NURS 6630 Week 10 Therapy for Patients with Impulsive and Substance Use Disorders Essay

NURS 6630 Week 10 Therapy for Patients with Impulsive and Substance Use Disorders Essay

NURS 6630 Week 10 Therapy for Patients with Impulsive and Substance Use Disorders Essay

Assignment: Assessing and Treating Patients with Impulsivity, Compulsivity, and Addiction

There is a close connection between impulsivity, compulsivity, and addiction. While addiction is defined as a process coordinating the change from an impulsive to compulsive behavior, impulsivity occurs in the early stages of addiction. A person acting impulsively experiences the pleasure of their addiction, and the compulsive aspect would take control when there is a shift causing a person to stay away from their addictions. However, the compulsive behavior would compel a person to participate in their addictions to relieve themselves from the withdrawal effects. The purpose of this write-up is to determine an appropriate treatment plan for a patient diagnosed with addiction, impulsivity, and compulsivity.

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Introduction to the Case Study

The case in question is about a 53-year-old Puerto Rican female who presented to the clinic with an “embarrassing problem.” The problem is alcohol addiction that she started in her early 20s when her father passed. The client’s report on being involved in alcoholism is anonymously defined as “on and off” for the last twenty-five years. The patient has difficulty sustaining sobriety which has been worse in the worst in the last two years. The patient is also suffering from gambling addiction after a casino was opened near her home. This later heightened her smoking habit, and she is concerned about the recent smoking habit that would have a negative effect on her health.

Decision #1

            I will commence the treatment with Naltrexone (Vivitrol) 380mg injection intramuscularly through the gluteal region after every month.  

Reason for this Decision

Naltrexone (Vivitrol) is a common description for alcohol addiction, and it works by reducing the amount of alcohol intake by modulating opioid systems. Solli et al. (2018) ascertain that this aids in reinforcing the side effects of alcohol. FDA approved Naltrexone injection in 2006 after issues of compliance had been raised on oral Naltrexone. The drug is taken monthly instead of taking the daily oral dosage of Naltrexone, which is used to reduce the opportunity of patients discontinuing their medications impulsively.  

Why Other Decisions Were Not Selected

The other two medications slotted in this case study include Antabuse (Disulfiram) 250 mg and Campral (Acamprosate) 666mg orally three times a day. These two drugs are not appropriate for the patient at this time. These medications are always prescribed for clients who would want to continue abstaining from alcohol. A patient taking Antabuse while undergoing alcohol addiction may face adverse side effects from the drug. For example, they may experience high levels of alcohol toxicity (Mason & Heyser, 2021). This makes this drug not ideal for the client at this time. On the other hand, Campral is not fit for the client because of her weight. She weighs 122lbs which is less than 132lbs. Such patients should take four tablets a day instead of six.

What I Was Hoping to Achieve by Making This Decision

By administering this medication, I hope to decrease the alcohol craving in the patient without letting her go through severe side effects and any future relapses. Naltrexone injection can start working within a few days, but its optimal effect would not be seen until the end of one or two weeks. After one month, the client revisited the clinic, and she felt great and had not craved alcohol since she started her medication. However, she is concerned that her smoking habit is still persistent and also fights the problem of anxiety and goes to the casino.

Ethical Considerations Impact on Treatment Plan

This treatment plan will trigger patient autonomy and beneficence ethical principles. I had to select a type of treatment that would result in the desired outcome. I prescribed Naltrexone injection because other treatments involving this medication plan had proved effective in addressing addiction issues. Besides, I had to seek consent from the patient to initiate treatment.

Decision #2

Recommend the client to a counselor to address the issue of gambling.

Reason for this Decision

The first assessment of the patient gave a positive result where the client responded positively to the given treatment. However, the next issue in the order of priority is to address gambling addiction. Therefore, referring her to a counselor is the correct stage to take for the client. Gambling addiction can best be solved through the help of support groups and treatment programs. The counselor helps the client to identify the underlying cause of pathogenic gambling (Pettorruso et al., 2020). The adverse effect of gambling will be on a person if they stay in an environment with high gambling practices. These enevri9omemnt increase the compulsive gambling behavior that affects the patient. Support groups will allow gamblers to share their feelings and, experiences, strengths and hope that they may solve their problems collectively. On the other hand, anxiety reported by the client is a side effect of Naltrexone injection. To solve this, the client should be educated on the side effect and allow her body to adjust to the medication.

