NURS 6630 Assignment 1 Assessing and Treating Patients With Impulsivity, Compulsivity, and Addiction

NURS 6630 Assignment 1 Assessing and Treating Patients With Impulsivity, Compulsivity, and Addiction

Walden University NURS 6630 Assignment 1 Assessing and Treating Patients With Impulsivity, Compulsivity, and Addiction-Step-By-Step Guide

This guide will demonstrate how to complete the Walden University  NURS 6630 Assignment 1 Assessing and Treating Patients With Impulsivity, Compulsivity, and Addiction  assignment based on general principles of academic writing. Here, we will show you the A, B, Cs of completing an academic paper, irrespective of the instructions. After guiding you through what to do, the guide will leave one or two sample essays at the end to highlight the various sections discussed below.

How to Research and Prepare for NURS 6630 Assignment 1 Assessing and Treating Patients With Impulsivity, Compulsivity, and Addiction 

Whether one passes or fails an academic assignment such as the Walden University  NURS 6630 Assignment 1 Assessing and Treating Patients With Impulsivity, Compulsivity, and Addiction  depends on the preparation done beforehand. The first thing to do once you receive an assignment is to quickly skim through the requirements. Once that is done, start going through the instructions one by one to clearly understand what the instructor wants. The most important thing here is to understand the required format—whether it is APA, MLA, Chicago, etc.

After understanding the requirements of the paper, the next phase is to gather relevant materials. The first place to start the research process is the weekly resources. Go through the resources provided in the instructions to determine which ones fit the assignment. After reviewing the provided resources, use the university library to search for additional resources. After gathering sufficient and necessary resources, you are now ready to start drafting your paper.

How to Write the Introduction for NURS 6630 Assignment 1 Assessing and Treating Patients With Impulsivity, Compulsivity, and Addiction 

The introduction for the Walden University  NURS 6630 Assignment 1 Assessing and Treating Patients With Impulsivity, Compulsivity, and Addiction  is where you tell the instructor what your paper will encompass. In three to four statements, highlight the important points that will form the basis of your paper. Here, you can include statistics to show the importance of the topic you will be discussing. At the end of the introduction, write a clear purpose statement outlining what exactly will be contained in the paper. This statement will start with “The purpose of this paper…” and then proceed to outline the various sections of the instructions.

How to Write the Body for NURS 6630 Assignment 1 Assessing and Treating Patients With Impulsivity, Compulsivity, and Addiction  

After the introduction, move into the main part of the NURS 6630 Assignment 1 Assessing and Treating Patients With Impulsivity, Compulsivity, and Addiction  assignment, which is the body. Given that the paper you will be writing is not experimental, the way you organize the headings and subheadings of your paper is critically important. In some cases, you might have to use more subheadings to properly organize the assignment. The organization will depend on the rubric provided. Carefully examine the rubric, as it will contain all the detailed requirements of the assignment. Sometimes, the rubric will have information that the normal instructions lack.

Another important factor to consider at this point is how to do citations. In-text citations are fundamental as they support the arguments and points you make in the paper. At this point, the resources gathered at the beginning will come in handy. Integrating the ideas of the authors with your own will ensure that you produce a comprehensive paper. Also, follow the given citation format. In most cases, APA 7 is the preferred format for nursing assignments.

How to Write the Conclusion for NURS 6630 Assignment 1 Assessing and Treating Patients With Impulsivity, Compulsivity, and Addiction 

After completing the main sections, write the conclusion of your paper. The conclusion is a summary of the main points you made in your paper. However, you need to rewrite the points and not simply copy and paste them. By restating the points from each subheading, you will provide a nuanced overview of the assignment to the reader.

How to Format the References List for NURS 6630 Assignment 1 Assessing and Treating Patients With Impulsivity, Compulsivity, and Addiction 

The very last part of your paper involves listing the sources used in your paper. These sources should be listed in alphabetical order and double-spaced. Additionally, use a hanging indent for each source that appears in this list. Lastly, only the sources cited within the body of the paper should appear here.

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Sample Answer for NURS 6630 Assignment 1 Assessing and Treating Patients With Impulsivity, Compulsivity, and Addiction

Impulsivity disorders are characterized by the inability to resist the sudden, powerful desire to do something and difficulties controlling emotions or behaviors. On the other hand, addiction is a complex mental condition characterized by compulsive substance use regardless of detrimental consequences. The purpose of this paper is to describe a patient with an addiction disorder and the treatment interventions.

Introduction to the Case

The case scenario depicts Mrs. Perez, a 53-year-old Puerto Rican woman with alcohol drinking problems since her late teenage years. Perez has been a part of Alcoholics Anonymous from time to time for the last 25 years. The patient also reports that she has been finding it more difficult to remain sober in the past two years since a casino was opened in her neighborhood. Perez mentions that she gets high when gambling since she takes some drinks when playing high-stake gambling games. However, this leads to increased alcohol consumption and irresponsible gambling. In addition, the client states she has increasingly been smoking in the past two years and is worried about the adverse health impacts.

Mrs. Perez reports that she has tried refraining from alcohol consumption, but gambling makes her high, making her take a few drinks to even up. She has also realized that when she consumes alcohol, she smokes minimally, but she enjoys smoking when gambling. The patient has experienced weight gain from excessive drinking, and her current weight is 122 lbs, having gained 7 lbs. The patient is worried since she borrowed more than $50,000 from her retirement account to pay gambling debts. Noteworthy MSE findings include avoiding eye contact, sad mood, and impaired impulse control. Mrs. Perez is diagnosed with Gambling disorder and alcohol use disorder. The patient factors that may affect decision-making with regard to treatment include age, overall health status, comorbid mental health illnesses, the patient’s previous experience with medication, the patient’s beliefs and opinions on useful therapies, history of treatment compliance, and the patient’s motivation for abstinence.

Decision #1

Vivitrol (naltrexone) injection, 380 mg IM in the gluteal region four-weekly.

