Impulsivity Compulsivity and Addiction Assessing and Treating Patients

NURSING

Nursing: Assessing and Treating Patients with Impulsivity, Compulsivity, and Addiction

Case Introduction

The current case concerns a 53-year-old Puerto Rico female, Mrs. Maria Perez. She suffers from embarrassing problem, which is gambling addiction and alcoholism. She frequently smokes as well; however, this is on certain occasions.

According to the client’s self-reports, alcoholism started during her late teenage years after her father’s death. She stated that she had tried several times to get rid of the nasty habit; however, she has been experiencing more difficulty doing so for two years. She was involved with Alcoholics Anonymous, but all in vain. The past two years changed her significantly since a new casino opened near her home. Mrs. Perez visited “Rising Sun” with her friend, after which it became impossible to offload her addiction to gambling and the ever-increasing alcoholism.

She admitted that she needed alcohol, often one or two drinks, when gambling to keep down her ‘high’ movement while in the game. She also mentioned smoking during playing with the slot machines. She smoked less and drank more. She gained weight in these two years, knowing it was due to her habit of drinking. Her current weight is 122 pounds, a straight 7-pound weight gain from drinking. Her normal weight was 115 pounds before this scenario.

Another troubling factor is she borrowed $50,000 from her retirement account to pay off her gambling debts. Her husband is not aware of the action she has already taken. Her fear and awkwardness were evident in how she sat, such as looking away or down when someone was making eye contact. Otherwise, her mental state seems normal as she was goal-directed, wearing appropriate clothes according to the weather, and showed clear speech signs. Her discernment and understanding were unimpaired, while the overall mood was distressed and sad.

Decision 1

The first selected decision is to refer the client to a counselor to address gambling issues. It is selected because she has mentioned improving her curbing of the addition of alcohol. Still, the problem remains with the gambling issue. She knows she cannot stop spending money once she is inside the casino. However, she has experienced anxiety lately. It is presumed it could be with the use of Vivitrol as it is its common side effect (Thornton, 2022).

The other two options were not selected since it was assumed that drug interactions might cause further complications in her condition. Research has suggested that Vivitrol and Valium might cause pain in extremities in females for anxiety treatment; valium is recommended along with Naltrexone (eHealthme, n.d.-a). Also, prescribing Chantix could have worked better for smoking cessation, yet, anxiety problems might have stayed. It could not be ignored that for certain females, drug interaction of Chantix and Vivitrol might be serious, resulting in kidney disease when a decrease in creatinine renal clearance is observed (eHealthme, n.d.-b). Therefore, it was not deemed effective to focus only on smoking or anxiety; rather, an entire behavioral change might be essential.

It is hoped that face-to-face psychological interventions would effectively address the impulsivity for gambling (Mental help.net, n.d.). Anxiety might have also risen from the continuing embarrassment noted in the first session. She might think that medications are not healing her completely, and she can still not control her guilt. Cognitive-behavioral therapies and motivational interviewing (MI) would effectively teach her self-control strategies to activate self-help organization (Rodda et al., 2018). It could be more helpful with Internet intervention to stay in touch with the client whenever she needs support.

The ethical considerations impacting the communication with patients and treatment outcomes comprise nonmaleficence, beneficence, privacy and confidentiality, autonomy, and justice (Silva & Ludwick, 1999). The patient must have the right to accept or reject the decision and respect his ethnic implications. Discrimination is prohibited based on her geographical associations, so that fair treatment is suggested for positive health outcomes without harm.

Decision 2

The second selected decision is to continue the current dose of Antabuse and refer to counseling sessions to address the gambling issue. The currently prescribed dose of Antabuse is already quite low compared to the normally prescribed dose, which is 500 mg (Web MD, n.d.-a). However, having a bad metallic taste in the mouth could be one of its side effects (Web MD, n.d.-a). The feeling of the heart going out of the chest could be possibly due to resuming alcohol intake despite being on strict medication. The reaction of alcohol and the prohibition the drug formula creates did not create favorable health conditions for the client. Otherwise, continuing the same dose of the same medicine would be fine.

The other two options are not selected due to the fear of drug interactions. It is not compulsory that drug interactions of Antabuse and Campral or Antabuse and Wellbutrin would not affect the patient. Since Campral is also for treating alcoholism, giving another same medicine for the same purpose is not suggested. Their reactions might occur with particular foods (Drugs.com, n.d.). Behavioral counseling is deemed more effective as it is the impulse that needs to be treated, not a disease.

It is expected that the selected decision would help prevent face-to-face interactions from becoming an embarrassment when she is into deep gambling problems (Jonas et al., 2020). They want to seek support but cannot as it is due to unease. In today’s modern science world, medical interventions for behavioral change could be conducted with email or web-based psychological interventions with the help of nurses or certified counselors (Jonas et al., 2020). Cognitive behavioral theory is the most effective in bringing massive change by inducing self-control and self-regulation, even via an online medium (Jonas et al., 2020).

The ethical considerations remain the same for this decision as well.

Decision 3

The third selected decision is discontinuing Campral and beginning Antabuse. Some of the serious side effects of Campral include suicidal thoughts or intentions (Web MD, n.d.-b). Medication change would be an intelligent option as Campral also induces anxiety in some patients. Antabuse exhibits anti-alcohol stimulants in the body and works best with counseling (Web MD, n.d.-a).

The reason for not selecting is the fear of drug reaction of Valium and Campral. Since the patient is experiencing high anxiety, valium might not be effective with the current Campral’s dosage prescribed. Also, decreasing Campral from TID to BID is not suggested due to the same factor. Research has indicated that Campral-treated patients showed rare but more ratios of suicide intentions as compared to placebo-treated clinical trials (“Campral Delayed-Release Tablets,” n.d.).

It is expected that the selected decision would help nullify the suicide intentions and cause psychological disturbances for the patient. Since the client also has anxiety problems, the condition could get out of hand if not prevented on time. Hence, discontinuing the current drug and giving an alternate solution is a wise precaution. Antabuse has produced positive health outcomes for problematic alcoholics for more than 60 years, along with behavioral counseling (Pedersen et al., 2018). Antabuse would bring drowsiness; it is therefore suggested it could be prescribed before bedtime.

The ethical considerations remain the same for the client in this decision.

Conclusion

After a review of the pharmacological and psychological treatments for addressing gambling issues, anxiety, embarrassment, and suicide intention, behavioral counseling seems to be an inevitable solution. It is inevitable as the drugs are proven not to produce optimistic results alone. Psychological empowerment must show its validation as it is the specific loss of control towards gambling for which the patient seeks treatment.

Only behavioral alterations can work effectively when inhibition of impulsivity is witnessed. The consequences of actions are causing distress for the patient, which might lead her to more serious behavioral problems. It is said so because, during her first visit, she could not make eye contact due to embarrassment and further indulgence in taking loans to pay off her gambling debts. It is predicted if the same patterns persist, she might have marital problems or social exclusion due to the inability to face people. The uncomfortable feelings are not solely treated with medications; hence, behavioral intervention becomes mandatory.

Some part should be fulfilled with patient education since the client must know what medications she would be taking, how they would produce results, and what initial side effects her body might face. For example, extreme drowsiness was one of the cases that troubled her. She needs to be completely aware of how her body would react according to her condition. Also, it is necessary not to harm her, and keeping her informed are the two primary ethical implications of the entire practice. It is evident that the client does want to get rid of her addiction and wants to lead herself to recovery; the brain regions would have to be managed carefully with medications for limiting powerful urges and letting the brain adjust with corrective measures and adaptations resulting from prescribed drugs.