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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...
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…
References
Antabuse. (2017). Drugs.com. Retrieved from: https://www.drugs.com/antabuse.html
Armand, W. (2016). What's the best way to quit smoking? Harvard Health Publications.
Retrieved from: http://www.health.harvard.edu/blog/whats-best-way-quit-smoking-201607089935
Campral. (2017). Drugs.com. Retrieved from: https://www.drugs.com/campral.html
https://www.drugabuse.gov/publications/drugfacts/cigarettes-other-tobacco-products
https://www.drugabuse.gov/publications/principles-drug-addiction-treatment-research-based-guide-third-edition/evidence-based-approaches-to-drug-addiction-treatment/behavioral
http://www.everydayhealth.com/drugs/naltrexone
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