Assessing and Treating Patients With Impulsivity, Compulsivity, and Addiction

This assignment is a case study about Mrs. Perez, a 53-year-old with a diagnosis of gambling disorder, alcohol use disorder. The client in this case study uncontrollable alcohol intake and addiction to alcohol, as well as increasing smoking of tobacco. The findings from the MSE indicated that her mood was sad, avoided eye contact, well-oriented and alert, clear and coherent speech, and both judgment and insight intact. However, her impulse control was impaired. Gambling disorder is characterized by persistent and repetitive maladaptive behavior where a person is preoccupied with gambling. Gambling leads the individual gambling with bigger amounts of money to achieve the expected excitement, inability to stop gambling, continue to gamble even after suffering from bog financial losses, lying to family members, among others (Ferrara et al., 2018). As a result, gambling may affect interpersonal relationships, education, and work. Alcohol use disorder is characterized by the inability of an individual to control or manage alcohol intake despite the desire to reduce or stop the alcohol intake, and the alcohol drinking having an adverse effect on an individual’s education, work, or relationships (Knox et al., 2019). Since the diagnosis for Mrs. Perez is gambling disorder, alcohol use disorder, this paper will discuss her appropriate treatment choices and outline the ethical principles applied during her treatment.

Decision Point One

The appropriate decision is for the client to start Naltrexone (Vivitrol) injection, 380 mg intramuscularly in the gluteal region every 4 weeks. Naltrexone was prescribed because it is a competitive antagonist for alcohol receptors and hence the medication hinders agonist-induced effects. The medication is also effective in reducing the desire to drink alcohol and its efficacy in treating efficacy has been shown in various studies (Alanis-Hirsch et al., 2016). In addition, administration of the medication through injective will improve her treatment adherence and it has minimal side effects. The reason why Antabuse was not chosen is due to its several side effects like dyspnea, vomiting, coma, palpitations, headache, among other serious side effects. Additionally, Antabuse is associated with a high non-adherence rate and a high risk of toxicity. The reason why Campral was not considered is because the medication should be combined with a psychotherapy treatment to ensure adequate recovery from alcohol addiction. Moreover, Campral should not be used while the patient is still taking alcohol, yet Mrs. Perez has not yet stopped taking alcohol.

Prescribing naltrexone injection expected that the client would stop craving for alcohol, and eventually stop alcohol intake. It was also expected that the gambling would reduce. Evidence demonstrates that Naltrexone is effective in reducing the desire to drink alcohol and reducing the desire to gamble (Ward et al., 2018). It is also expected that she would adhere to treatment and she would also not experience major side effects.

As expected, after four weeks Mrs. Perez reported that she had stopped taking alcohol and also her desire to gamble had reduced, but she was still using large sums of money in the casino. She also reported an increased need to smoke and anxiety, which is the medication’s side effect (anxiety) (Ward et al., 2018).

During Mr. Perez’s treatment, informed consent was sought to ensure she agreed to receive the treatment after being provided with adequate information about all the available treatment options. Additionally, the privacy and confidentiality of her information and hence her diagnosis and treatment were not revealed to any other person, without her authorization (Darby & Weinstock, 2018).

Decision Point Two

The treatment options for decision point two are the addition of valium; having Mrs. Perez referred to a counselor or the addition of Chantix. Valium acts on the brain’s GABA receptors to treat anxiety by generating a calming effect. According to Warren et al (2016), valium is used in treating and improving symptoms of anxiety. Chantix is used to treat smoking addiction. The appropriate decision is to refer Mrs. Perez to a counselor to have the gambling addiction addressed. This is because psychotherapies such as counseling have been shown to be effective in the treatment of gambling addictions.  The reason why the addition of Chantix was not selected is because this medication is allied to various side effects such as sleep disturbance, suicidal thoughts, cardiovascular events such as palpitations, headache, among other serious adverse effects (Benowitz et al., 2018). The option of adding valium was not selected because Mr. Perez may become addicted to valium. The dependency is attributable to the addictive effects of benzodiazepines such as valium (Tvete et al., 2016).

Referring Mrs. Perez for counseling anticipated that she would eventually stop gambling and spending huge sums of money gambling. This is because psychotherapy treatments such as counseling are effective in improving gambling (Choliz, 2018). The counseling is also expected to reduce anxiety for Mrs. Perez as she reported that the medication was causing anxiety.

After four weeks, Mrs. Perez reported that the anxiety had significantly decreased as well as the gambling and spending large sums of money in gambling. This is due to the effectiveness of counseling in improving and treating gambling addiction. Psychotherapy treatments such as counseling have been demonstrated to be effective in reducing gambling (Choliz, 2018). Mrs. Perez however reported that she did not like the counselor.

The ethical principles that guided this decision include informed consent and beneficence. For informed consent, Mr. Perez was adequately educated about valium, include the possible dependency on the medication (Darby & Weinstock, 2018). Moreover, the addition of valium was selected because it will result in the best outcomes for the client by treating anxiety, while naltrexone treated alcoholism and gambling.

