Assessing and Treating Patients with Impulsivity, Compulsivity, and Addiction

Introduction

The case study is about Mrs. Perez, a 53-year-old woman who presented with complaints about alcoholism and addiction to gambling. She reported that her alcohol problem started in her late teens when her father died and she has struggled with alcoholism for the last 25 years. She further reported that for the last 2 years she is experiencing difficulties maintaining sobriety. She states that she is also addicted to gambling and she drinks more alcohol while gambling. She further stated that her tobacco smoking has worsened over the last two years. Mrs. Perez also reported having gained a lot of weight with drinking alcohol. She is also spending a lot of money due to gambling and her husband is not aware of her gambling debts. The mental status exam shows that she is alert and oriented to time, place, person, and event. She is well-groomed. Her speech is goal-directed, coherent, and clear. However, her eye contact is somehow avoidant throughout the clinical interview. She does not manifest any noteworthy tics, mannerisms, or gestures. Her mood is sad and affect suitable to the content of the conversation and sad mood. She denies any hallucinations. No paranoid or delusional thought process. Both her judgment and insight are intact. Nonetheless, impairment of impulse control is notable. She denies any suicidal ideation. The client was diagnosed with gambling disorder, alcohol use disorder. This paper will discuss the appropriate treatment choices for the client and provide the ethical principles applied when selecting treatment choices for Mrs. Perez.

Decision Point One

The available treatment options include Naltrexone injection, 380 mg IM, Antabuse (disulfiram) 250 mg orally, and Campral 666 mg orally. Naltrexone is an FDA-approved medication used to treat alcoholism by reducing the craving for alcohol in an individual (Leighty & Ansara, 2019). Naltrexone works by suppressing alcohol desire by preventing alcohol to bind to alcohol-mediated receptors and thus treats alcohol dependency (Farhadian et al., 2020). Antabuse is also FDA approved and treats alcohol dependency by blocking alcohol breakdown and hence leads to the accumulation of a toxic alcohol-related compound (Shirley et al., 2021). Therefore, when a person takes alcohol while taking Antabuse, one experiences very bad side effects. On the other hand, Campral is a medication used to treat alcoholism but it should be combined with social and psychological treatments (Cheng et al., 2020). Naltrexone was selected for this patient as its efficacy in treating alcoholism has been shown (Farhadian et al., 2020). Additionally, naltrexone will be administered intramuscularly and after four weeks and this will improve the patient’s adherence to treatment. Antabuse was not selected because Mrs. Perez is still drinking alcohol and the reaction of the medication with alcohol will lead to severe side effects. On the other hand, Campral was not chosen because the medication should be combined with social and psychological treatments for effective treatment.

By selecting Naltrexone for Mrs. Perez, it is expected that she would stop or reduce alcohol consumption. This is due to the medication’s efficacy in treating alcoholism by reducing an individual’s craving for alcohol (Leighty & Ansara, 2019).

As anticipated, after four weeks since the time she was administered with Naltrexone, Mrs. Perez had stopped taking alcohol. This is due to the efficacy of the medication in the treatment of alcoholism (Leighty & Ansara, 2019). She also reported reduced frequency to the casino to gamble. However, she reported concerns about smoking and anxiety. Anxiety is a side effect of naltrexone (Leighty & Ansara, 2019).

Informed consent was sought from Mrs. Perez before starting the treatment. This involved providing her with all information about the medications, including their side effects.

Decision Point Two

The available treatment options include adding valium 5 mg orally for anxiety, referring Mrs. Perez to a counselor due to gambling, and adding Chantix 1 mg orally. Valium is a benzodiazepine used to treat anxiety, alcohol withdrawal, and other conditions (DeKosky & Williamson, 2020). Chantix is a medication used to treat smoking addiction by activating brain regions affected by nicotine and hence reduces nicotine (smoking) craving (Tonstad et al., 2020). The decision to refer Mrs. Perez for counseling to reduce gambling was chosen because she is still gambling and psychotherapy like counseling is the FDA-approved form of treatment for gambling addiction (Tracy & Wallance, 2016). Valium was not selected because it is a benzodiazepine and benzodiazepines are not recommended for people with alcohol addiction as it can lead to further abuse of benzodiazepines and alcohol (DeKosky & Williamson, 2020). Chantix was not chosen because gambling is a priority over smoking for Mrs. Perez.

By selecting the decision to refer Mrs. Perez for counseling, it was hoped that gambling addiction and anxiety would be treated and improve for this client (Tracy & Wallance, 2016). A good therapeutic relationship between Mrs. Perez and the counselor is also expected.

