Case Study For Patient With Comorbid Addiction Assignment Paper

Case Study For Patient With Comorbid Addiction Assignment Paper

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 clientâ€™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) Case Study For Patient With Comorbid Addiction Assignment Paper

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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) Case Study For Patient With Comorbid Addiction Assignment Paper

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)

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.

Assessing And Treating Patients With Impulsivity, Compulsivity, And Addiction

Pathological gambling is a habit and impulsive disease that is frequently accompanied by several mental illnesses. It refers to maladaptive patterns of conduct that an individual continues to engage in despite unfavorable outcomes(Ford et al.,2020). This is congruent with behavioral patterns reported in other addictions. Gambling and depression, anxiety disorders, and several personality disorders frequently coexist. Gambling addiction is frequently associated with substance misuse, particularly alcohol addiction. Both men and women are impacted, but men are more likely to be younger. Nonetheless, secondary diagnoses are more common in women than in males. It presents three therapeutic options that would be more convenient for the consumer, considering pharmaceutical pharmacokinetic and pharmacodynamic properties. The study also highlights the significance of ethics.

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Case study

Mrs. Maria Perez, a 5-year-old Puerto Rican girl who arrived at the clinic with a serious complaint she characterizes as an “Embarrassing condition,” is the case study’s topic. She admits to having a drinking problem since her father died while she was in her teens, that she suffered from it in her twenties, and that she has been attending Alcoholics Anonymous “on and off” for the past 25 years. She revealed that she had struggled to maintain her sobriety since the opening of a new Rising Sun Casino near her home when she got hooked. She claimed to receive “such a high” while gambling and enjoying a glass or two to relax at high stakes, which she said led to further drinking and irresponsible gambling. She smokes cigarettes as well and is concerned about the detrimental effects of cigarettes on health. She tried not to drink, but she gets “such a high” from gambling that she feels the need for an additional drink to “balance out.” She notes that she does not smoke as much when she drinks, but she does love it when she plays the slot machine. She reported gaining 7 lbs from her regular 115lb, and she is anxious about the $50,000 she borrowed from her retirement account to pay off her gambling habit without her husband’s agreement. She is alert, and oriented to person, place, time, and event but appears sad. Her insight and judgment are grossly intact; however, her impulse control is impaired. Denied suicidal thoughts.

Decision point 1#

As a PMHP, I have the choice of starting the client on IM naltrexone injection 380mg, PO Disulfiram 250mg OD, or PO Acamprosate 666mg TID at this moment. I decided to start the client on IM Naltrexone 380mg every four weeks. This choice was taken because Naltrexone is beneficial in lowering cravings and relapse rates in people with alcohol consumption disorder (Zimmermann et al.,2022). It works by preventing the effects of opioids and reducing the pleasure experienced when drinking. It is also useful in the treatment of gambling addiction. Furthermore, the medicine may assist the patient in losing weight by reducing the desire to eat excessively. Since it’s taken on a 4 weeks basis, the client may comply.

Antabuse 250mg, on the other hand, is an excellent option but cannot be considered as first-line treatment in this case because it is primarily intended to treat alcohol use disorder. This patient is primarily suffering from a gambling addiction, and there is no evidence that Antabuse would be beneficial in treating that addiction (Antonelli et al.,2022)Case Study For Patient With Comorbid Addiction Assignment Paper. Furthermore, Antabuse can cause substantial adverse effects like as nausea and vomiting, which can further impede the patient’s ability to work. Furthermore, because this woman is significantly handicapped by her gambling addiction, any possible Antabuse adverse effects would be magnified.

Acamprosate 666mg is a medicine used to treat alcohol addiction by reducing cravings for alcohol and increasing the capacity to refrain from drinking. However, it may not be the ideal choice for this patient because it does not address the underlying issues that are leading to her gambling addiction, such as impulsivity and poor judgment (Nielsen et al.,2022). Acamprosate can also be habit-forming and induce weight gain in certain people.

I believe that by picking this option, the client will report a significant reduction in her addiction. I also expect the client to report a decrease in her BMI. After four weeks of therapy, t The client claimed to feel “wonderful” since she had not “touched a drop” to drink since receiving the injection. She also stated that she visits casinos infrequently and that when she does, she overspends. She still smokes and suffers from anxiety. There was no significant variance in the results. Anxiety was discovered as an unforeseen side effect of naltrexone.