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Decision Point Three

The treatment choices for decision point three include exploring the problem Mrs. Perez has with the counselor and encouraging attendance of gamblers anonymous meeting; encourage Mrs. Perez to continue with the current counselor while attending gamblers anonymous group, or ensure she discontinues Vivitrol and continue seeing the current counselor while attending gamblers anonymous meetings.  The suitable decision was to explore the problem Mrs. Perez has with the counselor and encouraging attendance of gamblers anonymous meetings. Exploring would identify the issue with an aim of improving the client-therapist relationship between Mrs. Perez and the counselor. This is because a therapeutic relationship plays a major role in improving the treatment outcomes. The decision to discontinue Vivitrol was not appropriate since it is necessary for Mrs. Perez to continue being administered with Vivitrol to treat the alcohol addiction.

By selecting the decision of exploring the problem Mrs. Perez has with the counselor and encouraging attendance of gamblers anonymous meeting, the treatment goal is that the problem Mrs. Perez has with the counselor would be identified to improve the therapeutic relationship. This would promote the treatment of gambling for Mrs. Perez because she is likely to adhere to the treatment. It was also hoped that while naltrexone would continue addressing alcoholism, counseling would help reduce the gambling addiction for Mrs. Perez.

 

The ethical principle of beneficence guided this decision because, with this decision, Mrs. Perez would continue abstaining from alcohol, stop gambling, and treat the anxiety, hence ensuring the best care outcomes for her (Darby & Weinstock, 2018).

Conclusion

Mrs. Perez was diagnosed with gambling disorder, alcohol use disorder. The first decision involved administering her with Naltrexone injection every 4 weeks. The reason for prescribing Naltrexone is because the drug has been demonstrated to be effective in treating alcoholism. After being administered Naltrexone Mrs. Perez stopped taking alcohol and the frequency of gambling decreased. However, she reported anxiety, a side effect associated with naltrexone. Therefore, the second decision involved referring Mrs. Perez to a counselor to have the gambling addiction addressed. This is because she was still spending large sums of money on gambling and counseling is effective in treating gambling addiction. However, during the review, Mrs. Perez stated that she did not like the therapist. This could negatively impact the therapeutic relationship and thus the third decision would be the exploration of the problem she had with the therapist and encourage Mrs. Perez to continue attending the gambling anonymous meetings. This would identify the problem she has with the therapist and have the problem identified and hence improve the therapeutic relationship between them

All three decisions were guided by various ethical principles that included informed consent, confidentiality, autonomy, and beneficence.

References

Alanis-Hirsch K, Coff R, Ford J, Johnson K, Mady C, Laura S & Dennis M. (2016). Extended-release naltrexone: A qualitative analysis of barriers to routine use. J Subst Abuse Treat. 1(62), 68–73.

Benowitz, N. L., Pipe, A., West, R., Hays, J. T., Tonstad, S., McRae, T., … & Anthenelli, R. M. (2018). Cardiovascular safety of varenicline, bupropion, and nicotine patch in smokers: a randomized clinical trial. JAMA internal medicine, 178(5), 622-631.

Choliz M. (2018). Ethical Gambling: A Necessary New Point of View of Gambling in Public Health Policies. Front Public Health, 6(12).

Darby, W. C., & Weinstock, R. (2018). The Limits of Confidentiality: Informed Consent and Psychotherapy. Focus (American Psychiatric Publishing), 16(4), 395–401. https://doi.org/10.1176/appi.focus.20180020

Ferrara, P., Franceschini, G., & Corsello, G. (2018). Gambling disorder in adolescents: what do we know about this social problem and its consequences? Italian journal of pediatrics, 44(1), 1-5.

Fluyau D, Revadigar N & Brittany M. (2018). Challenges of the pharmacological management of benzodiazepine withdrawal, dependence, and discontinuation. Ther Adv Psychopharmacology, 8(5), 147–168.

Knox, J., Hasin, D. S., Larson, F., & Kranzler, H. R. (2019). Prevention, screening, and treatment for heavy drinking and alcohol use disorder. The lancet. Psychiatry, 6(12), 1054–1067. https://doi.org/10.1016/S2215-0366(19)30213-5

Tvete I, Trine B & Tor S. (2016). A 5-year follow-up study of users of benzodiazepine: starting with diazepam versus oxazepam. Br J Gen Pract. 66(645), e241–e247.

Ward, S., Smith, N., & Bowden-Jones, H. (2018). The use of naltrexone in pathological and problem gambling: A UK case series. Journal of behavioral addictions, 7(3), 827–833. https://doi.org/10.1556/2006.7.2018.89

Warren A, Cowen G & Harmer C. (2016). Cognitive mechanisms of diazepam administration: a healthy volunteer model of emotional processing. Psychopharmacology (Berl). 1(233), 2221–2228.

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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

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

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

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

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

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.
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