A Sample Answer For the Assignment: NURS 6630 Assignment Assessing and Treating Patients With Impulsivity, Compulsivity, and Addiction

Background

Mrs. Maria Perez, a 53-year-old Puerto Rican woman, has presented with an issue that she finds “embarrassing.”

Subjective

Mrs. Perez has struggled with alcohol since her father’s death in her late teens. She has been in and out of Alcoholics Anonymous for the past 25 years. Recently, she has been finding it difficult to maintain her sobriety due to the opening of the “Rising Sun” casino near her home. During a visit to the casino’s grand opening, Mrs. Perez became hooked on gambling, which provides her with a sense of high.

She often drinks while gambling, which leads to reckless gambling and further drinking. She has also noticed an increase in cigarette smoking over the past two years, which worries her about its negative effects on her health. Mrs. Perez has attempted to stop drinking but finds it challenging to resist the high she experiences from gambling. She has gained seven pounds from drinking and weighs 122 lbs.

Mental Status Exam

During the clinical interview, Mrs. Perez demonstrated an alert and oriented state of mind. Her speech was clear, coherent, and goal-directed, and her eye contact was somewhat avoidant. She had no noteworthy mannerisms, gestures, or tics. Although her self-reported mood was “sad,” her affect was appropriate to the conversation and her mood. She reported no visual or auditory hallucinations, delusional or paranoid thought processes, and her insight and judgment were intact. However, her impulse control was impaired, and she denied any suicidal or homicidal ideation.

Diagnosis

Mrs. Perez has been diagnosed with gambling disorder and alcohol use disorder.

Introduction

Compulsivity and impulsivity can manifest in various ways and often coincide with other psychiatric disorders. Individuals who act without thinking may struggle to refuse certain things, such as spending money or using illegal drugs. Some people may engage in compulsive behavior that leads to adverse consequences.

In many cases, compulsivity and impulsivity contribute to addiction-related problems. To assess and treat clients effectively, a Psychiatric Mental Health Nurse Practitioner (PMHNP) must have a clear understanding of the differences between these disorders, their symptoms, and their impact on both clients and their families (Bandelow, Michaelis, & Wedekind, 2017).

Decision #1

I have selected to begin the Naltrexone (Vivitrol) injection, 380 mg intramuscularly in the gluteal region every 4 weeks for the patient described in the case. My decision to choose Naltrexone was based on its effectiveness in reducing alcohol consumption, craving, and relapse rates in patients with alcohol use disorder.

Studies have demonstrated the efficacy of Naltrexone in reducing alcohol use in patients with alcohol use disorder, including those with comorbid psychiatric conditions. Additionally, Naltrexone has been shown to improve overall treatment outcomes and increase the likelihood of abstinence. In the context of the patient’s case, Naltrexone could help her maintain her sobriety by blocking the pleasurable effects of alcohol and reducing her craving for alcohol (Ray et al., 2019).

I did not select Campral (Acamprosate) or Antabuse (Disulfiram) for the patient because they have different mechanisms of action and may not be as effective as Naltrexone in this particular case. Campral works by reducing cravings and withdrawal symptoms in patients who have already stopped drinking.

While it is generally well-tolerated, it has not been shown to be effective in reducing heavy drinking or promoting abstinence in patients with alcohol use disorder (Akbar et al., 2018). Antabuse, on the other hand, works by causing a psychologically unpleasant reaction if the patient drinks alcohol, which can serve as a deterrent. However, it has limited efficacy and is associated with low patient adherence due to its side effects (De Souza, 2019).

By choosing Naltrexone, I hoped to achieve a reduction in the patient’s alcohol consumption, craving, and risk of relapse. I also hoped to improve her overall treatment outcomes and increase her likelihood of abstinence. Studies such as Ray et al. (2019) have shown Naltrexone to be effective in reducing alcohol use in patients with alcohol use disorder, and I hoped to have similar results replicated in this case.

Ethical considerations play a significant role in the treatment plan and communication with patients. It is important to obtain informed consent from the patient before initiating any treatment, ensuring that they understand the risks and benefits associated with the treatment. In the case of Naltrexone, it is important to inform the patient of the potential side effects, including nausea, headache, and fatigue, and monitor them for any adverse reactions.