Reason for this Decision

Naltrexone was the ideal treatment because it is an FDA-indicated drug for treating alcohol use disorder (AUD). Joshi et al. (2021) explain that naltrexone alleviates alcohol cravings, decreases alcohol consumption, and the monthly injectable formulation helps in compliance. Kranzler and Soyka (2018) explain that naltrexone decreases mesolimbic opioidergic activity, thus controlling the dopamine-mediated rewarding effects of alcohol, resulting in decreased alcohol consumption.

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Why Other Decisions Were Not Selected

Disulfiram was not ideal because the physical reaction of alcohol and disulfiram causes dizziness, tachycardia, nausea, flushing, chest pain, and BP changes, which can harm patients, making it less recommended (Joshi et al., 2021). Acamprosate was not selected because it is approved by the FDA to promote abstinence in patients who are abstinent when starting treatment (Kranzler & Soyka, 2018). Mrs. Perez was not abstinent and thus not a suitable candidate for acamprosate therapy.

What I Was Hoping To Achieve By Making This Decision

The PMHNP hoped that naltrexone would reduce the patient’s alcohol cravings and excessive consumption (Witkiewitz et al., 2019). Kranzler and Soyka (2018) found that naltrexone effectively reduces the risk of relapse into alcohol and relapse to binge drinking.

Ethical Considerations, Impact on Treatment Plan and Communication

Nonmaleficence impacted the treatment plan since the PMHNP had to select the intervention with the best outcomes and the least side effects. Consequently, naltrexone was chosen for its strong safety profile, and disulfiram was rejected. Respect for autonomy impacted communication with the clinician seeking patient consent to initiate treatment.

Decision #2

Refer the patient to a counselor to address gambling issues.

Reason for this Decision

The patient was referred to a counselor because she had persistent gambling issues that got her into financial problems. Menchon et al. (2018) explain that psychological therapies are the most effective approach for gambling disorders and are connected with marked improvements in the short and the long term. Counseling focuses on the patient, enabling them to search and solve uncertainties, and improving their willingness to change behavior (Ribeiro et al., 2021).

Why Other Decisions Were Not Selected

Adding diazepam to treat anxiety was not ideal because the patient’s anxiety is a likely side effect of naltrexone therapy and thus does not justify medication (Joshi et al., 2021). Chantix was also not added to promote smoking cessation because the smoking problem was linked to gambling, and thus it is important first to solve the gambling issue. Menchon et al. (2018) explain that cognitive behavioral therapy (CBT) facilitates an individual’s understanding of cognitive distortions connected to gambling behavior.

What I Was Hoping To Achieve By Making This Decision

The PMHNP hoped that psychological therapy would help the patient identify cognitive distortions connected with her gambling behavior. Counseling weakens the irrational beliefs, perseveration patterns, and magical thinking associated with the gambling disorder (Menchon et al., 2018). Ribeiro et al. (2021) explain that counseling primarily focuses on the patient’s behavior, cognition, and motivation, thus solving the psychological determinants of gambling.

Ethical Considerations Impact on Treatment Plan and Communication

Beneficence influenced the patient’s treatment since the PMHNP had to refer the patient for counseling to address the gambling issue and promote better health outcomes. Confidentiality impacted communication since the PMHNP had to ensure the patient’s health information was kept confidential and only shared after obtaining the patient’s consent.

Decision #3

Identify the patient’s problems with her counselor, and encourage her to continue attending GA meetings.

Reason for this Decision,

The PMHNP selected this decision because the client reported not liking her counselor, which could affect her adherence to counseling sessions and treatment outcomes. Bolsinger et al. (2020) explain that creating a good therapeutic relationship (TR) in counseling is crucial to improving clinical outcomes, quality of patient care, and patient satisfaction. Kleiven et al. (2020) explain that it is essential for the patient to open up to and connect with personal issues internally, despite this being highly uncomfortable.

Why Other Decisions Were Not Selected

It was not ideal to encourage the patient to continue counseling without addressing the concerns with the counselor because it would have further worsened the therapeutic relationship between Mrs. Perez and the counselor. Kleiven et al. (2020) explain that the TR in psychotherapy is crucial since it facilitates the clients’ ability to approach, acknowledge, and reflect upon challenging issues with sincerity and authenticity. Discontinuing naltrexone was not also ideal because it exhibited efficacy in alleviating alcohol consumption and cravings (Joshi et al., 2021).

What I Was Hoping To Achieve By Making This Decision

The PMHNP hoped that exploring Mrs. Perez’s issues with her counselor would enable her to open up and have an effective relationship with the counselor (Kleiven et al., 2020). Bolsinger et al. (2020) found that a positive TR is connected with better therapy outcomes with regard to clinical improvement, re-hospitalization, and patient satisfaction.

Ethical Considerations Impact on Treatment Plan and Communication

Beneficence affected the treatment plan since the PMHNP had to help the patient identify her issues with the counselor to create a positive TR, promoting better outcomes. Besides, the respect for autonomy affected communication with the client since the PMHNP had to engage the patient to identify the issues with the counselor and address them.

Conclusion

Mrs. Perez was diagnosed with alcohol use disorder and gambling disorder based on her history of excessive alcohol consumption and gambling, which got her in financial trouble. The patient was prescribed Naltrexone injection, 380 mg four weekly, since it reduces alcohol consumption and alcohol cravings (Joshi et al., 2021). Besides, naltrexone is well-tolerated and is not associated with dependence. Disulfiram was not selected because of its disulfiram-alcohol interaction, which causes BP changes, nausea, chest pain, flushing, dizziness, and tachycardia. Acamprosate was not also ideal because it is indicated for patients who have already achieved abstinence (Kranzler & Soyka, 2018).

The patient’s gambling disorder persisted, and the PMHNP referred her for counseling. A psychotherapy approach was the most ideal since it is considered the most treatment for gambling disorders and associated with marked improvements in the short and the long term (Menchon et al., 2018). However, she reported having issues with the counselor, although she participated in gambler anonymous groups. Consequently, the PMHNP sought to examine the client’s issues with her counselor and encouraged her to continue attending GA meetings. This was crucial to maintain a positive TR and ensure the client received the maximum from psychotherapy.

