(Solution) NURS 6630 Week 10 Assignment:
Assessing and Treating Patients With
Impulsivity, Compulsivity, and Addiction / A
Puerto Rican Woman with Comorbid
Addiction.
NURS 6630 Week 10 Assignment Solution: Assessing
and Treating a Puerto Rican Woman with Comorbid
Addiction
Case Summary
The patient is a 46-year-old Puerto Rican woman presenting with comorbid alcohol use
disorder and cocaine addiction. She reports increased impulsivity in decision-making,
compulsive behaviors related to substance use, and significant impairment in
occupational and social functioning. She has attempted to quit multiple times without
sustained success and expresses ambivalence about complete abstinence.
Comprehensive Assessment
1. Cultural Formulation
• Cultural identity: Puerto Rican woman with strong family ties, Catholic
background
• Cultural stressors: Acculturation stress, potential language barriers in treatment
settings
, • Cultural factors in substance use: Possible use of substances in social/family
contexts
• Cultural strengths: Strong family support system, spiritual resources
• Treatment implications: Need for bilingual provider, incorporation of family in
treatment, consideration of spiritual components
2. Biopsychosocial Assessment
• Biological: Assess for co-occurring medical conditions (liver function,
cardiovascular health), genetic predisposition to addiction
• Psychological: Screen for comorbid mental health disorders (depression, anxiety,
trauma history), assess coping skills and cognitive patterns
• Social: Evaluate occupational stability, legal issues, family dynamics, social
support network
3. Diagnostic Considerations
• Primary diagnoses:
o Severe Alcohol Use Disorder (F10.20)
o Severe Cocaine Use Disorder (F14.20)
• Rule out: Major depressive disorder, anxiety disorders, PTSD, personality
disorders
• Assessment tools recommended:
o Addiction Severity Index (ASI)
o AUDIT and DAST-10
o PHQ-9 and GAD-7 for mood/anxiety
o Cultural Formulation Interview
Pharmacological Treatment Plan
Phase 1: Detoxification & Stabilization (Days 1-14)
• Alcohol withdrawal management:
o Diazepam 10mg PO Q6H PRN for CIWA-Ar score >8
, o Thiamine 100mg daily, folate 1mg daily, multivitamin daily
o Monitor vital signs Q4H, CIWA-Ar Q8H
• Cocaine withdrawal support:
o Supportive care only (no FDA-approved medications)
o Propranolol 20mg BID PRN for anxiety/tremors (if no contraindications)
o Trazodone 50mg HS PRN for insomnia
Phase 2: Maintenance & Relapse Prevention (Week 3 onward)
• For alcohol use disorder:
o First-line: Naltrexone 50mg daily
▪ Rationale: Reduces alcohol craving and rewarding effects
▪ Monitor for hepatotoxicity (baseline LFTs)
▪ Patient education: Must be opioid-free for 7-10 days before
initiation
o Alternative: Acamprosate 666mg TID
▪ Rationale: Stabilizes neurotransmitter imbalance
▪ Advantage: Safe in liver disease, no opioid interaction
• For cocaine use disorder (off-label options):
o Consider: Topiramate titrated from 25mg daily to target 100mg BID
▪ Rationale: Reduces cocaine cravings and use
▪ Monitor for cognitive side effects, paresthesias
o Alternative: Modafinil 200mg daily
▪Rationale: May reduce cocaine cravings and withdrawal symptoms
• Comorbid psychiatric management:
o If depression persists after 4 weeks of sobriety: Sertraline 50mg daily
o If anxiety persists: Consider buspirone 5mg BID (low abuse potential)
Phase 3: Long-term Maintenance (3+ months)
• Continue effective medications for minimum 12 months
• Regular monitoring of liver function, renal function, and medication adherence
• Consider extended-release naltrexone (Vivitrol) 380mg IM monthly if adherence
concerns
Assessing and Treating Patients With
Impulsivity, Compulsivity, and Addiction / A
Puerto Rican Woman with Comorbid
Addiction.
NURS 6630 Week 10 Assignment Solution: Assessing
and Treating a Puerto Rican Woman with Comorbid
Addiction
Case Summary
The patient is a 46-year-old Puerto Rican woman presenting with comorbid alcohol use
disorder and cocaine addiction. She reports increased impulsivity in decision-making,
compulsive behaviors related to substance use, and significant impairment in
occupational and social functioning. She has attempted to quit multiple times without
sustained success and expresses ambivalence about complete abstinence.
Comprehensive Assessment
1. Cultural Formulation
• Cultural identity: Puerto Rican woman with strong family ties, Catholic
background
• Cultural stressors: Acculturation stress, potential language barriers in treatment
settings
, • Cultural factors in substance use: Possible use of substances in social/family
contexts
• Cultural strengths: Strong family support system, spiritual resources
• Treatment implications: Need for bilingual provider, incorporation of family in
treatment, consideration of spiritual components
2. Biopsychosocial Assessment
• Biological: Assess for co-occurring medical conditions (liver function,
cardiovascular health), genetic predisposition to addiction
• Psychological: Screen for comorbid mental health disorders (depression, anxiety,
trauma history), assess coping skills and cognitive patterns
• Social: Evaluate occupational stability, legal issues, family dynamics, social
support network
3. Diagnostic Considerations
• Primary diagnoses:
o Severe Alcohol Use Disorder (F10.20)
o Severe Cocaine Use Disorder (F14.20)
• Rule out: Major depressive disorder, anxiety disorders, PTSD, personality
disorders
• Assessment tools recommended:
o Addiction Severity Index (ASI)
o AUDIT and DAST-10
o PHQ-9 and GAD-7 for mood/anxiety
o Cultural Formulation Interview
Pharmacological Treatment Plan
Phase 1: Detoxification & Stabilization (Days 1-14)
• Alcohol withdrawal management:
o Diazepam 10mg PO Q6H PRN for CIWA-Ar score >8
, o Thiamine 100mg daily, folate 1mg daily, multivitamin daily
o Monitor vital signs Q4H, CIWA-Ar Q8H
• Cocaine withdrawal support:
o Supportive care only (no FDA-approved medications)
o Propranolol 20mg BID PRN for anxiety/tremors (if no contraindications)
o Trazodone 50mg HS PRN for insomnia
Phase 2: Maintenance & Relapse Prevention (Week 3 onward)
• For alcohol use disorder:
o First-line: Naltrexone 50mg daily
▪ Rationale: Reduces alcohol craving and rewarding effects
▪ Monitor for hepatotoxicity (baseline LFTs)
▪ Patient education: Must be opioid-free for 7-10 days before
initiation
o Alternative: Acamprosate 666mg TID
▪ Rationale: Stabilizes neurotransmitter imbalance
▪ Advantage: Safe in liver disease, no opioid interaction
• For cocaine use disorder (off-label options):
o Consider: Topiramate titrated from 25mg daily to target 100mg BID
▪ Rationale: Reduces cocaine cravings and use
▪ Monitor for cognitive side effects, paresthesias
o Alternative: Modafinil 200mg daily
▪Rationale: May reduce cocaine cravings and withdrawal symptoms
• Comorbid psychiatric management:
o If depression persists after 4 weeks of sobriety: Sertraline 50mg daily
o If anxiety persists: Consider buspirone 5mg BID (low abuse potential)
Phase 3: Long-term Maintenance (3+ months)
• Continue effective medications for minimum 12 months
• Regular monitoring of liver function, renal function, and medication adherence
• Consider extended-release naltrexone (Vivitrol) 380mg IM monthly if adherence
concerns
