(Solution) NURS 6630 Week 10 Assignment: Assessing and Treating Patients With Impulsivity, Compulsivity, and Addiction / A Puerto Rican Woman with Comorbid Addiction.

(Solution) NURS 6630 Week 10 Assignment: Assessing and Treating Patients With Impulsivity, Compulsivity, and Addiction / A Puerto Rican Woman with Comorbid Addiction. Assessing and Treating Patients with Impulsivity, Compulsivity, and Addiction Course: NURS-6630- Psychopharmalogical Approaches to Treat Psychopathology Week 10: Assignment 1 Walden University Introduction The provided case study is of Mrs. Maria Perez who is 53 years old Puerto Rican female. The case study indicated that she is suffering from alcohol use disorder and gambling disorder. The background information indicated that the patient became alcoholic after the death of her father and she is struggling with addiction to alcohol since her 20’s. She is now seeking for help because her addiction to alcohol and gambling has increased from the past two years. Patient reported that the reason behind her increased addiction is due to the opening of a new casino “Rising Sun” near her home. She and her friend went to visit the new casino at its grand opening and from that point she got “hooked”. Patient reported that she enjoys drinking alcohol during gambling because alcohol help her to remain calm during the high-stake games. Patient mentioned that she does not smoke during gambling but she smokes more when she is playing slot machines. Alcoholism has increased her weight from 115 lbs to 122 lbs. Patient is embarrassed because she borrowed over $50,000 from retirement account to pay off her gambling debts and her husband in not aware of this. The mental status examination indicated that she is oriented to person, place, time and event. Her speech is clear but she is avoidant to make eye contact during interview which indicates that she is embarrassed about herself. Self- reported mood is sad but she denies suicidal or homicidal ideation. Patient also denied paranoid or delusional thought process, auditory or visual hallucinations. Insight and judgment are grossly intact. The pertinent positive information that will impact decision making when prescribing medication for this patient include her age factor, addiction to alcohol, gambling and cigarette smoke, absence of information related to abstinence and impaired impulse control. Assessing and Treating Patients with Impulsivity, Compulsivity, and Addiction Decision 1 For decision 1 I selected “Vivitrol (Naltrexone) injection, 380mg intramuscularly in the gluteal region every four weeks”. I selected this decision because Naltrexone is considered as the first line medication for alcohol use disorder. According to the study of Spithoff et al. (2017) Disulfiram, Naltrexone and Acamprosate are the first line alcohol use disorder medications. Among these Disulfiram is a cost effective medication but Acamprosate and Naltrexone are safe and cost effective medications for the treatment of alcohol use disorder. The study discussed that Naltrexone not only helps patients in achieving abstinence but it also helps patients in reducing their heavy drinking to lower risk levels. On the other hand, Acamprosate is effective when therapy is initiated after detoxification. The use of Naltrexone does not depend on conditions but other drugs like Acamprosate is recommended only when the patient shows treatment failure with Naltrexone or Naltrexone is contraindicated in relevance to patient’s health status or the patient has shown abstinence for at least 4 days. Considering these facts, the other options of Disulfiram (Antabuse) and Acamprosate (Campral) are not selected. As the patient is already facing severe financial loss due to gambling, therefore in such conditions it would not be a prudent decision to recommend a cost effective medication like Disulfiram. The study has mentioned that Disulfiram is not accessible easily and it is only accessible through compounding pharmacies at a cost of approximately $150 annually (excluding the compounding costs). The other option of Acamprosate is not selected because the patient is not currently at detoxification state. Moreover, the conditions related to the recommendation of Acamprosate are not fulfilled because the patient has not showed any failure to Naltrexone nor the case study provided any information related to the patient’s contraindications towards the use of Naltrexone and nor the patient has shown any abstinence for at least 4 days. In such cases, the only medication left is Naltrexone which will be effective, safe and cost effective option for patient (Spithoff et al., 2017). With decision 1 I was hoping that the patient will came and will report reduced consumption of alcohol. I was also hoping that the patient will only complaint about the feeling of anxiety or sleep disturbance because these are common side effects of Naltrexone. According to the study of Schwaiger (2018) Naltrexone possess common side effects of anxiety, depression and sleep disturbance. As in decision 1, the treatment goal was to reduce her alcohol consumption therefore I am not hoping that Naltrexone will make any changes in her addiction to gambling and smoking. Decision 2 For decision 2 I selected “refer to a counselor to address gambling issues”. I selected this decision on the basis of results of decision 1. As the patient came after four weeks and reported that she is feeling wonderful as she has not touched a drop of alcohol since receiving the injection. Patient also reported that she has not been going to casino as frequently, but when she does go she spends a lot of money in gambling. Patient also reported that she is still smoking which has her concerned and mentioned problems with anxiety. On the basis of these results a counselor is referred because the medication has proved to be effective in controlling her alcohol consumption. Instead, Naltrexone was effective in reducing her alcohol consumption to the lower levels without causing any serious side effects. The anxiety side effect of Naltrexone is not considered a serious issue because such side effects get subsided after the patient’s body gets adjusted to medication. According to Alcohol and Drug Foundation (ADF, 2021) Naltrexone has fewer side effects like anxiety and sleep problems but these side effects usually go away after the medication is taken for few days. Therefore, the concern of anxiety is not considered a significant issue. However, patient reported spending money due to gambling which is due to her impaired impulse control. In such cases, referring to counselor would be a prudent decision because there is no pharmacological therapy that is indicated for the treatment of gambling disorder. According to the study of Potenza et al. (2019) no pharmacological therapy has a formal indication for the treatment of gambling disorder, however improved identification and prevention can help people with gambling disorder. Another study of Rizeanu (2015) has discussed that gambling is a psychological syndrome and therefore cognitive and behavioral therapies and self-help interventions are considered as effective approaches. The study also mentioned that counseling is another effective approach. Through counseling, the gambler can identify the triggers associated with gambling and can avoid those triggers and thus can get prevented from significant financial loss. The study also discussed that counseling also provides education and information about the risks of gambling and supports gamblers who are experiencing problems with gambling. Patient also complained about cigarette smoking and counseling could also help her in adopting smoking cessation. According to the study of Al-Jdani, Mashabi, Alsaywid & Zahrani (2018) healthcare professionals can reduce the rate of smoking in those who smoke by providing effective counseling. This effective counseling is based on building rapport relationship with the patient and completely determining and understanding their social context and background. It means that through counseling she will not only get help related to her gambling addiction but counseling will also help her in adopting smoking cessation.