After four weeks, Mrs. Perez reported that anxiety had reduced. The reduced anxiety is because Mrs. Perez was starting to tolerate Naltrexone and hence side effects had faded (Leighty & Ansara, 2019). She also reported that she had joined Gamblers Anonymous and she felt supported in the group. However, Mrs. Perez reported that she did not like the counselor, which may lead to a poor therapeutic relationship affecting health outcomes.

Informed consent was sought from Mrs. Perez for this decision. Additionally, beneficence and non-maleficence ethical principles were applied to ensure that Mrs. Perez’s best interests were considered, and the decision with the minimal risks and most benefits was chosen (McKenna, 2020).

Decision Point Three

The available treatment options include exploring the issue Mrs. Perez has with the counselor as she continues participating in gamblers anonymous meetings, encourage her to continue meeting the counselor and participating in gamblers anonymous meetings, and discontinue Naltrexone as she continues seeing the counselor and attending Gamblers meetings. The first decision was selected because it is important to have the issue, she has with the counselor explored because therapeutic relationship affects treatment outcomes. Moreover, she should continue attending Gamblers anonymous meetings because such support groups provide the necessary peer support to help patients deal with their health conditions (Wahesh et al., 2017). The second and third decisions were not selected as the poor relationship between Mrs. Perez and the counselor may have negative effects on the treatment outcomes. Discontinuing Naltrexone was not chosen because Mrs. Perez needs to continue with the treatment of alcohol addiction.

With this decision, it is anticipated that the issue Mrs. Perez has with the counselor will be identified to improve their therapeutic relationship and thus improve treatment outcomes (Molina-Mula & Gallo-Estrada, 2020). It is also expected that she would continue abstaining from alcohol and gambling.

For this decision, beneficence and non-maleficence ethical principles were applied to ensure that Mrs. Perez’s best interests were considered, and the decisions chosen had the best treatment outcomes (McKenna, 2020).

Conclusion

The first decision that was selected for Mrs. Perez was to administer her with Naltrexone 380 mg IM every 4 weeks. This is because Naltrexone reduces the desire to drink alcohol and hence treating alcoholism. After four weeks Mrs. Perez reported that she had abstained from alcohol but would still gamble and smoke. The second decision was thus to refer her to a counselor to treat gambling addiction because psychotherapies like counseling are the recommended treatment modalities for gambling addiction. Mrs. Perez reported she did not like the counselor and thus the third decision was to explore the issue she had with the counselor as she continued joining Gamblers Anonymous meetings. This was to improve the therapeutic relationship and hence facilitate the best treatment outcomes. In order to address all her addictions, including smoking, it would be important to discuss and recommend the most appropriate smoking cessation options for Mrs. Perez. Before starting treatment, informed consent was obtained to make sure that Mrs. Perez made an informed treatment decision. Moreover, both beneficence and non-maleficence ethical principles were applied by selecting treatment decisions likely to lead to the best treatment outcomes for Mrs. Perez.

References

Cheng, H. Y., McGuinness, L. A., Elbers, R. G., MacArthur, G. J., Taylor, A., McAleenan, A., … & Kessler, D. (2020). Treatment interventions to maintain abstinence from alcohol in primary care: a systematic review and network meta-analysis. BMJ, 371.

DeKosky, S. T., & Williamson, J. B. (2020). The Long and the Short of Benzodiazepines and Sleep Medications: Short-Term Benefits, Long-Term Harms? Neurotherapeutics, 17(1), 153-155.

Farhadian, N., Moradi, S., Zamanian, M. H., Farnia, V., Rezaeian, S., Farhadian, M., & Shahlaei, M. (2020). Effectiveness of naltrexone treatment for alcohol use disorders in HIV: a systematic review. Substance abuse treatment, prevention, and policy, 15(1), 1-7.

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

McKenna H. (2020). Covid-19: Ethical issues for nurses. International journal of nursing studies, 110, 103673. https://doi.org/10.1016/j.ijnurstu.2020.103673

Molina-Mula, J., & Gallo-Estrada, J. (2020). Impact of Nurse-Patient Relationship on Quality of Care and Patient Autonomy in Decision-Making. International journal of environmental research and public health, 17(3), 835. https://doi.org/10.3390/ijerph17030835

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, 165.

Tonstad, S., Arons, C., Rollema, H., Berlin, I., Hajek, P., Fagerström, K., … & Russ, C. (2020). Varenicline: mode of action, efficacy, safety, and accumulated experience salient for clinical populations. Current medical research and opinion, 36(5), 713-730.

Tracy K & Wallance S. (2016). Benefits of peer support groups in the treatment of addiction. Subst Abuse Rehabil, 1(1), 143–154.

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Assignment: 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)

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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.

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