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Assessing and Treating Clients With Impulsivity, Compulsivity, and Addiction Essay
Co-morbid Addiction (ETOH and Gambling) 53-year-old Puerto Rican FemaleBACKGROUND
Mrs. Maria Perez is a 53-year-old Puerto Rican female who presents to your office today due to a rather “embarrassing problem.”SUBJECTIVE
Mrs. Perez admits that she has had “problems” with alcohol since her father died in her late teens. She reports that she has struggled with alcohol since her 20’s and has been involved with Alcoholics Anonymous “on and off” for the past 25 years. She states that for the past two years, she has been having more and more difficulty maintaining her sobriety since they opened the new “Rising Sun” casino near her home. Mrs. Perez states that she and a friend went to visit the new casino during their grand opening at which point she was “hooked.” She states that she gets “such a high” when she is gambling. While gambling, she “enjoys a drink or two” to help calm her during high-stakes games. She states that this often gives way to more drinking and more reckless gambling. She also reports that her cigarette smoking has increased over the past two years and she is concerned about the negative effects of the cigarette smoking on her health. Assessing and Treating Clients With Impulsivity, Compulsivity, and Addiction Essay. She states that she attempts to abstain from drinking but that she gets such a “high” from the act of gambling that she needs a few drinks to “even out.” She also notices that when she drinks, she doesn’t smoke “as much” but enjoys smoking when she is playing at the slot machines. She also reports that she has gained weight from drinking so much- she currently weights 122 lbs., which represents a 7 lb. weight gain from her usual 115 lb. weight. Mrs. Perez is quite concerned today because she has borrowed over $50,000 from her retirement account to pay off her gambling debts. Assessing and Treating Clients With Impulsivity, Compulsivity, and Addiction Essay. She is very concerned because her husband does not know that she has spent this much money.MENTAL STATUS EXAM
The client is a 53-year-old Puerto Rican female who is alert, oriented to person, place, time, and event. She is dressed appropriately for the weather and time of year. Her speech is clear, coherent, and goal directed. Her eye contact is somewhat avoidant during the clinical interview. As you make eye contact with her, she looks away or looks down. She demonstrates no noteworthy mannerisms, gestures, or tics. Her self-reported mood is “sad.” Affect is appropriate to content of conversation & self-reported mood. She visual or auditory hallucinations, no delusional or paranoid thought processes are readily appreciated. Insight and judgment are grossly intact, however, impulse control is impaired. She is currently denying suicidal or homicidal ideation. Assessing and Treating Clients With Impulsivity, Compulsivity, and Addiction Essay. Diagnosis: Gambling disorder, alcohol use disorder Decision Point One Select what the PMHNP should do: Naltrexone (Vivitrol) injection, 380 mg intramuscularly in the Naltrexone (Vivitrol) injection, 380 mg intramuscularly in the gluteal region every 4 weeks gluteal region every 4 weeks Antabuse (Disulfiram) 250 mg orally daily Antabuse (Disulfiram) 250 mg orally daily Campral (Acamprosate) 666 mg orally three times/day Campral (Acamprosate) 666 mg orally three times/day To prepare for this Assignment: • Review this week’s Learning Resources. Consider how to assess and treat adolescent clients requiring therapy for impulsivity, compulsivity, and addiction.The Assignment;
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 stop to complete the following: • Decision #1 o Which decision did you select? o Why did you select this decision? Support your response with evidence and references to the Learning Resources. o What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources. o Explain any difference between what you expected to achieve with Decision #1 and the results of the decision. Why were they different? Assessing and Treating Clients With Impulsivity, Compulsivity, and Addiction Essay.• Decision #2
o Why did you select this decision? Support your response with evidence and references to the Learning Resources. o What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources. o Explain any difference between what you expected to achieve with Decision #2 and the results of the decision. Why were they different?• Decision #3
o Why did you select this decision? Support your response with evidence and references to the Learning Resources. o What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources. o Explain any difference between what you expected to achieve with Decision #3 and the results of the decision. Assessing and Treating Clients With Impulsivity, Compulsivity, and Addiction Essay. Why were they different? Note: Support your rationale with a minimum of three academic resources. While you may use the course text to support your rationale, it will not count toward the resource requirement. In each decision please discuss reason why the other 2 medication were not used, there should be an introduction and a conclusion. Assessing and Treating Clients with Impulsivity, Compulsivity, and AddictionIntroduction
