Side Effects and Alcohol

Puerto Rican Woman with Comorbid Addiction: A Case Study

Ms. Perez is a 53-year-old Puerto Rican female who has complained that she is suffering from co-morbid addictions of alcoholism and gambling. Ms. Perez has sought treatment for alcoholism in the past but the combination of living near a casino and the availability of alcohol has caused her to relapse as well as to engage in gambling on a regular basis. Her gambling has negatively impacted her marriage and has also caused her to borrow significant sums from her retirement account. The patient is exhibiting the symptoms of depression, including a sad and lethargic demeanor.

Decision One

One option for the patient is prescribing Antabuse (Disulfiram), a medication which "blocks an enzyme that is involved in metabolizing alcohol intake" and "produces very unpleasant side effects when combined with alcohol in the body" ("Antabuse," 2017). The drug is designed to interfere with the rewards drinking alcohol produces in the patient, given that alcoholism is an addiction with both physical and mental components. Antabuse has the benefit of being specifically prescribed to treat alcohol addiction, in contrast to other medications such as Naltrexone (Vivitrol), which is prescribed for both opioid and alcohol-related addictions. Naltrexone has the disadvantage of being injected versus taken orally, and the patient has a greater sense of control over the administration of this particular drug when taken orally, which may enhance long-term compliance.

Another possible pharmaceutical intervention is Campral (acamprosate), a drug which is also exclusively prescribed to treat alcohol dependence. However, Campral can produce very unpleasant side effects in some patients, including drowsiness "that may impair your thinking or reactions," according to its warning label, and users are instructed to "be careful if you drive or do anything that requires you to be awake and alert" ("Campral," 2017). Although side effects are also reported with Antabuse, drowsiness is listed as a less common side effect ("Antabuse," 2017). The hope is to reduce the patient's reliance upon alcohol without causing effects that could act as a deterrent in her pursuit of sobriety.

Decision Two

Despite the fact that the side effects of Antabuse are not considered to be as severe as Campral, the patient returned to her next appointment complaining of unpleasant side effects, including fatigue and a metallic taste in her mouth. She did not wish to discontinue the medication, which is a positive sign, since many addicts are ambivalent about letting go of their addictions. The patient did admit to relapsing once and reported that the effects of the drug were extremely unpleasant and severe. She stated that she was spending less money at the casino but was smoking more.

Replacing one addiction with another is not uncommon. Cigarette smoking, like alcohol addiction, has a profound biological and psychological component. Smokers are addicted to the chemical substance known as nicotine but may also enjoy the social elements of sharing cigarettes. According to the National Institute of Health: "When an addicted user tries to quit, he or she experiences withdrawal symptoms including irritability, attention difficulties, sleep disturbances, increased appetite, and powerful cravings for tobacco" ("Cigarettes and other tobacco products," 2016).

While it is heartening to see that Ms. Perez is gambling less frequently and that she is consuming less alcohol, her smoking is still a negative coping mechanism. Further pharmacological support is suggested in the form of Wellbutrin (bupropion) XL, on a daily basis using an oral dose. Wellbutrin is an antidepressant and is designed to reduce the stress and anxiety that may be called by the patient's weaning herself off of alcohol and gambling. "Treatment with medications (nicotine replacement, varenicline, or bupropion) increases quit-rates, especially when combined with counseling" (Armand 2016). Wellbutrin has the additional positive benefit of reducing the associated weight gain with quitting smoking, a frequently-reported concern of many female patients in particular. Ms. Perez was already concerned with the weight gain she was experiencing with drinking. Wellbutrin, in contrast to other antidepressants, thus has a number of potential positive benefits for the patient in terms of alleviating her depressed mood and helping her cope with her addictions.

Decision Three