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

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

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

The case study is about a 53-year-old Puerto Rican female who came to the clinic with an “embarrassing condition.” She has struggled with drinking ever since she lost her father in her 20s. The client claims that she has been in occasional touch with an AA group for close to 25 years. She alleges that she struggles with remaining sober and that since a neighboring casino came up close to her home two years ago, her issues have become worse. She fears that her gambling addiction has increased her likelihood of smoking, but she finds it difficult to stop drinking while she plays since it makes her feel “cool.” The number of beverages has climbed as a result of two every night.

Several factors may influence the client’s treatment. It is critical to ascertain if drug interactions might impact the pharmacodynamics, or mechanism of action, of the therapy. Take the opioid antagonist Vivitrol, for instance. Therefore, it is essential to determine whether a patient has an opioid addiction or is taking any medications that are related to opioids before giving them Vivitrol (Trick & Le Foll, 2020). Before taking Vivitrol, the client must have abstained from opioids for at least 7 to 10 days. Age, gender, race, and any restrictions on the individual must all be considered. Vivitrol’s pharmacokinetics, for instance, provides comprehensive details on how it affects biological sex, ethnicity, and age; nevertheless, caution is advised when giving it to individuals with moderate to severe renal deficiencies (Yang et al., 2022).The purpose of this discussion is tochoose the best treatments for the patient while detailing the expected outcomes and any moral conundrums at each stage of the decision-making process.

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Decision #1

Selected Decision

            Every four weeks, the patient would get 380 mg of Vivitrol intramuscularly (IM) into the gluteal area.

Justification

Alcohol and drug dependency are treated with the help of the extended-release naltrexone formulation Vivitrol (Zein

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

& Itai Danovitch, 2023). The drug is taken every month (Yang et al., 2022). In 2006, the American Food and Drug Administration granted its first approval for the treatment of alcohol abuse disorder (Pettorruso et al., 2023). The beginning dosage, which aims to change how the brain reacts to alcohol usage, is 380 mg (Trick & Le Foll, 2020). Even though the client has not revealed any medications with opioids as well as other opiate addictions, the FDA states that Vivitrol is considered unsafe in patients who are experiencing opioid symptoms of withdrawal (Taubin et al., 2022). I also chose Vivitrol since it is neither narcotic nor addictive.

Reasons to Reject the Other Two Options

Decisions two and three might be utilized for people who misuse alcohol, but I chose against them since they required to be given to someone clean for some time. The patient’s degree of compliance may be impacted by the disulfiram formulation’s short half-life and higher risk of adverse effects including palpitations (Antonelli et al., 2022). Acamprosate is similarly short-acting and needs more frequent dosing, which could make it difficult for patients to adhere to the necessary dose (Mistarz et al., 2021).

Expected Outcome

            After taking this medication, it is hoped that the patient will have reductions in the symptoms present at the beginning of therapy (Zein & Itai Danovitch, 2023). It is predicted that the patient’s fundamental problem with alcohol dependence would improve (Yang et al., 2022). She needs to reduce or stop consuming alcohol regularly.

Ethical Consideration

            Clinicians are urged to treat persons with drug use problems equally regardless of their gender, color, or any other characteristic (Mistarz et al., 2021). The patient was treated according to the PMHNP’s ethical criterion of fairness.

Decision #2

Selected Decision

            It was reasonable to recommend the client visit a psychiatrist for her predisposition for gambling as the second intervention.

Justification

A counselor will use several counseling techniques to address this problem (Mistarz et al., 2021). Among the most popular therapies are CBT, group therapy, and psychodynamic therapy (Taubin et al., 2022). CBT, which teaches patients how to stop gambling and promotes optimistic attitudes, is one of the finest methods to assist patients in overcoming their gambling addictions (Zein & Itai Danovitch, 2023). A three-month follow-up examination demonstrates that, as a consequence of cognitive-behavioral therapy, the gamblers’ habits have dramatically improved (Yang et al., 2022). Additionally, this will instruct them in relapse prevention strategies, help them learn new coping and problem-solving skills, and develop their social skills (Ray et al., 2020).

Reasons to Reject the Other Two Options

It was incorrect to utilize diazepam as a supplementary treatment to naltrexone since it is addictive (Mistarz et al., 2021). The potent quitting smoking medication Chantix should only be administered for a short time and in minimal dosages when combined with naltrexone (Pettorruso et al., 2023).

Expected Outcome

It is predicted that the patient would report decreased gaming tendencies within a few weeks (Zein & Itai Danovitch, 2023). She continued by saying she had been going to Gamblers Anonymous meetings. She says she was inspired by the last organization she belonged to (Antonelli et al., 2022).

Ethical Consideration

            According to nursing ethics, every patient must get the same treatment from the nurse without exception. It is crucial to promote patient-centered care with a focus on meeting the needs of the patient (Pettorruso et al., 2023). For instance, a therapist may successfully treat the patient’s major concern in this circumstance, which was gambling (Trick & Le Foll, 2020). The ethical rule of non-maleficence had an impact on the PMHNP’s decision.

Decision #3

Selected Decision

            The patient was asked to continue attending Gamblers Anonymous meetings and the decision was made after considering her communication difficulties with her psychotherapist.