References

Bolsinger, J., Jaeger, M., Hoff, P., & Theodoridou, A. (2020). Challenges and Opportunities in Building and Maintaining a Good Therapeutic Relationship in Acute Psychiatric Settings: A Narrative Review. Frontiers in psychiatry, 10, 965. https://doi.org/10.3389/fpsyt.2019.00965

Joshi, P., Duong, K. T., Trevisan, L. A., & Wilkins, K. M. (2021). Evaluation and Management of Alcohol Use Disorder among Older Adults. Current geriatrics reports, 10(3), 82–90. https://doi.org/10.1007/s13670-021-00359-5

Kleiven, G. S., Hjeltnes, A., Råbu, M., & Moltu, C. (2020). Opening Up: Clients’ Inner Struggles in the Initial Phase of Therapy. Frontiers in Psychology, 11, 591146. https://doi.org/10.3389/fpsyg.2020.591146

Kranzler, H. R., & Soyka, M. (2018). Diagnosis and Pharmacotherapy of Alcohol Use Disorder: A Review. JAMA, 320(8), 815–824. https://doi.org/10.1001/jama.2018.11406

Menchon, J. M., Mestre-Bach, G., Steward, T., Fernández-Aranda, F., & Jiménez-Murcia, S. (2018). An overview of gambling disorder: from treatment approaches to risk factors. F1000Research, 7, 434. https://doi.org/10.12688/f1000research.12784.1

Ribeiro, E. O., Afonso, N. H., & Morgado, P. (2021). Non-pharmacological treatment of gambling disorder: a systematic review of randomized controlled trials. BMC Psychiatry, 21(1), 105. https://doi.org/10.1186/s12888-021-03097-2

Witkiewitz, K., Litten, R. Z., & Leggio, L. (2019). Advances in the science and treatment of alcohol use disorder. Science advances, 5(9), eaax4043. https://doi.org/10.1126/sciadv.aax4043

Sample Answer 2 for NURS 6630 Assignment 1 Assessing and Treating Patients With Impulsivity, Compulsivity, and Addiction

The 53-year-old Puerto Rican female presents with alcohol use disorder which was diagnosed when she was in her 20s. She claims that her problems are embarrassing comprising of alcohol addiction, cigarette smoking, and gambling. About 2 years back, the patient claims that a casino was opened in the neighborhood, which made her start drinking a gain after several years of sober, as she enjoys taking alcohol and smoking when gambling. This also led to her gaining about 7lbs. Her gambling has been getting worse ever since, as she reports that she borrowed about $50,000 from her retirement account and used the money to pay gambling debts. She is afraid that when her husband finds out, he will be furious. Mental status examination results reveal that the patient is sad, and her impulse control is also impaired. The patient displayed no psychiatric symptoms, hence diagnosed with alcohol use disorder (AUD) and gambling.

In the management of the patient’s health needs, several factors will be taken into account when choosing the most effective and safest medication to prescribe. For instance, the patient history of chronic alcohol use disorder and gambling will promote the selection of the most effective medication. Her age and race will also help in selecting the medication in addition to determining the appropriate dosage and frequency. Her recent weight gain will also influence the decision on which drug to select as most psychotropic agents usually lead to weight gain. The purpose of this discussion is to select the most appropriate interventions in the management of this patient, with an illustration of the expected outcome and ethical considerations at each decision point.

Decision Point One

Selected Decision and Rationale

Administering naltrexone 380mg IM injection on the gluteal area was selected as the initial intervention. Naltrexone has been approved by the FDA and recommended by most clinical guidelines including National Institute for Health and Care Excellence (NICE) as the most effective and safest medication for treating alcohol use disorder (Martinac et al., 2019). Naltrexone had an antagonistic effect on the opioid receptors which inhibits the binding of endogenous opioids (Pakri Mohamed et al., 2018). Studies show that naltrexone also has potential effectiveness in reducing the urge of gambling among patients with comorbid gambling and alcohol addiction (Blanco-Gandía & Rodríguez-Arias, 2018). Naltrexone has been reported to mainly target the Asp40 allele with is predominant among Puerto Ricans hence promoting its effectiveness among this population (Wieczorek & Dąbrowska, 2020). The long-acting formulation was selected as it is more convenient for the patient due to its administration once a month (Renner & Ward, 2016).

The disulfiram preparation provided is short-acting, which might affect the patient’s compliance level, in addition to its increased risks of adverse events like palpitations (Pakri Mohamed et al., 2018). Acamprosate is also short-acting, with an even higher frequency of administration, which might make it hard for the patient to remain compliant with the medication (Kelly & Renner, 2016).

Expected Outcome

With the use of naltrexone for the following month, the patient’s urge to drink or gamble should reduce significantly (Grant & Chamberlain, 2020). His smoking habit is associated with gambling, hence also expected to reduce within this time (Wieczorek & Dąbrowska, 2020).

Ethical Consideration

In taking care of patients with substance use disorder, clinicians are advised to be non-judgment and not to discriminate against the patient based on their gender or race, or any other factors (Martinac et al., 2019). The PMHNP observed the ethical principle of justice in taking care of this patient (Blanco-Gandía & Rodríguez-Arias, 2018).

Decision Point Two

Selected Decision and Rationale

Referring the patient to a counselor to help with the patient’s gambling habits was selected as the second decision. The patient displayed great effectiveness with naltrexone based on the reported outcome as she claims to have never used alcohol ever since the day she received the first injection (Kelly & Renner, 2016). The only side effect that was reported was anxiety, which is common among patients on naltrexone but disappears with time itself (Grant & Chamberlain, 2020). The patient urge of gambling was also reduced but she was still concerned about the few times that she gambles as she wastes a lot of money hence the need for a specialist (Pakri Mohamed et al., 2018; Renner & Ward, 2016). Evidence demonstrates that there is no specific medication for gambling, but most patients have reported positive outcomes with the use of cognitive behavioral therapy (Wieczorek & Dąbrowska, 2020). The counselor is expected to address the patient’s gambling, which will in turn help her stop smoking.