The focus of this assignment is on Mrs. Maria Perez is a 53-year-old Puerto Rican female who was diagnosed with a gambling disorder, alcohol use disorder. Gambling disorder refers to the repetitive and persistent maladaptive gambling behavior as manifested by preoccupation with gambling; has to gamble with larger sums of money to attain the anticipated excitement; constant unsuccessful efforts to stop or control gambling; irritability when trying to stop gambling; goes back to gambling even after losing money; lies to family and endangers relationships, work, education etc. to gamble, among other symptoms (Calado & Griffiths, 2016). On the other hand, alcohol use disorder is the inability of a person to manage or control their alcohol-intake behaviors in spite of the desire to stop or the alcohol intake jeopardizing their relationships, work, education etc. (Yau & Marc, 2015). The client reported of alcohol and gambling addiction and is also worried about her increased tobacco smoking. MSE for the client indicates that the client is avoiding direct eye contact and is sad as well. Accordingly, in this paper, three decisions will be made on the client’s treatment while considering the pharmacokinetic and pharmacodynamics effects on the client. Assessing and Treating Clients With Impulsivity, Compulsivity, and Addiction Essay.Decision Point One
The first decision that was selected is to administer the client with Naltrexone (Vivitrol) injection, 380 mg intramuscularly in the gluteal region every 4 weeks. The rationale for selecting this decision is based on the fact that naltrexone is a competitive antagonist at addiction/alcohol receptors and therefore inhibits alcohol agonist-induced effects, including the effects the alcohol abusers desire. The medication also represses the desire for alcohol intake (Sullivan et al, 2014). Therefore, Naltrexone (Vivitrol) is an appropriate choice to treat alcohol addiction for the client. Additionally, clinical trials demonstrate the efficacy of Naltrexone in treating alcoholism (Alanis-Hirsch et al, 2016). Assessing and Treating Clients With Impulsivity, Compulsivity, and Addiction Essay. Moreover, the medication has minimal side effects and therefore the client is likely to tolerate the administered dose with the targeted efficacy. The option of Antabuse (Disulfiram) 250 mg orally daily was not selected because the medication is associated with numerous serious side effects such as a headache, dyspnea, sympathetic over-activity, palpitations, vomiting, seizure, coma, and even death. Moreover, there is a high risk of toxicity with the medication in addition to the high rate of non-adherence with Disulfiram (Crowley, 2015). On the other hand, the option of Campral (Acamprosate) was not selected because evidence recommends Campral to be used in combination with psychological and social treatment as a component of a full alcohol addiction treatment (Crowley, 2015). In addition, guidelines recommend the medication to be started 5-7 days after the last drink yet the client has not withdrawn from the alcohol. In addition, the 3-times daily dosing regimen with Campral can reduce its adherence (Crowley, 2015). Assessing and Treating Clients With Impulsivity, Compulsivity, and Addiction Essay. With this decision, the expectation was that the client will gradually reduce her alcohol abuse, and stop craving for alcohol and desire to gamble as well. This is because studies demonstrate the efficacy of Naltrexone (Vivitrol) in lowering the desire to take alcohol as well as in reducing gambling cravings in individuals with gambling disorder. The other expectation was that the client would tolerate the medication and therefore she would not experience any adverse event. The outcome that was hoped for and the results of the decision were almost similar. This is because after starting Naltrexone (Vivitrol) injection, the client did stop alcohol intake and also there was a reduction in gambling. The only difference is that the client reported complaints about anxiety. The anxiety is a common side effect of Naltrexone (Vivitrol) medication.Decision Point Two
For decision 2, the decision that was chosen is to add valium (diazepam) 5 mg. This reason for choosing this decision is to treat the anxiety for the client. The medication was selected because valium influences GABA receptors within the brain; the receptors regulate anxiety. Valium influences GABA receptors by slowing the central nervous system which reduced the feelings of anxiety and produces a calming effect and therefore reduced anxiety symptoms (Calcaterra & Barrow, 2014). A study conducted by Warren et al (2016) indicated the efficacy of valium in the treatment of anxiety symptoms. Assessing and Treating Clients With Impulsivity, Compulsivity, and Addiction Essay. The choice to have the client attend counseling for gambling issue was not chosen because this option would not address the anxiety the client is currently manifesting and also the client is already manifesting improvement in regard to gambling. The option of adding Chantix (varenicline) was not chosen due to the many adverse and side effects associated with varenicline, for example, suicide, sleep disturbance, cardiovascular events etc. (Davies et al, 2015). Selection of this decision aimed to ensure that the symptoms of anxiety that the client is manifesting would improve. This is because the evidence demonstrates the efficacy of valium in improving anxiety symptoms (Warren et al, 2016). Another expectation was that the client would not have a dependency on the medication. There were no notable differences between the expected results and the actual outcome of the decision. Assessing and Treating Clients With Impulsivity, Compulsivity, and Addiction Essay. The actual outcome was that the symptoms of anxiety considerably improved. The only difference is that the client was asking for higher and frequent doses of the medication indicating a dependency on the medication. The dependency the client is manifesting on valium is because of the addictive effect of valium as a benzodiazepine (Tvete et al, 2016).