Justification

The patient is still highly devoted to her battle against addiction even if she and her therapist did not get along (Taubin et al., 2022). She is inspired as a result to join Gamblers Anonymous. She may now mostly rely on treatment to assist her in overcoming her gambling addiction (Mistarz et al., 2021). Due to this, the therapist and client must discuss their problem for them to guide how to address it and get the most out of group therapy (Ray et al., 2020). Counseling can only be effective when there is a solid therapeutic connection built on trust (Trick & Le Foll, 2020). The issue should be resolved beforehand so that the nurse can concentrate on the sessions that follow (Antonelli et al., 2022). It became vital to reestablish the relationship and trust as a consequence.

Reasons to Reject the Other Two Options

The patient will discontinue psychotherapy if you push her to continue while disregarding her differences with the therapist (Taubin et al., 2022). It is undesirable to quit utilizing naltrexone treatment since it is more successful when sustained over time, particularly in persons with severe drug addiction (Pettorruso et al., 2023).

Expected Outcome

            When the client’s conflict with her counselor has been resolved, she will be expected to stop gambling and continue to abstain from alcohol(Ray et al., 2020). She ought to be able to modify her smoking behaviors in collaboration with her therapist (Zein & Itai Danovitch, 2023).

Ethical Considerations

            To obtain greater results, psychiatrists are urged to take part in helping their patients form a strong therapeutic relationship (Ray et al., 2020). It’s important to keep neutrality while resolving conflicts between a patient and her counselors and to explain to the patient the importance of focusing on this relationship. Ethics concerns such as nonmaleficence and autonomy also played a part in this decision (Trick & Le Foll, 2020).

Conclusion

To provide the best possible care for clients with drug use disorders and addiction, healthcare practitioners must have a solid basis in pharmacology. Before entering the clinic, the woman in the case study was preoccupied with the shame caused by her drinking and gambling addiction. Age, gender, and ethnicity were taken into account while choosing the most effective therapy for the patient’s illness. The initial step was to deliver naltrexone, which is often recommended as the first-line treatment for drug addiction problems and has FDA licensing (Trick & Le Foll, 2020). Due to their brief half-lives and increased risk of negative patient effects,  Campral and Disulfiram are inappropriate (Zein & Itai Danovitch, 2023). The woman claimed that she had stopped drinking since the initial injection, despite continuing to smoke and gamble after four weeks (Mistarz et al., 2021). Therefore, it was crucial to suggest that the client gets in touch with a psychologist for assistance with her gambling. It was inappropriate to include either varenicline or diazepam in the client’s treatment plan since both medications are addictive and only modest doses are recommended for stopping smoking (Yang et al., 2022).

The client reported increased symptoms at the next session, but her primary concern was that she detested her therapists (Taubin et al., 2022). Because of this, the client’s problems should be discussed with her counselor as part of the overall treatment plan, and she should be encouraged to keep going to Gamblers Anonymous meetings (Pettorruso et al., 2023). Stopping naltrexone use and ignoring the patient’s disdain for her therapist were both poor decisions (Antonelli et al., 2022).The PMHNP has several ethical issues to keep in mind while making decisions, like protecting the patient’s autonomy and averting bias (Ray et al., 2020). Additional ethical standards that are upheld include fairness and non-maleficence.

References

Antonelli, M., Sestito, L., Tarli, C., & Addolorato, G. (2022). Perspectives on the pharmacological management of alcohol use disorder: Are the approved medications effective? European Journal of Internal Medicine103, 13–22. https://doi.org/10.1016/j.ejim.2022.05.016

Mistarz, N., Nielsen, A. S., Andersen, K., Goudriaan, A. E., Skøt, L., Mathiasen, K., Michel, T. M., & Mellentin, A. I. (2021). Brain+ AlcoRecover: A Randomized Controlled Pilot-Study and Feasibility Study of Multiple-Domain Cognitive Training Using a Serious Gaming App for Treating Alcohol Use Disorders. Frontiers in Psychiatry12. https://doi.org/10.3389/fpsyt.2021.727001

Pettorruso, M., Di Carlo, F., Romeo, V. M., Jimenez-Murcia, S., Grant, J. E., Martinotti, G., & di Giannantonio, M. (2023). The pharmacological management of gambling disorder: if, when and how. Expert Opinion on Pharmacotherapy. https://doi.org/10.1080/14656566.2023.2172329

Ray, L. A., Meredith, L. R., Kiluk, B. D., Walthers, J., Carroll, K. M., & Magill, M. (2020). Combined Pharmacotherapy and Cognitive Behavioral Therapy for Adults With Alcohol or Substance Use Disorders. JAMA Network Open3(6), e208279. https://doi.org/10.1001/jamanetworkopen.2020.8279

Taubin, D., Wilson, J. C., & Wilens, T. E. (2022). ADHD and Substance Use Disorders in Young People. Child and Adolescent Psychiatric Clinics of North America. https://doi.org/10.1016/j.chc.2022.01.005

Trick, L., & Le Foll, B. (2020). Pharmacological Treatment of Alcohol Use Disorder. Textbook of Addiction Treatment, 123–139. https://doi.org/10.1007/978-3-030-36391-8_10

Yang, W., Singla, R., Maheshwari, O., Fontaine, C. J., & Gil-Mohapel, J. (2022). Alcohol Use Disorder: Neurobiology and Therapeutics. Biomedicines10(5), 1192. https://doi.org/10.3390/biomedicines10051192

Zein, M., & Itai Danovitch. (2023). Substance-Related and Addictive Disorders. Springer EBooks, 437–467. https://doi.org/10.1007/978-3-031-15401-0_14