It is also important to involve the patient in the decision-making process and respect their autonomy by considering their preferences and values. Additionally, confidentiality and privacy must be maintained throughout the treatment process, and the patient’s dignity and respect must be upheld (Adams & Volkow, 2020).

Decision #2

I selected to refer the client to a counselor to address her gambling issues. This decision was based on the client’s primary concern being gambling disorder and the potential benefits of concurrent counseling with her current medication regimen. Research has shown that counseling and therapy are effective in treating gambling disorder, including cognitive-behavioral therapy (CBT) and motivational interviewing (MI) (Hodgins et al., 2019).

Counseling can help the client identify and address the underlying reasons for their gambling behavior, develop coping skills, and improve their self-efficacy and motivation to change. Furthermore, counseling can provide ongoing support for maintaining sobriety and reducing the risk of relapse.

I did not select the other two options provided. Adding on Chantix (varenicline) may be effective in reducing nicotine dependence, but it does not address the client’s primary concern of gambling disorder. Additionally, the client’s smoking may be a secondary issue that can be addressed through counseling or other means.

Adding on Valium (diazepam) also presents a risk for the client due to her history of alcohol and drug abuse. Valium is a benzodiazepine meaning it has potential for being abused. Mixing alcohol with Valium is also associated with side effects such as slowed breathing which can be life threatening (Powers, 2022).

By referring the client to a counselor to address gambling issues, I hope to achieve additional support for the client’s primary concern of gambling disorder. The counselor can work with the client to identify triggers and develop coping strategies to prevent relapse. Additionally, the counselor can help the client address any underlying psychological or emotional issues that may be contributing to their gambling behavior (Knaebe et al., 2019).

Ethical considerations play a significant role in the treatment plan and communication with patients. It is essential to obtain informed consent from the patient and respect their autonomy in making decisions about their treatment. The patient must understand the benefits and risks associated with counseling and be able to provide informed consent.

Confidentiality must also be maintained, and the patient’s privacy and dignity must be upheld. Additionally, the counselor must be appropriately trained and qualified to address the client’s specific needs and concerns (Adams & Volkow, 2020).

Referring the client to a counselor to address gambling issues was the appropriate decision based on the patient’s primary concern and the potential benefits of concurrent counseling with her current medication regimen. Counseling can help the client identify underlying issues and develop coping strategies to prevent relapse. Ethical considerations must be considered throughout the treatment plan to ensure the patient’s autonomy and privacy are upheld (Knaebe et al., 2019).

Decision #3

I selected to explore the issue that Mrs. Perez is having with her counselor and encourage her to continue attending the Gamblers Anonymous meetings for decision #3. This decision was based on the client’s report that she did not really like her counselor and the potential benefits of addressing this issue and continuing with Gamblers Anonymous. Research has shown that a positive therapeutic alliance between the patient and therapist is critical for successful treatment outcomes (Knaebe et al., 2019).

Patients who have a positive relationship with their therapist are more likely to engage in therapy, feel supported, and make progress towards their treatment goals. Therefore, addressing the issue that Mrs. Perez is having with her counselor is crucial for maintaining her engagement in counseling and improving her treatment outcomes.

I did not select the other two options provided in the exercise. Encouraging Mrs. Perez to continue seeing her current counselor may not be effective if she does not have a positive therapeutic alliance with her therapist. Discontinuing Vivitrol is not recommended as it has been shown to be effective in reducing alcohol consumption and preventing relapse in patients with alcohol use disorder (Ray et al., 2019).

By exploring the issue that Mrs. Perez is having with her counselor and encouraging her to continue attending the Gamblers Anonymous meetings, I hope to improve her engagement in counseling and increase her chances of successful treatment outcomes. By addressing the issue with her counselor, we can work to improve the therapeutic alliance and ensure that Mrs. Perez is receiving effective treatment. Additionally, continuing with Gamblers Anonymous provides her with additional support and resources for maintaining sobriety and preventing relapse.

Ethical considerations must be considered throughout the treatment plan and communication with patients. It is essential to respect the patient’s autonomy and preferences in their treatment. Mrs. Perez must be informed of the potential benefits and risks associated with continuing with her current counselor and encouraged to express any concerns or issues she may have. Confidentiality must also be maintained, and any communication with her counselor must be conducted with her informed consent. The goal is to provide Mrs. Perez with the best possible care while respecting her autonomy and privacy (Adams & Volkow, 2020).

