Comorbid Addiction Treatment: Puerto Rican Woman Case Study
This case study examines a 53-year-old Puerto Rican woman presenting with comorbid alcohol addiction, gambling disorder, and depression. The paper traces three sequential clinical decision points, evaluating pharmacological options including Antabuse (disulfiram), Campral (acamprosate), and Wellbutrin (bupropion), while addressing the patient's emerging tobacco use as a substitute coping mechanism. Each decision is grounded in the side-effect profiles, administration methods, and therapeutic goals of the medications considered. The paper concludes by recommending continued pharmacological treatment alongside cognitive behavioral therapy as an evidence-based integrated approach to managing addiction and depression simultaneously.
- Patient Overview: Patient background, comorbid diagnoses, and presenting symptoms
- Decision One: Choosing a Pharmacological Intervention for Alcohol Addiction: Comparison and selection of alcohol addiction medications
- Decision Two: Addressing Side Effects and Emerging Tobacco Use: Managing Antabuse side effects and substitute smoking behavior
- Decision Three: Continuing Treatment and Adding Counseling: Ongoing medication and cognitive behavioral therapy recommendation
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What makes this paper effective
- The case study is organized as a progressive clinical narrative, with each decision point building logically on the outcome of the previous one, mirroring real-world treatment sequencing.
- Comparative drug analysis is grounded in specific side-effect profiles and administration methods, demonstrating applied pharmacological reasoning rather than abstract description.
- The paper addresses a nuanced clinical reality — addiction substitution — by noting the patient's shift toward increased smoking, and responds with a targeted pharmaceutical adjustment.
Key academic technique demonstrated
The paper demonstrates evidence-based clinical reasoning by systematically weighing treatment alternatives at each decision point. Rather than presenting a single solution, the writer compares medications by mechanism, side-effect burden, and patient-specific factors (e.g., gender-related concerns about weight gain), then justifies each selection with cited sources.
Structure breakdown
The paper opens with a patient profile establishing diagnosis and context, then proceeds through three clearly labeled decision sections. Each section describes the clinical situation, evaluates pharmaceutical options, and selects a course of action with rationale. The final section integrates a recommendation for cognitive behavioral therapy alongside continued medication, broadening the treatment model beyond pharmacology alone.
Patient Overview
The patient is a 53-year-old Puerto Rican woman presenting with comorbid addictions to alcohol and gambling. She has sought treatment for alcoholism in the past, but the combination of living near a casino and the ready availability of alcohol has caused her to relapse and to engage in gambling on a regular basis. Her gambling has negatively affected her marriage and has led her to borrow significant sums from her retirement account. The patient is also exhibiting symptoms of depression, including a sad and lethargic demeanor.
Decision One: Choosing a Pharmacological Intervention for Alcohol Addiction
One option for the patient is prescribing Antabuse (disulfiram), a medication that "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 that drinking alcohol produces, 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 medications such as Naltrexone (Vivitrol), which is prescribed for both opioid and alcohol-related addictions. Naltrexone has the disadvantage of being administered by injection rather than taken orally; when taken orally, the patient retains a greater sense of control over drug administration, which may enhance long-term compliance.
Another possible pharmaceutical intervention is Campral (acamprosate), a drug also prescribed exclusively 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; 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 goal is to reduce the patient's reliance on alcohol without producing effects that could act as a deterrent to her pursuit of sobriety. For these reasons, Antabuse is selected as the initial pharmacological intervention.
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
Cigarettes and other tobacco products. (2016). NIH. Retrieved from https://www.drugabuse.gov/publications/drugfacts/cigarettes-other-tobacco-products
Cognitive behavioral therapy. (2012). NIH. Retrieved from https://www.drugabuse.gov/publications/principles-drug-addiction-treatment-research-based-guide-third-edition/evidence-based-approaches-to-drug-addiction-treatment/behavioral
What is Naltrexone? (2017). Everyday Health. Retrieved from http://www.everydayhealth.com/drugs/naltrexone
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