Administering diazepam as an adjunct to naltrexone was inappropriate as the drug is addictive (Pakri Mohamed et al., 2018). Chantix is effective in smoking cessation but can only be used together with naltrexone in low doses once daily for a short period (Kelly & Renner, 2016).

Expected Outcome

With appropriate intervention implemented by the counselor and continuous use of naltrexone, the patient will continue being sober, with a reduced urge to gamble (Wieczorek & Dąbrowska, 2020). She will also be able to stop smoking (Grant & Chamberlain, 2020). The previously reported anxiety symptoms are also expected to resolve completely within this time.

Ethical Consideration

Ethically, nurses are required to treat every patient equally with no discrimination. Promoting patient-centered care is also crucial, with more focus on satisfying the needs of the patient (Martinac et al., 2019). For instance, in this decision, the patient was mainly concerned about her gambling, which can be adequately addressed by a counselor (Blanco-Gandía & Rodríguez-Arias, 2018). The PMHNP observed the ethical principle of nonmaleficence in making this decision.

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NURS 6630 Case Study 53-year-old Puerto Rican Female with Comorbid Addiction

Decision Point Three

Selected Decision and Rationale

Exploring the issues that the patient was having with her counselor and advising her to continue attending gamblers’ anonymous meetings was selected as the last decision. The decision was based on the reported outcome as the patient claimed to dislike her counselor (Pakri Mohamed et al., 2018). A healthy therapeutic relationship between the patient and the counselor is needed to promote positive outcomes (Wieczorek & Dąbrowska, 2020). Consequently, studies show that a patient with a negative attitude toward their psychiatrist is more likely to stop going to therapy (Grant & Chamberlain, 2020). Attending alcohol anonymous meetings is also beneficial in promoting further sobriety from alcohol (Blanco-Gandía & Rodríguez-Arias, 2018). Previous evidence also demonstrates that naltrexone can take between 8 to 12 weeks for the most patient to attain full control over not taking alcohol (Kelly & Renner, 2016).

Encouraging the patient to continue seeing the counselor and ignoring their difference will make her stop attending the therapy sessions (Martinac et al., 2019). Discontinuing the use of naltrexone is also not appropriate as the drug is more effective for long-term use, especially among patients with chronic substance use disorder (Pakri Mohamed et al., 2018).

Expected Outcome

With the resolved conflict between the patient and her counselor, she is expected to stop gambling and continue abstaining from taking alcohol (Grant & Chamberlain, 2020). She should also be able to work on her smoking habits with her counselor (Blanco-Gandía & Rodríguez-Arias, 2018).

Ethical Considerations

Psychiatrists are encouraged to invest in developing a good therapeutic relationship with their patients to promote positive outcomes (Martinac et al., 2019). When resolving differences between the patient and her counselor, it is necessary to be neutral and help the patient understand the need of working on this relationship. Ethical principles such as respect for patient autonomy and non-maleficence were also considered in making this decision (Wieczorek & Dąbrowska, 2020).

Conclusion

The 53-year-old patient reported to the clinic with a chief complaint of embarrassing problems of alcohol use disorder and gambling. Several factors were considered in deciding on the most appropriate intervention for the management of the patient’s condition, such as her age, gender, and race. From the provided options, the initial intervention was to administer naltrexone, which is FDA approved and recommended by most clinical guidelines including NICE as the first line for the management of substance use disorder (Pakri Mohamed et al., 2018). Disulfiram and Campral are short-acting, with elevated risks of adverse events hence not appropriate for the patient (Kelly & Renner, 2016). After 4 weeks, the patient reported that she has never taken alcohol ever since she received the first injection, but was still gambling and smoking (Martinac et al., 2019). It was thus necessary to refer the patient to a counselor to help with her gambling.  Adding diazepam to the patient’s treatment regimen or varenicline was not appropriate as the former is addictive and the latter is only used in small doses for smoking cessation (Blanco-Gandía & Rodríguez-Arias, 2018).

During the following visit, the patient reported improved symptoms but was mainly concerned about her dislike for her counselor. It was thus decided that the issues between the patient and her counselor be examined and encouraged the patient to continue attending gambling anonymous meetings as the final decision (Grant & Chamberlain, 2020). Discontinuing the use of naltrexone and ignoring the patient’s dislike for her counselor were not appropriate decisions. The PMHNP encountered several ethical considerations at every decision point such as not discriminating against the patient and observing the right to autonomy (Wieczorek & Dąbrowska, 2020). Additional ethical principles encountered include justice and non-maleficence.

References

Blanco-Gandía, M. C., & Rodríguez-Arias, M. (2018). Pharmacological treatments for opiate and alcohol addiction: A historical perspective of the last 50 years. European journal of pharmacology, 836, 89-101. https://doi.org/10.1016/j.ejphar.2018.08.007

Grant, J. E., & Chamberlain, S. R. (2020). Gambling and substance use: Comorbidity and treatment implications. Progress in Neuro-Psychopharmacology and Biological Psychiatry, 99, 109852. https://doi.org/10.1016/j.pnpbp.2019.109852

Kelly, J. E., & Renner, J. A. (2016). Alcohol-Related disorders. In T. A. Stern, M. Favo, T. E. Wilens, & J. F. Rosenbaum. (Eds.), Massachusetts General Hospital psychopharmacology and neurotherapeutics (pp. 163–182). Elsevier.

Martinac, M., Karlović, D., & Babić, D. (2019). Alcohol and gambling addiction. In Neuroscience of alcohol (pp. 529-535). Academic Press. https://doi.org/10.1016/B978-0-12-813125-1.00054-4

Pakri Mohamed, R. M., Kumar, J., Ahmad, S. U., & Mohamed, I. N. (2018). Novel pharmacotherapeutic approaches in the treatment of alcohol addiction. Current drug targets, 19(12), 1378-1390. https://doi.org/10.2174/1389450119666180523092534

Renner, J. A., & Ward, N. (2016). Drug addiction. In T. A. Stern, M. Favo, T. E. Wilens, & J. F. Rosenbaum. (Eds.), Massachusetts General Hospital psychopharmacology and neurotherapeutics (pp. 163–182). Elsevier.