Conclusion

In summary, my recommendations for the treatment of Mrs. Perez’s alcohol and gambling disorders involved a combination of pharmacological and psychosocial interventions. Treating addiction, compulsivity, and impulsivity disorders presents significant challenges to healthcare providers. These disorders are often associated with negative behaviors that can have adverse consequences for patients. It is crucial for Psychiatric Mental Health Nurse Practitioners (PMHNPs) to actively listen to clients with these disorders, evaluate their circumstances, and create a comprehensive treatment plan.

The decision to administer Naltrexone (Vivitrol) injection, 380 mg intramuscularly in the gluteal region every 4 weeks. Was based on the effectiveness of Naltrexone in reducing alcohol cravings and preventing relapse in patients with alcohol use disorder (Ray et al., 2021). The client responded well to this medication, with reduced alcohol consumption and improved sobriety.

In Mrs. Perez’s case, there are inadequate FDA-approved medications for gambling addiction. However, counseling has been shown to be an effective treatment option for this disorder. For the gambling disorder, I referred her to a counselor to address her gambling issues and encouraged her to participate in Gamblers Anonymous meetings.

This decision was based on research that supports the effectiveness of counseling and support groups combined with pharmacological intervention in treating comorbid alcohol abuse and gambling disorder (Kraus, Etuk, & Potenza, 2020). The client reported feeling supported and engaged in the Gamblers Anonymous group, and her anxiety and gambling behaviors improved.

For the third decision point, I recommended exploring the issue that Mrs. Perez was having with her counselor and encouraging her to continue attending Gamblers Anonymous meetings. This decision was based on the importance of a positive therapeutic alliance in successful treatment outcomes (Knaebe et al., 2019) and the potential benefits of addressing any concerns with the counselor and continuing with the support provided by Gamblers Anonymous.

Overall, the combination of pharmacological and psychosocial interventions was effective in treating Mrs. Perez’s alcohol and gambling disorders. Ethical considerations were also taken into account throughout the treatment plan to ensure the patient’s autonomy and privacy were respected. It is important to note that every patient is unique, and treatment plans must be tailored to their specific needs and concerns. Clinicians must consider the patient’s individual history, comorbidities, preferences, and potential risks and benefits of treatment options. Therefore, ongoing assessment and modification of the treatment plan are necessary for successful outcomes.

References

Adams, V. J. M., & Volkow, N. D. (2020). Ethical imperatives to overcome stigma against          people with substance use disorders. AMA Journal of Ethics, 22(8), 702-708. Doi:         10.1001/amajethics.2020.702.

Akbar, M., Egli, M., Cho, Y. E., Song, B. J., & Noronha, A. (2018). Medications for alcohol use disorders: An overview. Pharmacology & therapeutics, 185, 64-85.     https://doi.org/10.1016/j.pharmthera.2017.11.007

Bandelow, B., Michaelis, S., & Wedekind, D. (2017). Treatment of anxiety disorders. Dialogues

De Souza, A. (2019). Disulfiram in the Management of Alcohol Dependence.             https://link.springer.com/chapter/10.1007/978-981-32-9876-7_3

            in clinical neuroscience, 19(2), 93. https://doi.org/10.31887/DCNS.2017.19.2/bbandelow

Knaebe, B., Rodda, S. N., Hodgins, D. C., & Lubman, D. I. (2019). Behaviour change strategies endorsed by gamblers subtyped by psychological distress, risky alcohol use, and            impulsivity. Journal of Gambling Studies, 35(1), 275-292. https://doi.org/10.1007/s10899-      018-9803-x

Kraus, S. W., Etuk, R., & Potenza, M. N. (2020). Current pharmacotherapy for gambling disorder: a systematic review. Expert Opinion on Pharmacotherapy, 21(3), 287-296.             https://doi.org/10.1080/14656566.2019.1702969

Powers, H. (2022). The use of valium in alcohol withdrawal.           https://scholarworks.utep.edu/cohort_10/5/

Ray, L. A., Green, R., Roche, D. J., Magill, M., & Bujarski, S. (2019). Naltrexone effects on        subjective responses to alcohol in the human laboratory: A systematic review and meta‐        analysis. Addiction Biology, 24(6), 1138-1152. https://doi.org/10.1111/adb.12747