Decision point 2#

At this point, the PMHNP can incorporate PO Valium 5mg TID or PO Chantix 1mg BID into the client’s therapy or recommend the client to a counselor to address gaming problems. I decide to refer the client to a therapist to help him deal with his gambling addiction. This strategy is based on the fact that Naltrexone has been demonstrated to be successful in treating gambling addiction and that it can help people reduce their alcohol use. Furthermore, the client reported a considerable reduction in both gambling and alcohol use, and the anxiety issue was an expected adverse effect of naltrexone. Taking another medication may interfere with naltrexone’s effects, resulting in decreased success in stopping gambling. Besides, naltrexone is more effective when paired with non-pharmacological therapy, such as psychotherapy (Wei et al.,2022)Case Study For Patient With Comorbid Addiction Assignment Paper. A referral to a counselor is suggested to help her address her gambling tendencies. It will also allow the patient to get insight into her behavior and develop a strategy for coping with the issues that are causing her distress. Counseling may also assist her in developing stronger impulse control skills.

Adding PO Valium 5mg to the client’s treatment is also a potential option given the client’s anxiety, but it was not chosen in this case since her gambling and smoking activities are more related to her general condition of impaired impulse control. Adding valium to the therapy regimen may not be appropriate owing to probable adverse effects such as tiredness and sedation (Huestis et al.,2019). Additionally, Valium might promote constipation, making it harder for the woman to keep hydrated and lose weight.

Chantix, on the other hand, is an excellent treatment option for the patient since it may help the patient quit smoking. It is not suitable in this situation, however, because it may have the unexpected result of making the user feel euphoric, which would be detrimental to their goal of quitting smoking. It is also not recommended for persons who have a history of drinking. Because this patient already has a significant alcohol problem, adding Chantix might make her even more addicted to alcohol and increase her risk of developing other addiction-related problems.

By making this decision point, I expect the client to report significant reductions in her gambling and alcohol addiction, BMI, and anxiety. After four weeks of therapy, the client indicated that she no longer has anxiety symptoms; nonetheless, she dislikes the counselor. She also reported attending a support group (gamblers anonymous) and felt supported Case Study For Patient With Comorbid Addiction Assignment Paper.

Decision point 3 #

In this decision point, PMHNP has the option to explore what the client has with the counselor and encourage her attendance to gamblers anonymous, encourage her to continue seeing her counselor and attending gamblers synonymous, or encourage her to discontinue vivitriol and continue seeing her counselor and attending gamblers synonymous. As a PMHNP, I would prefer to discuss the client’s concerns with the counselor and encourage her to continue coming to gamblers regularly, as failure to do so may result in a breakdown in the therapeutic alliance, leading to the client discontinuing treatment. Furthermore, there is no FDA-approved therapy for gambling addiction, therefore ongoing counseling will assist her in managing her symptoms.

Discontinuing vivitrol would be an inappropriate option at this time since four weeks is probably too soon. According to research, using Naltrexone for more than three months is optimum for effective therapy (Murphy et al.,2019)Case Study For Patient With Comorbid Addiction Assignment Paper. Furthermore, there is a risk of relapse of the gambling issue, which is not ideal. Because the client has previously experienced positively perceived assistance from gamblers anonymous, she should be encouraged to continue her involvement in the group. PMHNPs must also discuss smoking cessation options with clients to treat the client’s overall health and addiction.

Ethical consideration

The ethical considerations in treating a client with alcohol and gambling addiction are multifaceted. The therapist must consider the client’s autonomy, privacy, and the possibility of injury. It is crucial to be sensitive to the client’s sentiments and problems and to refrain from making any judgmental or negative remarks. It is also critical that the patient is informed of the possible hazards linked with alcohol, such as the risk of liver disease and heart disease. Clients must also grasp the treatment’s goals and how to best attain them (Shaffer et al.,2020)Case Study For Patient With Comorbid Addiction Assignment Paper. This involves setting realistic expectations for how much change they will see and clearly defining what is and is not acceptable conduct. Her permission must be obtained before beginning the therapy.

References

Antonelli, M., Sestito, L., Tarli, C., & Addolorato, G. (2022). Perspectives on the pharmacological management of alcohol use disorder: Are the approved medications effective? European Journal of Internal Medicine.

Ford, M., & Håkansson, A. (2020). Problem gambling, associations with comorbid health conditions, substance use, and behavioral addictions: Opportunities for treatment pathways. PLoS One, 15(1), e0227644.https://doi.org/10.1371/journal.pone.0227644

Huestis, M. A., Solimini, R., Pichini, S., Pacifici, R., Carlier, J., & Busardò, F. P. (2019). Cannabidiol adverse effects and toxicity. Current neuropharmacology, 17(10), 974-989.

Murphy IV, C. E., Wang, R. C., Montoy, J. C., Whittaker, E., & Raven, M. (2022). Effect of extended‐release naltrexone on alcohol consumption: a systematic review and meta‐analysis. Addiction, 117(2), 271-281.

Nielsen, A. S., Askgaard, G., & Thiele, M. (2022). Treatment of alcohol use disorder in patients with liver disease. Current Opinion in Pharmacology, 62, 145-151.