Wieczorek, Ł., & Dąbrowska, K. (2020). Difficulties in treatment of people with comorbid gambling and substance use disorders. Journal of Substance Use, 25(4), 350-356. https://doi.org/10.1080/14659891.2019.1704078

Sample Answer 3 for NURS 6630 Assignment 1 Assessing and Treating Patients With Impulsivity, Compulsivity, and Addiction

The case study examines Mrs. Perez, a 53-year-old Puerto Rican woman who seeks treatment at the clinic for her alcohol and gambling addictions. The patient indicates experiencing difficulties with alcohol use after the death of her father during her late adolescence. She has intermittently participated in Alcoholics Anonymous for over 25 years. Over the last couple of years, her need for gambling has intensified due to the establishment of the new “Rising Sun” casino near her residence. Consequently, she resorted to withdrawing more than $50,000 from her retirement savings in order to settle her mounting gambling obligations. Remarkably, she has managed to conceal this financial predicament from her spouse. Mrs. Perez displayed attentiveness and awareness during the mental status assessment, while her eye contact tended to avoid direct engagement. She expressed experiencing sadness, and her ability to regulate her impulses was compromised. Her presentation led to a diagnosis of a gambling problem and alcohol use disorder.

Various patient variables might influence the process of providing medicine for Mrs. Perez. The variables include her past alcohol and gambling dependency, increase in body weight, tobacco consumption, apprehensions about the detrimental impact of smoking on her well-being, and her recent withdrawal of $50,000 from her retirement fund to settle her gambling obligations. Additionally, one must also take into account her compromised ability to regulate impulses and her worries about anxiousness and thoughts of suicide when on Campral. These patient considerations emphasize the significance of tailored and comprehensive treatment strategies for persons grappling with addiction and the need for thoughtful deliberation when selecting a suitable drug choice. This paper provides a detailed analysis of the patient’s issues with gambling and alcohol use, as well as the therapy choices made to achieve favorable results.

Decision Point One

Selected Decision and Rationale

For the first choice, the chosen course of action was administering a Vivitrol (naltrexone) injection, with a dosage of 380 mg, into the gluteal area every four weeks. Mrs. Perez had experienced severe difficulties sustaining her sobriety as a result of her high-risk gambling behavior. Naltrexone is a pharmaceutical agent that inhibits the physiological responses of opioids, such as endorphins, which are generated during wagering and produce a gratifying sensation comparable to that of consuming alcohol (Kedia et al., 2022). According to studies, naltrexone may help people with gambling addictions by lowering their frequency of gambling and their impulse to gamble (Grant & Chamberlain, 2020). In addition, given Mrs. Perez’s alcohol use problem, naltrexone may assist her in maintaining sobriety by diminishing the enjoyable effects of alcohol intake. Naltrexone demonstrates efficacy in decreasing the frequency and quantity of alcohol intake among those afflicted with alcohol dependency (Ford & Håkansson, 2020).

The administration of disulfiram was unnecessary, given that its deleterious effects were intended to deter alcohol consumption. The possible negative consequences, such as rapid or irregular heartbeats, low blood pressure, dizziness, severe headaches, and sudden skin reddening, might pose further risks to the patient’s overall health (Di Nicola et al., 2019).  Hence, the recommended regimen for delivering Campral requires three doses per day, which raises the likelihood of patients failing to comply with the prescription and resulting in suboptimal adherence (Grant & Chamberlain, 2020).

Expected Outcome

            It is expected that when the patient comes back to the clinic after taking naltrexone for four weeks, there will be a reduction in both the desire for alcohol and its use (Ventricelli & Peterson, 2021). Reducing alcohol use should lead to a restoration of her body mass to its natural state. Moreover, enhancing her capacity to control her impulses is expected to influence her overall well-being and satisfaction positively. She should reduce the frequency of her gambling activities.

Ethical Consideration

            According to the code of ethics in the nursing profession, patient-centered care requires patients to actively participate in making decisions regarding their treatment (Koob, 2024). Therefore, it is critical to furnish the client with comprehensive information regarding each treatment alternative, encompassing their advantages and disadvantages, to enable them to make an informed decision.

Decision Point Two

Selected Decision and Rationale

As an additional intervention, upon evaluating the results of each of the three alternatives, it was determined that the most optimal course of action for Mrs. Perez was to recommend her to a counselor in order to tackle her gambling problems. The choice was made based on the client’s main worry, which is the gambling problem, and the possible advantages of receiving counseling with her existing pharmaceutical regimen. Studies have shown the efficacy of counseling and treatment in addressing gambling problems, namely via the use of cognitive-behavioral therapy and motivational interviewing (Kedia et al., 2022). Therapeutic counseling may assist the client in recognizing and dealing with the fundamental causes of their gambling behavior, acquiring effective strategies for managing it, and enhancing their belief in their ability to make positive changes and their desire to do so (Grant & Chamberlain, 2020). In addition, counseling may provide continuous assistance in sustaining abstinence and mitigating the likelihood of relapse (Ford & Håkansson, 2020).

Patients with a drug addiction problem should not be prescribed Valium since benzodiazepines, including Valium, have addictive properties (Di Nicola et al., 2019). Conversely, the use of Chantix was deemed unnecessary due to its association with heightened negative consequences when combined with naltrexone, such as anxiety, restlessness, sleeplessness, and dizziness (Grant & Chamberlain, 2020).

Expected Outcome

            The patient is expected to have a reduction in symptoms of anxiety over the following month (Ventricelli & Peterson, 2021).  The patient is anticipated to effectively manage their gambling behavior within the specified period by regularly attending and ultimately committing to treatment sessions focused on addressing gambling addiction. It is anticipated that the patient will give up gambling and smoking.

Ethical Consideration

            According to Koob (2024), legal and ethical requirements require that the well-being and enjoyment of the patient should be given the utmost priority. To maximize patient satisfaction and build trust in the therapeutic method, it is essential to address all patient concerns, which may include anxiety, tobacco use, or gambling.

