Introduction
To a great extent, the victim, Mrs. Maria Perez, a 53-year-old Puerto Rican lady, is presented to the hospital with comorbid gambling disorder and alcohol dependence. A strong correlation exists between the impacts of a guardian’s death with alcohol usage (Lacey et al., 2018). Notably, increased alcohol consumption and smoking among adolescents and adults are associated with parental absence due to demise. Mrs. Perez states that she has struggled to maintain sobriety since opening a new venture, “Rising Sun” casino. The physical environment can influence a person not to change negative behaviors.
In addition, Mrs. Perez reports being highly obsessed with gambling. Therefore, she drinks excessively to remain calm, particularly when participating in high-stake games. Significantly, Mrs. Perez has been smoking for the past two years, but currently, she is alarmed regarding the cigarette’s severe effects. There is a significant association between behavioral and substance addictions, leading to mental health disorders, thus a need for rehabilitation efforts, clinical courses, and treatment efficacy (“Impaired Decision-Making,” n.d.). She has increased weight by 7lbs due to excessive drinking, and Mrs. Perez is considering borrowing cash to pay her gambling debts amounting to $50,000. There are high similarities in hormonal responses between gambling and alcohol abuse disorders.
During the examination, various client factors can impact my decision-making as a psychiatric nurse practitioner (PNP). The patient was alert and oriented to the event, time, and place and appropriately dressed for the occasion, season, and weather. In addition, her speech was coherent and clear, and Mrs. Perez denies auditory and visual hallucinations. Even though the client rejects homicidal and suicidal ideation, her impulse control is impaired. Mrs. Perez is diagnosed with gambling and alcohol use disorders. In this case, the treatment is guided by clinical results, including reducing smoking, alcohol consumption, and gambling addiction.
Decision Point One
At first, I decided to give the victim an Antabuse (disulfiram), 250mg orally every morning. I selected this alternative as Antabuse was approved by the food and drug administration (FDA) in 1951 for the treatment of chronic alcohol dependence. Significantly, disulfiram helps deter clients from excessive drinking, thus improving their recovery. In the given case, Mrs. Perez is diagnosed with alcohol use disorder; Antabuse medication can aid her rehabilitation program as she is not engaged in active drinking. For example, Mrs. Perez takes one drink for approximately five days. Notably, disulfiram can be integrated with other drugs or used alone, making it effective in the treatment plan (Kleczkowska et al., 2021). The FDA administration has not authenticated pharmaceutical therapy to address gambling addiction. Therefore, Antabuse will make Mrs. Perez reduce alcohol uptake, which escalates when she visits casinos. Her smoking habit will deteriorate after the reduction of her gambling behavior.
When I decided to use disulfiram, I was hoping to achieve behavior modification for Mrs. Perez to assist her in stopping drinking. Even though the drug is not the cure for alcoholism, making her reduce excessive drinking will help her not to engage in huge debt for her to gamble. In hospitals, the PNP must provide the necessary medical prescription to the patients to help them enhance their daily behaviors (“Impaired Decision-Making,” n.d.). Another projected outcome I anticipated was to ensure that the clients stop complaining of metallic tastes, fatigue, and taste before visiting the clinic in the next four weeks. One of the essential ethical considerations while treating Mrs. Perez is nurse-patient communication about introducing her to alcohol medication. Patients not suffering from mental health illnesses must be involved in the decision-making process regarding their well-being (Cerit & Özveren, 2019). For example, since she is addicted to alcohol consumption and gambling, Mrs. Perez may reject disulfiram, which may negatively impact my treatment plan.
Decision Point Two
My next decision is to ensure the client continues with her current dose of Antabuse and begins taking Wellbutrin (bupropion) XL 150mg orally daily. After four weeks, the clinical assessment indicates that the clients report feeling better and has reduced smoking and spending much money on gambling. Significantly, disulfiram can be integrated with bupropion, which will help Mrs. Perez reduce her extensive anxiety and depression, which is the primary rationale behind her excessive expenditure and high stakes on gambling. Mrs. Perez will not experience negative side effects of Wellbutrin as she rarely goes to the casino and has not taken alcohol for the last four weeks. In addition, bupropion will enable clients to stop smoking (Naglich et al., 2019). Therefore, contrasted with other options, incorporating Antabuse and Wellbutrin is better as it will enable the client to stop smoking and gambling.
