic with an “embarrassing condition.” She has struggled with drinking ever since she lost her father in her 20s. The client claims that she has been in occasional touch with an AA group for close to 25 years. She alleges that she struggles with remaining sober and that since a neighboring casino came up close to her home two years ago, her issues have become worse. She fears that her gambling addiction has increased her likelihood of smoking, but she finds it difficult to stop drinking while she plays since it makes her feel “cool.” The number of beverages has climbed as a result of two every night.

Several factors may influence the client’s treatment. It is critical to ascertain if drug interactions might impact the pharmacodynamics, or mechanism of action, of the therapy. Take the opioid antagonist Vivitrol, for instance. Therefore, it is essential to determine whether a patient has an opioid addiction or is taking any medications that are related to opioids before giving them Vivitrol (Trick & Le Foll, 2020). Before taking Vivitrol, the client must have abstained from opioids for at least 7 to 10 days. Age, gender, race, and any restrictions on the individual must all be considered. Vivitrol’s pharmacokinetics, for instance, provides comprehensive details on how it affects biological sex, ethnicity, and age; nevertheless, caution is advised when giving it to individuals with moderate to severe renal deficiencies (Yang et al., 2022).The purpose of this discussion is tochoose the best treatments for the patient while detailing the expected outcomes and any moral conundrums at each stage of the decision-making process.

 

Decision #1

Selected Decision

            Every four weeks, the patient would get 380 mg of Vivitrol intramuscularly (IM) into the gluteal area.

Justification

Alcohol and drug dependency are treated with the help of the extended-release naltrexone formulation Vivitrol (Zein & Itai Danovitch, 2023). The drug is taken every month (Yang et al., 2022). In 2006, the American Food and Drug Administration granted its first approval for the treatment of alcohol abuse disorder (Pettorruso et al., 2023). The beginning dosage, which aims to change how the brain reacts to alcohol usage, is 380 mg (Trick & Le Foll, 2020). Even though the client has not revealed any medications with opioids as well as other opiate addictions, the FDA states that Vivitrol is considered unsafe in patients who are experiencing opioid symptoms of withdrawal (Taubin et al., 2022). I also chose Vivitrol since it is neither narcotic nor addictive.

Reasons to Reject the Other Two Options

Decisions two and three might be utilized for people who misuse alcohol, but I chose against them since they required to be given to someone clean for some time. The patient’s degree of compliance may be impacted by the disulfiram formulation’s short half-life and higher risk of adverse effects including palpitations (Antonelli et al., 2022). Acamprosate is similarly short-acting and needs more frequent dosing, which could make it difficult for patients to adhere to the necessary dose (Mistarz et al., 2021).

Expected Outcome

            After taking this medication, it is hoped that the patient will have reductions in the symptoms present at the beginning of therapy (Zein & Itai Danovitch, 2023). It is predicted that the patient’s fundamental problem with alcohol dependence would improve (Yang et al., 2022). She needs to reduce or stop consuming alcohol regularly.

Ethical Consideration

            Clinicians are urged to treat persons with drug use problems equally regardless of their gender, color, or any other characteristic (Mistarz et al., 2021). The patient was treated according to the PMHNP’s ethical criterion of fairness.

Decision #2

Selected Decision

            It was reasonable to recommend the client visit a psychiatrist for her predisposition for gambling as the second intervention.

Justification

A counselor will use several counseling techniques to address this problem (Mistarz et al., 2021). Among the most popular therapies are CBT, group therapy, and psychodynamic therapy (Taubin et al., 2022). CBT, which teaches patients how to stop gambling and promotes optimistic attitudes, is one of the finest methods to assist patients in overcoming their gambling addictions (Zein & Itai Danovitch, 2023). A three-month follow-up examination demonstrates that, as a consequence of cognitive-behavioral therapy, the gamblers’ habits have dramatically improved (Yang et al., 2022). Additionally, this will instruct them in relapse prevention strategies, help them learn new coping and problem-solving skills, and develop their social skills (Ray et al., 2020).

Reasons to Reject the Other Two Options

It was incorrect to utilize diazepam as a supplementary treatment to naltrexone since it is addictive (Mistarz et al., 2021). The potent quitting smoking medication Chantix should only be administered for a short time and in minimal dosages when combined with naltrexone (Pettorruso et al., 2023).

Expected Outcome

It is predicted that the patient would report decreased gaming tendencies within a few weeks (Zein & Itai Danovitch, 2023). She continued by saying she had been going to Gamblers Anonymous meetings. She says she was inspired by the last organization she belonged to (Antonelli et al., 2022).

Ethical Consideration

            According to nursing ethics, every patient must get the same treatment from the nurse without exception. It is crucial to promote patient-centered care with a focus on meeting the needs of the patient (Pettorruso et al., 2023). For instance, a therapist may successfully treat the patient’s major concern in this circumstance, which was gambling (Trick & Le Foll, 2020). The ethical rule of non-maleficence had an impact on the PMHNP’s decision.

Decision #3

Selected Decision

            The patient was asked to continue attending Gamblers Anonymous meetings and the decision was made after considering her communication difficulties with her psychotherapist.