Decision Point Three

Selected Decision and Rationale

            It was advised that Mrs. Perez’s counselor discussed the situation with her and strongly encouraged her to participate in Gamblers Anonymous meetings as the third course of action. The choice was made in light of the client’s admission that she did not like her counselor and the possible advantages of dealing with this matter and carrying on with Gamblers Anonymous. Studies have shown that establishing a favorable therapeutic connection between the individual receiving therapy and the therapist is crucial for achieving good treatment results (Kedia et al., 2022). Patients with a favorable rapport with their psychiatrist are more inclined to actively participate in therapy, experience a sense of being supported, and achieve advancements in their treatment objectives (Grant & Chamberlain, 2020). Hence, it is essential to resolve Mrs. Perez’s counselor’s matter to sustain her involvement in counseling and enhance her treatment results (Ford & Håkansson, 2020).

If the negative attitude of the patient toward her gambling counselor is disregarded, she will exhibit a lack of dedication to her treatment and will often skip appointments (Di Nicola et al., 2019). It is recommended to continue Vivitrol treatment for chronic alcoholism for a minimum of three months, indicating that discontinuing the medication at this juncture is unnecessary (Grant & Chamberlain, 2020).

Expected Outcome

            It was anticipated that the client would have conveyed her issues to her counselor and actively engaged in treatment sessions during the next month (Ventricelli & Peterson, 2021). It is expected that she will successfully overcome her dependency on smoking and gambling throughout this period. Smoking should be reduced since it is associated with gambling, which needs regulation now.

Ethical Consideration

Recognizing and addressing any ethical concerns the patient may have about their counselor is essential to optimize treatment results and promote increased patient participation. Implementing this may improve the patient’s overall well-being and satisfaction. Before the patient consented to engage in the gambling sessions, it is essential to address her worries since she has the autonomy to make decisions about her well-being (Koob, 2024).

Conclusion

To address Mrs. Perez’s alcohol and gambling addictions, there was a blend of pharmaceutical and psychological therapies. The first decision was to deliver the Naltrexone (Vivitrol) injection, with a dosage of 380 mg, intramuscularly in the gluteal area every four weeks. The efficacy of Naltrexone in diminishing alcohol cravings and avoiding relapse among individuals diagnosed with alcohol use disorder (Kedia et al., 2022). The patient had a positive response to this treatment, with decreased alcohol intake and enhanced abstinence (Ford & Håkansson, 2020). To treat her gambling condition, it was recommended that she seek counseling to specifically target her gambling difficulties and strongly advised her to actively engage in Gamblers Anonymous meetings (Di Nicola et al., 2019). The client expressed a sense of being supported and actively involved in the Gamblers Anonymous group, which resulted in a reduction in her anxiety levels and an improvement in her gambling behaviors (Ventricelli & Peterson, 2021). Regarding the third choice point, it was proposed to investigate Mrs. Perez’s problem with her counselor and motivate her to attend Gamblers Anonymous gatherings (Grant & Chamberlain, 2020).

In summary, the integration of pharmaceutical and psychosocial therapies proved to be efficacious in addressing Mrs. Perez’s alcohol and gambling issues. Ethical issues were carefully considered throughout the treatment plan to preserve the patient’s autonomy and privacy. Acknowledging that each patient has distinct characteristics, treatment strategies should be customized to address their requirements and concerns (Koob, 2024). When making treatment decisions, clinicians must consider the patient’s medical background, other health conditions, personal preferences, and possible advantages and disadvantages of different therapy choices. Hence, continuous evaluation and adjustment of the treatment strategy are necessary for achieving favorable results.

References

Di Nicola, M., De Crescenzo, F., D’Alò, G. L., Remondi, C., Panaccione, I., Moccia, L., Molinaro, M., Dattoli, L., Lauriola, A., Martinelli, S., Giuseppin, G., Maisto, F., Crosta, M. L., Di Pietro, S., Amato, L., & Janiri, L. (2019). Pharmacological and Psychosocial Treatment of Adults with Gambling Disorder: A Meta-Review. Journal of Addiction Medicine, 14(4), e15–e23. https://doi.org/10.1097/adm.0000000000000574

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

Grant, J. E., & Chamberlain, S. R. (2020). Gambling and substance use: Comorbidity and treatment implications. Progress in Neuro-Psychopharmacology and Biological Psychiatry, p. 99, 109852. https://doi.org/10.1016/j.pnpbp.2019.109852

Kedia, S., Ahuja, N., Dillon, P., Jones, A., Kumar, S., & Satapathy, S. K. (2022). Efficacy of Extended-Release Injectable Naltrexone on Alcohol Use Disorder Treatment: A Systematic Review. Journal of Psychoactive Drugs, 1–13. https://doi.org/10.1080/02791072.2022.2073300

Koob, G. F. (2024). Alcohol Use Disorder Treatment: Problems and Solutions. Annual Review of Pharmacology and Toxicology, 64(1), 255–275. https://doi.org/10.1146/annurev-pharmtox-031323-115847

Ventricelli, D., & Peterson, A. M. (2021). Substance use disorders. In Elsevier eBooks (pp. 759–768). https://doi.org/10.1016/b978-0-12-820007-0.00040-4

Sample Answer 4 for NURS 6630 Assignment 1 Assessing and Treating Patients With Impulsivity, Compulsivity, and Addiction

Gambling and alcohol abuse are some of the mental health problems that psychiatric mental health nurse practitioners (PMHNP) face in their practice. PMHNP ensures that patients suffering from gambling and alcohol abuse disorders are assisted to overcome their addition and live a normal life. Therefore, this paper examines a case study of a patient that has been diagnosed with gambling disorder and alcohol use disorder. The patient is Maria Perez, a 53-year-old Puerto Rican female who came to the clinic with a complaint of an embarrassing problem. The client admitted having history of problems with alcohol since her father died during her teenage years. She has been struggling with alcohol since her 20’s and is involved with Alcohol Anonymous in on and off basis. The client reported to have difficulty in maintaining sobriety since the opening of a casino near her home. Perez has been gambling in the casino with her friend and enjoys drinking alcohol to calm her during high stake games. Her drinking behavior has predisposed her to reckless gambling. The client also has history of smoking cigarette for the last two years and is getting worried about its effects on her health. The client also reported to have gained more than 7 pounds of weight from her usual 115-pound weight. Mental status examination was administered to the client. The assessment showed the client to be oriented and alert, dressed appropriately for the occasion, has clear, goal directed and coherent speech and avoidance eye contact behaviors. The assessment also showed the client not to demonstrate any noteworthy mannerism, ticks or gestures. The mood of the client was sad with absence of hallucinations, delusions, paranoid, or suicidal and homicidal ideations.