Shaffer, H. J., Blaszczynski, A., & Ladouceur, R. (2020). Gambling control and public health: let’s be honest. International Journal of Mental Health and Addiction, 18, 819-824.

Wei, A., Navarro, M., Yeager, V., Goubran, B., & Moran, R. A. (2022). Naltrexone as an adjunctive treatment for adolescents with deliberate self-harm behavior and cannabis use. Consultant.

Zimmermann, S., Thomas, B. C., Krisam, J., Limprecht, R., Klose, C., Stenger, M., … & Bach, P. (2022). ON-ICE trial: Investigation of the combined effects of oxytocin and naltrexone on stress-induced and alcohol cue-induced craving in alcohol use disorder–Study protocol of phase II randomized double-blind placebo-controlled parallel-group trial. BMJ open, 12(4), e059672. Case Study For Patient With Comorbid Addiction Assignment Paper

Case study

Decision point 1#

As a PMHP, I have the choice of starting the client on IM naltrexone injection 380mg, PO Disulfiram 250mg OD, or PO Acamprosate 666mg TID at this moment. I decided to start the client on IM Naltrexone 380mg every four weeks. This choice was taken because Naltrexone is beneficial in lowering cravings and relapse rates in people with alcohol consumption disorder (Zimmermann et al.,2022)Case Study For Patient With Comorbid Addiction Assignment Paper. It works by preventing the effects of opioids and reducing the pleasure experienced when drinking. It is also useful in the treatment of gambling addiction. Furthermore, the medicine may assist the patient in losing weight by reducing the desire to eat excessively. Since it’s taken on a 4 weeks basis, the client may comply.

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Acamprosate 666mg is a medicine used to treat alcohol addiction by reducing cravings for alcohol and increasing the capacity to refrain from drinking. However, it may not be the ideal choice for this patient because it does not address the underlying issues that are leading to her gambling addiction, such as impulsivity and poor judgment (Nielsen et al.,2022)Case Study For Patient With Comorbid Addiction Assignment Paper. Acamprosate can also be habit-forming and induce weight gain in certain people.

Decision point 2#

Adding PO Valium 5mg to the client’s treatment is also a potential option given the client’s anxiety, but it was not chosen in this case since her gambling and smoking activities are more related to her general condition of impaired impulse control. Adding valium to the therapy regimen may not be appropriate owing to probable adverse effects such as tiredness and sedation (Huestis et al.,2019)Case Study For Patient With Comorbid Addiction Assignment Paper. Additionally, Valium might promote constipation, making it harder for the woman to keep hydrated and lose weight.

Decision point 3 #

Discontinuing vivitriol would be an inappropriate option at this time since four weeks is probably too soon. According to research, using Naltrexone for more than three months is optimum for effective therapy (Murphy et al.,2019). Furthermore, there is a risk of relapse of the gambling issue, which is not ideal. Because the client has previously experienced positively perceived assistance from gamblers anonymous, she should be encouraged to continue her involvement in the group. PMHNPs must also discuss smoking cessation options with clients to treat the client’s overall health and addiction.

Ethical consideration

The ethical considerations in treating a client with alcohol and gambling addiction are multifaceted. The therapist must consider the client’s autonomy, privacy, and the possibility of injury. It is crucial to be sensitive to the client’s sentiments and problems and to refrain from making any judgemental or negative remarks. It is also critical that the patient is informed of the possible hazards linked with alcohol, such as the risk of liver disease and heart disease. Clients must also grasp the treatment’s goals and how to best attain them (Shaffer et al.,2020)Case Study For Patient With Comorbid Addiction Assignment Paper. This involves setting realistic expectations for how much change they will see and clearly defining what is and is not acceptable conduct. Her permission must be obtained before beginning the therapy.

References

Nielsen, A. S., Askgaard, G., & Thiele, M. (2022). Treatment of alcohol use disorder in patients with liver disease. Current Opinion in Pharmacology, 62, 145-151.

Wei, A., Navarro, M., Yeager, V., Goubran, B., & Moran, R. A. (2022). Naltrexone as an adjunctive treatment for adolescents with deliberate self-harm behavior and cannabis use. Consultant.

Huestis, M. A., Solimini, R., Pichini, S., Pacifici, R., Carlier, J., & Busardò, F. P. (2019). Cannabidiol adverse effects and toxicity. Current neuropharmacology, 17(10), 974-989.

Shaffer, H. J., Blaszczynski, A., & Ladouceur, R. (2020). Gambling control and public health: let’s be honest. International Journal of Mental Health and Addiction, 18, 819-824. 246895__Week_10__Assignment_1_63d48c845b3d0.pdf (1)

Introduction to the case (1 page)