Justification

The patient is still highly devoted to her battle against addiction even if she and her therapist did not get along (Taubin et al., 2022). She is inspired as a result to join Gamblers Anonymous. She may now mostly rely on treatment to assist her in overcoming her gambling addiction (Mistarz et al., 2021). Due to this, the therapist and client must discuss their problem for them to guide how to address it and get the most out of group therapy (Ray et al., 2020). Counseling can only be effective when there is a solid therapeutic connection built on trust (Trick & Le Foll, 2020). The issue should be resolved beforehand so that the nurse can concentrate on the sessions that follow (Antonelli et al., 2022). It became vital to reestablish the relationship and trust as a consequence.

Reasons to Reject the Other Two Options

The patient will discontinue psychotherapy if you push her to continue while disregarding her differences with the therapist (Taubin et al., 2022). It is undesirable to quit utilizing naltrexone treatment since it is more successful when sustained over time, particularly in persons with severe drug addiction (Pettorruso et al., 2023).

Expected Outcome

            When the client’s conflict with her counselor has been resolved, she will be expected to stop gambling and continue to abstain from alcohol(Ray et al., 2020). She ought to be able to modify her smoking behaviors in collaboration with her therapist (Zein & Itai Danovitch, 2023).

Ethical Considerations

            To obtain greater results, psychiatrists are urged to take part in helping their patients form a strong therapeutic relationship (Ray et al., 2020). It’s important to keep neutrality while resolving conflicts between a patient and her counselors and to explain to the patient the importance of focusing on this relationship. Ethics concerns such as nonmaleficence and autonomy also played a part in this decision (Trick & Le Foll, 2020).

Conclusion

To provide the best possible care for clients with drug use disorders and addiction, healthcare practitioners must have a solid basis in pharmacology. Before entering the clinic, the woman in the case study was preoccupied with the shame caused by her drinking and gambling addiction. Age, gender, and ethnicity were taken into account while choosing the most effective therapy for the patient’s illness. The initial step was to deliver naltrexone, which is often recommended as the first-line treatment for drug addiction problems and has FDA licensing (Trick & Le Foll, 2020). Due to their brief half-lives and increased risk of negative patient effects,  Campral and Disulfiram are inappropriate (Zein & Itai Danovitch, 2023). The woman claimed that she had stopped drinking since the initial injection, despite continuing to smoke and gamble after four weeks (Mistarz et al., 2021). Therefore, it was crucial to suggest that the client gets in touch with a psychologist for assistance with her gambling. It was inappropriate to include either varenicline or diazepam in the client’s treatment plan since both medications are addictive and only modest doses are recommended for stopping smoking (Yang et al., 2022).

The client reported increased symptoms at the next session, but her primary concern was that she detested her therapists (Taubin et al., 2022). Because of this, the client’s problems should be discussed with her counselor as part of the overall treatment plan, and she should be encouraged to keep going to Gamblers Anonymous meetings (Pettorruso et al., 2023). Stopping naltrexone use and ignoring the patient’s disdain for her therapist were both poor decisions (Antonelli et al., 2022).The PMHNP has several ethical issues to keep in mind while making decisions, like protecting the patient’s autonomy and averting bias (Ray et al., 2020). Additional ethical standards that are upheld include fairness and non-maleficence.

NURS 6630 Assessing and Treating Patients With Impulsivity, Compulsivity, and Addiction References

Antonelli, M., Sestito, L., Tarli, C., & Addolorato, G. (2022). Perspectives on the pharmacological management of alcohol use disorder: Are the approved medications effective? European Journal of Internal Medicine103, 13–22. https://doi.org/10.1016/j.ejim.2022.05.016

Mistarz, N., Nielsen, A. S., Andersen, K., Goudriaan, A. E., Skøt, L., Mathiasen, K., Michel, T. M., & Mellentin, A. I. (2021). Brain+ AlcoRecover: A Randomized Controlled Pilot-Study and Feasibility Study of Multiple-Domain Cognitive Training Using a Serious Gaming App for Treating Alcohol Use Disorders. Frontiers in Psychiatry12. https://doi.org/10.3389/fpsyt.2021.727001

Pettorruso, M., Di Carlo, F., Romeo, V. M., Jimenez-Murcia, S., Grant, J. E., Martinotti, G., & di Giannantonio, M. (2023). The pharmacological management of gambling disorder: if, when and how. Expert Opinion on Pharmacotherapy. https://doi.org/10.1080/14656566.2023.2172329

Ray, L. A., Meredith, L. R., Kiluk, B. D., Walthers, J., Carroll, K. M., & Magill, M. (2020). Combined Pharmacotherapy and Cognitive Behavioral Therapy for Adults With Alcohol or Substance Use Disorders. JAMA Network Open3(6), e208279. https://doi.org/10.1001/jamanetworkopen.2020.8279

Taubin, D., Wilson, J. C., & Wilens, T. E. (2022). ADHD and Substance Use Disorders in Young People. Child and Adolescent Psychiatric Clinics of North America. https://doi.org/10.1016/j.chc.2022.01.005

Trick, L., & Le Foll, B. (2020). Pharmacological Treatment of Alcohol Use Disorder. Textbook of Addiction Treatment, 123–139. https://doi.org/10.1007/978-3-030-36391-8_10

Yang, W., Singla, R., Maheshwari, O., Fontaine, C. J., & Gil-Mohapel, J. (2022). Alcohol Use Disorder: Neurobiology and Therapeutics. Biomedicines10(5), 1192. https://doi.org/10.3390/biomedicines10051192

Zein, M., & Itai Danovitch. (2023). Substance-Related and Addictive Disorders. Springer EBooks, 437–467. https://doi.org/10.1007/978-3-031-15401-0_14