Decision Point One

Selected Decision

Administer Vivitrol (naltrexone) injection, 380 mg intramuscularly in the gluteal region every 4 weeks.

Reason for Selection

Vivitrol was selected as the first line of treatment because it works as a competitive antagonist of alcohol receptors, making it suitable for addiction management. The inhibition of alcohol receptors minimizes craving for alcohol, hence, improvement in abuse behaviors (Stahl, 2013). The inhibition of the alcohol receptors also reduces the perceived thirst for alcohol by the patient (Holt & Tobin, 2018). Patients who take alcohol but are in the process of overcoming their addiction problems may also use naltrexone. Naltrexone facilitates the systematic disuse of alcohol by the patients (Leighty & Ansara, 2019).

Why Other Options were not Selected

Antabuse (disulfiram) 250 mg orally daily and Campral (acamprosate) 666 mg orally three times a day were not selected because they are recommended for use in patients that have stopped alcohol intake (Stahl, 2013). The medications were also likely to predispose the patients to side effects such as nausea and tachycardia with the administration of disulfiram (Shirley et al., 2021). Since the patient has not abstained from alcohol abuse, the above options were not selected to ensure safety and quality in the care given.

Expectations

The above decision was made with the expectation of ensuring the reducing in symptoms of alcohol addiction being experienced by the client. The decision also aimed at promoting the systematic desensitization of alcohol desires that the patient was experiencing (Stern et al., 2015). It was anticipated that the administration of naltrexone would result in improved tolerability and abstinence of the patient from alcohol abuse (Wightman et al., 2018).

Impact of Ethical Considerations on Treatment Plan and Communication with the Client

Ethical considerations such as benevolence and non-maleficence informed the treatment plan. The PMHNP aimed at ensuring that the use of naltrexone would result in minimal harm and side effects to the client (Loreck David et al., 2016). The ethical aspect of informed consent would also influence the care given to the patient (Ellis, 2017). For example, the PMHNP was expected to seek informed consent prior to implementing the care plan to minimize ethical and legal issues related to the care given to the patient. Seeking informed consent ensures the protection of the rights of the patient to informed care. It also promotes patient autonomy, as he has the decision to accept or decline the available treatment interventions (Stern et al., 2015).

Decision Point Two

Selected Decision

Refer the client to counselor to address gambling issues.

Reason for Selection

The administration of naltrexone was effective in causing moderate improvement in the management of alcohol addiction and abuse by the client. The client however reported to engaging in severe gambling when she visits the casino. An effective intervention at this stage would therefore be referring the patient to the counselor for assistance in managing gambling issues. The FDA has not approved any drug for use in management of gambling issues (Grant et al., 2014). As a result, non-pharmacological interventions such as counseling are recommended. Counseling will enable the client to learn about the effective ways of overcoming gambling behaviors and coping up with her problem (Lee et al., 2021). The use of counseling interventions such as group therapy and cognitive behavioral therapy will equip the client with knowledge and skills needed in the management of anxiety.

Why Other Options were not Selected

The decisions to add valium (diazepam) 5 mg orally TID/PRN/anxiety and add Chantix (varenicline) 1 mg orally BID were not selected in the case study. The administration of valium was likely to increase the rise of side effects such as sedation, memory problems, tiredness, and drowsiness that were likely to affect the adherence to treatment (Sychla, Gründer, & Lammertz, 2017). The decision to add Chantix was also not selected because the administration of naltrexone had led to moderate improvement in symptoms of addiction in the client (Echeburúa & Amor, 2021). Augmenting the treatment is therefore not recommended.

Expectations

The above decision was made with the expectation of facilitating the effective management of the gambling problem being experienced by the client. It was also expected that the client would be assisted to identify effective strategies for managing her gambling problem. The decision was also made with the aim of improving the effectiveness of the pharmacological interventions used in addiction management (Pickering et al., 2020).

Impact of Ethical Considerations on Treatment Plan and Communication with the Client

The ethical consideration of promoting privacy and confidentiality of patient data would influence the selection of treatment plans at this phase. PMHNP is expected to seek informed consent from the client prior to sharing her information with other healthcare providers (Ellis, 2017). PMHNP is also expected to promote patient’s right to autonomous care by educating her about the aims of the selected treatment interventions.

Decision Point Three

Selected Decision

Explore the issue that Mrs. Perez is having with her counselor, and encourage her to continue attending the Gamblers Anonymous meetings.

Reason for Selection

The use of counseling services appears to have been effective for the client. For example, the client returned after 4 weeks reporting that the anxiety she had been experiencing was gone. She also reported that she has started attending Gamblers Anonymous group and has been participating in self-expression to seek the support that she needs. An effective intervention at this step would be to encourage the client to continue seeing her current counselor and continue with the Gamblers Anonymous group (Echeburúa & Amor, 2021). There is the need for the PMHNP to obtain information from the client on the factors that contributed to her dissatisfaction with the care given by her counselor (Kelly & Renner, 2016). The information obtained from her will be used to implement effective interventions that would strengthen the relationship between her and the counselor (Lee et al., 2021). There is also the need to refer the client to the smoking cessation clinic to be assisted on the management of her health problem of smoking cigarette.

