NURS6630 Comorbid Addiction ETOH and Gambling Case Paper 2

NURS6630 Comorbid Addiction ETOH and Gambling Case Paper 2

NURS6630 Comorbid Addiction ETOH and Gambling Case Paper 2

Week 8: Therapy for Clients With Impulsivity, Compulsivity, and Addiction

There are numerous different clinical manifestations for impulsivity and compulsivity, and they frequently co-occur with many other psychiatric diseases. While some people are impulsive and find it difficult to say “no” to activities like taking illegal drugs or overspending, other people engage in obsessive habits that have negative effects. These impulsive and obsessive actions might occasionally contribute to addiction-related problems. You must comprehend the variations between these diseases as well as how their symptoms affect clients and their families in order to assess and treat clients effectively.

This week, as you examine therapies for individuals with impulsivity, compulsivity, and addiction, you explore the assessment and treatment of clients with these disorders. You also consider ethical and legal implications of these therapies. NURS6630 Comorbid Addiction ETOH and Gambling Case Paper 2

Photo Credit: [Apolinar B. Fonseca]/[Moment]/Getty Images

Assignment: Assessing and Treating Clients With Impulsivity, Compulsivity, and Addiction

Addiction, compulsivity, and impulsivity are difficult disorders for clients of all ages. These illnesses frequently show up as negative behaviors, which have detrimental effects on the customers. As a psychiatric mental health nurse practitioner, you have the chance to assist patients in addressing the diseases’ underlying causes and overcoming these behaviors. For this assignment, think about how you could evaluate and handle clients who exhibit impulsivity, compulsivity, and addiction as you look over the client case study in this week’s learning resources. NURS6630 Comorbid Addiction ETOH and Gambling Case Paper 2

Learning Objectives
Students will:
  • Assess client factors and history to develop personalized therapy plans for clients with impulsivity, compulsivity, and addiction
  • Analyze factors that influence pharmacokinetic and pharmacodynamic processes in clients requiring therapy for impulsivity, compulsivity, and addiction
  • Evaluate efficacy of treatment plans
  • Analyze ethical and legal implications related to prescribing therapy for clients with impulsivity, compulsivity, and addiction
Learning Resources

Note: To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.

REQUIRED READINGS

Note: All Stahl resources can be accessed through the Walden Library using this link. This link will take you to a log-in page for the Walden Library. Once you log into the library, the Stahl website will appear.

Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge University Press.
To access the following chapters, click on the Essential Psychopharmacology, 4th ed tab on the Stahl Online website and select the appropriate chapter. Be sure to read all sections on the left navigation bar for each chapter. NURS6630 Comorbid Addiction ETOH and Gambling Case Paper 2

  • Chapter 14, “Impulsivity, Compulsivity, and Addiction”

Stahl, S. M., & Grady, M. (2012). Stahl’s illustrated substance use and impulsive disorder New York, NY: Cambridge University Press.
To access the following chapter, click on the Illustrated Guides tab and then the Substance Use and Impulsive Disorders tab.

  • Chapter 10, “Disorders of Impulsivity and Compulsivity”

Stahl, S. M. (2014b). The prescriber’s guide (5th ed.). New York, NY: Cambridge University Press.
To access information on the following medications, click on The Prescriber’s Guide, 5th ed tab on the Stahl Online website and select the appropriate medication.
Review the following medications:
For insomnia
For obsessive-compulsive disorder

  • Citalopram
  • clomipramine
  • escitalopram
  • fluoxetine
  • fluvoxamine
  • paroxetine
  • sertraline
  • venlafaxine
  • vilazodone

For alcohol withdrawal

  • chlordiazepoxide
  • clonidine
  • clorazepate
  • diazepam
  • lorazepam
  • oxazepam

For bulimia nervosa and binge eating

  • fluoxetine
  • topiramate
  • zonisamide

For alcohol abstinence

  • acamprosate
  • disulfiram

For alcohol dependence

  • nalmefene
  • naltrexone

For opioid dependence

  • buprenorphine
  • naltrexone

For nicotine addiction

  • bupropion
  • varenicline

Book Excerpt: Substance Abuse and Mental Health Services Administration. (1999). Treatment of adolescents with substance use disordersTreatment Improvement Protocol Series, No. 32. Retrieved from http://www.ncbi.nlm.nih.gov/books/NBK64350/

  • Chapter 1, “Substance Use Among Adolescents”
  • Chapter 2, “Tailoring Treatment to the Adolescent’s Problem”
  • Chapter 7, “Youths with Distinctive Treatment Needs” NURS6630 Comorbid Addiction ETOH and Gambling Case Paper 2

University of Michigan Health System. (2016). Childhood trauma linked to worse impulse control in adulthood, study finds. Retrieved from https://www.sciencedaily.com/releases/2016/01/1601…
Note: Retrieved from Walden Library databases.

Grant, J. E., Odlaug, B. L., & Schreiber, L. N. (2014). Pharmacological treatments in pathological gambling. British Journal of Clinical Pharmacology, 77(2), 375–381. doi:10.1111/j.1365-2125.2012.04457.x
Note: Retrieved from Walden Library databases.

Loreck, D., Brandt, N. J., & DiPaula, B. (2016). Managing opioid abuse in older adults: Clinical considerations and challenges. Journal of Gerontological Nursing, 42(4), 10–15. doi:10.3928/00989134-20160314-04
Note: Retrieved from Walden Library databases. NURS6630 Comorbid Addiction ETOH and Gambling Case Paper

Salmon, J. M., & Forester, B. (2012). Substance abuse and co-occurring psychiatric disorders in older adults: A clinical case and review of the relevant literature. Journal of Dual Diagnosis, 8(1), 74–84. doi:10.1080/15504263.2012.648439
Note: Retrieved from Walden Library databases.