When I was making this decision, I was hoping to achieve an increased reduction of the patient’s anxiety. The increased depression makes Mrs. Perez invest highly in gambling and smoke excessively. To a great extent, Wellbutrin is effective for treating major depressive disorder and has no effects that develop long-haul use (“Impaired Decision-Making,” n.d.). Therefore, the client will have a behavioral modification and fit into my clinical course. As a PNP, the ethical considerations may affect my communication and treatment blueprint with victims. In the case of patients suffering from alcohol disorders, the principle of nonmaleficence should be applied to ensure that the victim is not harmed (Cerit & Özveren, 2019). For example, effective dialogue with Mrs. Perez will ensure no medication errors are made and advise her that Wellbutrin should not be used by people who are drinking. Increasing patient safety and care is essential in the treatment, particularly when making decisions.
Decision Point Three
My third decision will be to ensure that the patient maintains the current doses of each medication and refer to counseling for her gambling problem. The victim reports that she experiences adverse side effects of Antabuse, including sedation, a metallic taste in her mouth, vomiting, nausea, and fatigue. Therefore, sustaining the existing dose and seeking counseling on the gambling problem is effective, as the client will be advised on better gambling techniques and ways to stop smoking (“Impaired Decision-Making,” n.d.). The patient will receive massive support on how to overcome smoking and drinking and continue benefitting socially and emotionally by attending consultative therapies.
When making the decision, I aimed to ensure that the client could appropriately manage the symptoms presented during the review. Therefore, since the patient report indicated that the side effects were declining, introducing pharmacological therapy would effectively manage the adverse medication impacts (Kleczkowska et al., 2021). Regarding Mrs. Perez’s case, one of the ethical considerations will be fear and internal resistance by the victim to comply with my new treatment plan of visiting a counselor. For example, Mrs. Perez is highly concerned with borrowing capital from her retirement account without alerting her spouse, which can hinder the treatment blueprint. In a healthcare facility, when making decisions, the PNP must involve the patient in decision-making (Cerit & Özveren, 2019). In the given case, Mrs. Perez suffers from alcohol consumption, gambling illness, and no mental health disorder. Therefore, her insights and contribution should be considered when a PNP makes a choice that directly affects her. For instance, when a PNP visits a counselor, Mrs. Perez can agree to receive cognitive behavioral therapies to make her stop smoking while taking Wellbutrin.
Conclusion
Notably, Mrs. Perez presents with symptoms of comorbid gambling and alcohol use disorders. Before gambling, the patient was addicted to excessive drinking after her father’s demise. There exists a high correlation between betting and alcoholism, particularly for teenagers who lack parental guidance (Kleczkowska et al., 2021). Regarding the use of Antabuse (disulfiram) 250mg orally every morning, I recommend the medication should not be discontinued after prescribing it to Mrs. Perez in eight weeks. To a great extent, Antabuse is associated with typical side effects, including nausea, vomiting, and flushing, which can impact the client negatively.
On the other hand, another treatment recommendation is that the client continues with her current dose of Antabuse and begins taking Wellbutrin (bupropion) XL 150mg orally daily. Integrating Wellbutrin will ensure that the client stops smoking, which is highly connected with anxiety, making her extensively invest a huge amount of money in gambling (Naglich et al., 2019). In addition, by utilizing bupropion, Mrs. Perez will highly reduce her depression and anxiety, which is the primary reason for her high stakes on betting.
Lastly, another treatment alternative is ensuring that the patient maintains the current doses of each medication and refers to counseling for her gambling issue. During consultative meetings with the advisor, the patient can receive adequate social and emotional assistance (“Impaired Decision-Making,” n.d.). The therapist may make her modify Mrs. Perez’s behaviors and stop her from drinking even if her father had died. The Antabuse and Wellbutrin medications should not be discontinued. To ensure improved relationship and interaction, the practitioner must adequately address the therapeutic alliance ruptures between the counselor and the patient. The client must be willing to discuss her social history for the effective clinical management of her gambling and alcohol disorders.
References
Cerit, B., & Özveren, H. (2019). Effect of hospital ethical climate on the nurses’ moral sensitivity.The European Research Journal, 5(2), 282-290.
Impaired decision-making, impulsivity, and compulsivity: Addictions’ effect on the cerebral cortex. (n.d.). MentalHelp.net.
Kleczkowska, P., Sulejczak, D., & Zaremba, M. (2021). Advantages and disadvantages of disulfiram coadministered with popular addictive substances.European Journal of Pharmacology, 904(2), 174143-174150.
Lacey, R. E., Zilanawala, A., Webb, E., Abell, J., & Bell, S. (2018). Parental absence in early childhood and onset of smoking and alcohol consumption before adolescence.Archives of Disease in Childhood, 103(7), 691-694.
Naglich, A. C., Brown, E. S., & Adinoff, B. (2019). Systematic review of preclinical, clinical, and post-marketing evidence of bupropion misuse potential.The American Journal of Drug and Alcohol Abuse, 45(4), 341-354.