Why Other Options were not Selected

The decision to encourage Mrs. Perez to continue seeing her current counselor and continue with Gamblers Anonymous group was not selected because a strained relationship between her and the counselor could affect client’s participation and increase the risk of relapse (Heinz, Romanczuk-Seiferth, & Potenza, 2019). The decision to discontinue vivitrol and encourage Mrs. Perez to continue seeing her counselor and participating in the Gamblers Anonymous group was not selected because it would result in symptom relapse (Wightman et al., 2018).

Expectations

The above decision was made with the aim of adopting interventions to improve the relationship between the counselor and the client. The decision also aimed at ensuring continued improvement in the adoption of positive behaviors against gambling by the client. It was also expected that the client would adopt sustainable interventions to manage her addiction problems (Holt & Tobin, 2018).

Impact of Ethical Considerations on Treatment Plan and Communication with the Client

The ethical principle of informed consent influenced the selection of the above decision. The patient has a right to participate or not in a treatment program. Obtaining information about the factors affecting the relationship between her and the counselor would therefore improve the interventions used to facilitate recovery process. The other ethical consideration is privacy and confidentiality of data (Ellis, 2017). The PMHNP should ensure that the client’s data is protected from unauthorized access, hence, data integrity.

Conclusion

Gambling and alcohol abuse disorder affects a significant proportion of people globally. Gambling and alcohol abuse disorder affect the social and occupational functioning of a patient. The increased dependence on alcohol and engagement in addictive gambling behaviors hinders one’s ability to contribute optimally to self and community development. The administration of naltrexone to the patient was an effective decision in the case study (Stahl, 2013). Naltrexone proved effective in managing the client’s alcohol addiction and abuse problem, leading to her improved social and occupational functioning. Naltrexone also facilitated the gradual cessation of alcohol abuse by the client (Holt & Tobin, 2018). Counseling was also found effective in managing the gambling problem being experienced by the client. Accordingly, counseling provided the client with knowledge and skills that are needed in coping up with addiction problems including gambling. The client also participated in social support groups such as Gamblers Anonymous group to learn from others about the effective ways of overcoming gambling. The relationship between the client and the healthcare provider is important for optimal behavioral and lifestyle modification in case management. As a result, it was important to examine the factors that contribute to the poor relationship between the client and her counselor to inform improvement interventions in managing the client (Echeburúa & Amor, 2021). Based on the above analysis, I believe that I made ethical decisions in determining the treatment needs and options for the client in the case study.

References

Echeburúa, E., & Amor, P. J. (2021). Psychological Management of Gambling Disorder With or Without Other Psychiatric Comorbidities. In N. el-Guebaly, G. Carrà, M. Galanter, & A. M. Baldacchino (Eds.), Textbook of Addiction Treatment: International Perspectives (pp. 929–942). Springer International Publishing. https://doi.org/10.1007/978-3-030-36391-8_65

Ellis, P. (2017). Understanding Ethics for Nursing Students. Learning Matters.

Grant, J. E., Odlaug, B. L., & Schreiber, L. R. N. (2014). Pharmacological treatments in pathological gambling. British Journal of Clinical Pharmacology, 77(2), 375–381. https://doi.org/10.1111/j.1365-2125.2012.04457.x

Heinz, A., Romanczuk-Seiferth, N., & Potenza, M. N. (2019). Gambling disorder. Cham, Springer.

Holt, S. R., & Tobin, D. G. (2018). Pharmacotherapy for alcohol use disorder. Medical Clinics, 102(4), 653–666. https://doi.org/10.1016/j.mcna.2018.02.008

Kelly, J. E., & Renner, J. A. (2016). Alcohol-Related disorders. In T. A. Stern, M. Favo, T. E. Wilens, & J. F. Rosenbaum. (Eds.), Massachusetts General Hospital psychopharmacology and neurotherapeutics (pp. 163–182). Elsevier.

Lee, K., Kim, H., & Kim, Y. (2021). Gambling disorder symptoms, suicidal ideation, and suicide attempts. Psychiatry Investigation, 18(1), 88–93. https://doi.org/10.30773/pi.2020.0035

Leighty, A. E., & Ansara, E. D. (2019). Treatment outcomes of long-acting injectable naltrexone versus oral naltrexone in alcohol use disorder in veterans. Mental Health Clinician, 9(6), 392–396. https://doi.org/10.9740/mhc.2019.11.392

Loreck David, Brandt Nicole J., & DiPaula Bethany. (2016). Managing opioid abuse in older adults: clinical considerations and challenges. Journal of Gerontological Nursing, 42(4), 10–15. https://doi.org/10.3928/00989134-20160314-04

Pickering, D., Spoelma, M. J., Dawczyk, A., Gainsbury, S. M., & Blaszczynski, A. (2020). What does it mean to recover from a gambling disorder? Perspectives of gambling help service users. Addiction Research & Theory, 28(2), 132–143. https://doi.org/10.1080/16066359.2019.1601178

Shirley, D.-A., Sharma, I., Warren, C. A., & Moonah, S. (2021). Drug repurposing of the alcohol abuse medication disulfiram as an anti-parasitic agent. Frontiers in Cellular and Infection Microbiology, 11. https://doi.org/10.3389/fcimb.2021.633194

Stahl, S. M. (2013). Stahl’s essential psychopharmacology: neuroscientific basis and practical applications. Cambridge university press.

Stern, T. A., Fava, M., Rosenbaum, J. F., & Wilens, T. E. (2015). Massachusetts General Hospital Psychopharmacology. Elsevier Science Health Science.

Sychla, H., Gründer, G., & Lammertz, S. E. (2017). Comparison of clomethiazole and diazepam in the treatment of alcohol withdrawal syndrome in clinical practice. European addiction research, 23(4), 211-218. https://doi.org/10.1159/000480380

Wightman, R. S., Nelson, L. S., Lee, J. D., Fox, L. M., & Smith, S. W. (2018). Severe opioid withdrawal precipitated by Vivitrol®. The American Journal of Emergency Medicine, 36(6), 1128.e1-1128.e2. https://doi.org/10.1016/j.ajem.2018.03.052