Sanches, M., Scott-Gurnell, K., Patel, A., Caetano, S. C., Zunta-Soares, G. B., Hatch, J. P., & … Soares, J. C. (2014). Impulsivity in children and adolescents with mood disorders and unaffected offspring of bipolar parents. Comprehensive Psychiatry, 55(6), 1337–1341. doi:10.1016/j.comppsych.2014.04.018
Note: Retrieved from Walden Library databases.

REQUIRED MEDIA

Laureate Education (2016c). Case study: A Puerto Rican woman with comorbid addiction [Interactive media file]. Baltimore, MD: Author
Note: This case study will serve as the foundation for this week’s Assignment. NURS6630 Comorbid Addiction ETOH and Gambling Case Paper 2

To prepare for this Assignment:

  • Review this week’s Learning Resources. Consider how to assess and treat adolescent clients requiring therapy for impulsivity, compulsivity, and addiction.
THE ASSIGNMENT

Examine Case Study: A Puerto Rican Woman With Comorbid Addiction. You will be asked to make three decisions concerning the medication to prescribe to this client. Be sure to consider factors that might impact the client’s pharmacokinetic and pharmacodynamic processes. NURS6630 Comorbid Addiction ETOH and Gambling Case Paper 2

At each decision point stop to complete the following:

  • Decision #1
    • Which decision did you select?
    • Why did you select this decision? Support your response with evidence and references to the Learning Resources.
    • What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
    • Explain any difference between what you expected to achieve with Decision #1 and the results of the decision. Why were they different?
  • Decision #2
    • Why did you select this decision? Support your response with evidence and references to the Learning Resources.
    • What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
    • Explain any difference between what you expected to achieve with Decision #2 and the results of the decision. Why were they different? NURS6630 Comorbid Addiction ETOH and Gambling Case Paper 2
  • Decision #3
    • Why did you select this decision? Support your response with evidence and references to the Learning Resources.
    • What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
    • Explain any difference between what you expected to achieve with Decision #3 and the results of the decision. Why were they different?

Note: Support your rationale with a minimum of three academic resources. While you may use the course text to support your rationale, it will not count toward the resource requirement. NURS6630 Comorbid Addiction ETOH and Gambling Case Paper 2

Co-morbid Addiction (ETOH and Gambling) 53-year-old Puerto Rican Female

BACKGROUND

Mrs. Maria Perez is a 53 year old Puerto Rican female who presents to your office today due to a rather “embarrassing problem.”

SUBJECTIVE

Mrs. Perez admits that she has had “problems” with alcohol since her father died in her late teens. She reports that she has struggled with alcohol since her 20’s and has been involved with Alcoholics Anonymous “on and off” for the past 25 years. She states that for the past two years, she has been having more and more difficulty maintaining her sobriety since they opened the new “Rising Sun” casino near her home. NURS6630 Comorbid Addiction ETOH and Gambling Case Paper 2

Mrs. Perez states that she and a friend went to visit the new casino during their grand opening at which point she was “hooked.” She states that she gets “such a high” when she is gambling. While gambling, she “enjoys a drink or two” to help calm her during high-stakes games. She states that this often gives way to more drinking and more reckless gambling. She also reports that her cigarette smoking has increased over the past two years and she is concerned about the negative effects of the cigarette smoking on her health. NURS6630 Comorbid Addiction ETOH and Gambling Case Paper 2

She states that she attempts to abstain from drinking but that she gets such a “high” from the act of gambling that she needs a few drinks to “even out.” She also notices that when she drinks, she doesn’t smoke “as much” but enjoys smoking when she is playing at the slot machines. She also reports that she has gained weight from drinking so much- she currently weights 122 lbs., which represents a 7 lb. weight gain from her usual 115 lb. weight.

Mrs. Perez is quite concerned today because she has borrowed over $50,000 from her retirement account to pay off her gambling debts. She is very concerned because her husband does not know that she has spent this much money.

MENTAL STATUS EXAM

The client is a 53 year old Puerto Rican female who is alert, oriented to person, place, time, and event. She is dressed appropriately for the weather and time of year. Her speech is clear, coherent, and goal directed. Her eye contact is somewhat avoidant during the clinical interview. As you make eye contact with her, she looks away or looks down. NURS6630 Comorbid Addiction ETOH and Gambling Case Paper 2

She demonstrates no noteworthy mannerisms, gestures, or tics. Her self-reported mood is “sad.” Affect is appropriate to content of conversation & self-reported mood. She visual or auditory hallucinations, no delusional or paranoid thought processes are readily appreciated. Insight and judgment are grossly intact, however, impulse control is impaired. She is currently denying suicidal or homicidal ideation. NURS6630 Comorbid Addiction ETOH and Gambling Case Paper

Diagnosis: Gambling disorder, alcohol use disorder

Decision Point One

Select what the PMHNP should do:

Naltrexone (Vivitrol) injection, 380 mg intramuscularly in the gluteal region every 4 weeks

Antabuse (Disulfiram) 250 mg orally daily

Campral (Acamprosate) 666 mg orally three times/day NURS6630 Comorbid Addiction ETOH and Gambling Case Paper 2

Next Assignment: NURS 6630 Week 8 Assignment 2