Introduction
The psychiatric nurse practitioner encounters a wide range of disorders in his professional practice that pose particular concern and require timely treatment. Among such issues, impulsivity, compulsivity, and addiction can be highlighted as the most challenging and complex problems. Medical specialists face the task of finding the most effective and appropriate approach for the patient’s case, taking into account external and internal factors. This case study examines the case of a Puerto Rican woman with comorbid addiction and provides ways to assess and treat the client’s disorder.
Before considering interventions to help a patient cope with a disorder, it is necessary to review the case carefully. The patient under examination is Maria Perez, a 53-year-old Puerto Rican female (“Case study: A Puerto Rican woman with comorbid addiction,” n.d.). She turned to specialists because she had had alcoholism since her 20s, the cause of which was childhood trauma after the death of her father (Arbor, 2016). In the last two years, she has been actively involved in gambling, which has only worsened her dependence on alcoholic beverages. Moreover, smoking was added to them, which increased the patient’s concern about her health.
The examination of the mental status showed entirely satisfactory results overall. The patient has no problems with coordination, speech, or perception of information, and no problems with insight or judgment. She avoids eye contact but shows no mannerisms, gestures, or tics. In the self-assessment, Mrs. Perez reported feeling sad. A separate factor is the impairment of impulse control, which causes alcohol and gambling addiction in the woman. The final diagnosis was made as a gambling disorder and an alcohol use disorder.
Decision #1
The first decision that can be selected to treat Mrs. Perez’s gambling and alcohol addiction is to prescribe her a medication such as Vivitrol (naltrexone) injection. The drug dosage is 380 mg intramuscularly in the gluteal region, and the injection frequency is every 4 weeks. This approach to the treatment of the patient’s addiction was chosen due to its increased efficiency and effectiveness. Moreover, this medication is suitable for treatment, as it allows the medical service provider to observe the condition and the treatment outcome.
This decision was made for several important reasons and in accordance with the patient’s case. First of all, it allows professionals to monitor her condition at the reception for the injection of the drug. Further, it is noted that “to be effective, treatment with Vivitrol must be used with other alcohol or drug recovery programs such as counseling” (FDA, n.d.). Therefore, it will provide her with the opportunity to support therapy visits.
The main reason why Campral (acamprosate) and Antabuse (disulfiram) were not chosen is the patient’s lack of motivation. Acamprosate is used to substitute for alcohol in patients during withdrawal (Stahl, 2021). Disulfiram, in turn, causes unpleasant reactions such as vomiting and nausea, which can negatively affect the patient’s complex condition.
By making this decision, I wanted to achieve the most effective results to understand the patient’s motivation and involvement in the treatment process. At the same time, it is necessary to be sensitive to motivational barriers to change at the beginning of intervention (Center for Substance Abuse Treatment, 1999). Vivitrol provides an opportunity to achieve long-term results (FDA, n.d.). It is worth noting that ethical considerations must be followed when communicating with the patient. In particular, it is vital to have cultural sensitivity and show respect for a woman’s trauma to limit the negative contribution to treatment plans and communication.
Decision #2
The second decision regarding Mrs. Perez’s treatment was referring her to a counselor to address gambling issues. It was decided based on how treatment with Vivitrol injections helped the patient stop drinking alcohol (FDA, n.d.). However, she noted that she continues to visit the gambling place, which contributes to the continuation of smoking.
Thus, in this case, the development of a co-occurring smoking disorder occurs, which is typical for such cases (Salmon & Forester, 2012). Valium (diazepam) 5 mg orally was not prescribed to the patient due to potential severe effects such as adverse behavioral effects (“Diazepam (Rx),” n.d.). In addition, Chantix (varenicline) 1 mg orally was not administered due to potential abnormal dreams and agitation.
I hope to improve the patient’s mental state by prescribing therapy. In addition, research stated that there are “no formally approved pharmacotherapeutic interventions for this disorder” (Grant et al., 2014, p. 375). Thus, this approach may be more efficient. In addition, it can provide an opportunity to solve the childhood trauma of a woman who developed addictions. Counseling will also aim to translate impulsive behavior into compulsive behavior (MentalHelp.net, n.d.). This will help to cope with gambling addiction that Mrs. Perez has.
In this context, it is crucial to take into account ethical considerations such as the vulnerability of the patient when discussing childhood trauma. This is because a woman may experience difficulties in social, academic, or occupational settings (Sanches et al., 2014). Thus, it is necessary to adjust and closely monitor the patient’s behavior and emotional state during treatment and when new approaches are implemented.
Decision #3
In extending the treatment, it was decided to discontinue exploring the issue that Mrs. Perez is having with her counselor and encourage her to continue attending the Gamblers Anonymous meetings. This aspect is because therapy in the case of gambling addiction requires a long and comprehensive approach (Bechtold & Wilson, 2021). If issues arise, it is necessary to discuss with the current counselor aspects that do not suit the patient and, if necessary, consider changing to a specialist who can meet the client’s needs and preferences.
The option of offering Mrs. Perez the opportunity to continue seeing her current counselor was not considered, as it is impossible to force a patient to see a specialist who does not suit her. This may worsen the treatment outcomes. Discontinuation of Vivitrol cannot be undertaken either, as this drug requires longer-term monitoring (FDA, n.d.). Thus, although both approaches could be used, the first solution was chosen as the most effective, as it resolves the issue and ensures greater comfort for the woman and more patient-centered care.
By making this decision, I was hoping to increase the patient’s involvement in the treatment process. This is also because she had previously experienced difficulties with attending therapy (“Case study: A Puerto Rican woman with comorbid addiction,” n.d.). Moreover, this aligns with ethical considerations that can affect treatment plans and patient communication. This is because, in providing care to the patient, it is necessary, first of all, to take into account her interests.
Conclusion
In conclusion, the case study “Puerto Rican woman with comorbid addiction” provided an opportunity to gain a more complete understanding of what approaches can be used to treat problems related to impulsivity, compulsivity, and addiction. This knowledge can be instrumental in medical practice, as it helps inform the decision-making process for the patient’s treatment. In the case under study, the patient faced the problem of gambling and alcohol addiction. The main reason was childhood trauma, which later became the cause of the development of problems with impulse control, which led to the need to consult a specialist.
The initial recommendation for the patient was to administer a course of 4 Vivitrol injections at 380 mg intramuscularly in the gluteal region over 4 weeks (FDA, n.d.). This intervention will be particularly effective but requires constant monitoring and check-ups with the healthcare provider. On the other hand, it will provide an excellent opportunity to improve a woman’s communication and involvement in the treatment process, thereby contributing to better outcomes.
The following recommendation for Mrs. Perez was to visit the counselor for a course of treatment for gambling addiction. This approach will also contribute to limiting smoking problems and have a positive impact on solving issues related to childhood trauma (Arbor, 2016). Therefore, this solution is valuable because it will address several of the patient’s problems at once. Problems with a specialist should be resolved promptly to ensure patient-centered care, and the continuation of Vivitrol should be closely monitored to determine its termination.
References
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