Why Other Decisions Were Not Selected

Other treatment choices for anxiety, such as Valium (diazepam) and Chantix (Varenicline), are not an option for the patient. The patient is already fighting an addictive behavior, and the addition of Valium as a secondary medication would worsen the addiction because the drug is highly addictive (Zahid et al., 2018). On the other hand, Chantix could be significant to stop smoking, but the main priority, in this case, is to stop or bring the gambling habit under control.

What I Was Hoping to Achieve by Making This Decision

I am hoping that patient will show positive results from the support groups and counseling sessions. I expect that the client will continue with the current medication of Naltrexone injection with no side effects (Solli et al., 2018). The client reported to the clinic after a month and reported that the anxiety was gone except, that she had issues with her counselor. However, she complained that she never liked her counselor but also admitted that she felt supported by the support groups she had joined.  

Ethical Considerations Impact on Treatment Plan and Communication

Two ethical principles are considered in this case. This includes beneficence and nonmaleficence. I had to select a treatment plan that would lower the risk of harm and give positive patient outcomes. For example, I switched to counseling to enhance the patient’s outcomes and alleviate the side effects of anxiety brought by Naltrexone injection (Pettorruso et al., 2020).

Decision #3

            Address the issue that the patient is facing with the counselor and encourage to attend the support group.

Reason for this Decision

At this point, the client is making better progress with the given treatment. However, the client’s issue with the counselor needs to be addressed as it could trigger relapse in the current treatment.

Why Other Decisions Were Not Selected

The other option of discontinuing the Naltrexone injection, encouraging the patient to continue seeing her counselor, and going to the support group program is not appropriate at this time (Pettorruso et al., 2020). The naltrexone injection effect may be invisible for four weeks. Therefore, it is not advisable to discontinue the medication as early as now. It is also imperative that the client be encouraged to attend the support groups while solving the issue between her and the counselor.

 What I Was Hoping to Achieve by Making This Decision

            I expect continuing with the Naltrexone injection plan, support group programs, and counseling will increase the safety and recovery of the patient. Although gambling addiction might be serious, it could be approached by combining various therapeutic modalities to improve patient outcomes.

Ethical Considerations Impact on Treatment Plan

Beneficence and nonmaleficence would also affect this stage of medication because I have to maintain Naltrexone injection, support programs, and counseling since they are associated with better outcomes. Involving the patient in the treatment decisions would also show respect for the patient’s autonomy.

Conclusion

            The 53-year-old Puerto Rican female reports that she had been admitted to the clinic with an embarrassing problem related to her alcohol, gambling, and smoking addiction. In my treatment plan, I initiated the medication by offering Naltrexone (Vivitrol) 380mg injection intramuscularly through the gluteal region after every four weeks. The client responded positively to the treatment and reported her alcohol addiction. However, she was still struggling with gambling, so I decided to refer her to counseling and support groups to solve her issues related to gambling. Her following assessment showed positive results because she was refraining from gambling. My third decision was to continue her on Naltrexone (Vivitrol) 380mg injection intramuscularly through the gluteal region after every four weeks and solve issues she was facing with her counselor. These measures gave a positive outcome to the patient despite them triggering beneficence and nonmaleficence ethical principles.

References

Bifarin, O., & Stonehouse, D. (2022). Beneficence and nonmaleficence: collaborative practice and harm mitigation. British Journal of Healthcare Assistants, 16(2), 70-74. https://doi.org/10.12968/bjha.2022.16.2.70

Mason, B. J., & Heyser, C. J. (2021). Alcohol use disorder: The role of medication in recovery. Alcohol Research: Current Reviews, 41(1). https://doi.org/10.35946%2Farcr.v41.1.07

Pettorruso, M., Zoratto, F., Miuli, A., De Risio, L., Santorelli, M., Pierotti, A., … & di Giannantonio, M. (2020). Exploring dopaminergic transmission in gambling addiction: A systematic translational review. Neuroscience & Biobehavioral Reviews, 119, 481-511. https://doi.org/10.1016/j.neubiorev.2020.09.034

Solli, K. K., Latif, Z. E. H., Opheim, A., Krajci, P., Sharma‐Haase, K., Benth, J. Š., … & Kunoe, N. (2018). Effectiveness, safety and feasibility of extended‐release Naltrexone for opioid dependence: a 9‐month follow‐up to a 3‐month randomized trial. Addiction, 113(10), 1840-1849. https://doi.org/10.1111/add.14278

Zahid, H., Tsang, B., Ahmed, H., Lee, R. C. Y., Tran, S., & Gerlai, R. (2018). Diazepam fails to alter anxiety-like responses but affects motor function in a white-black test paradigm in larval zebrafish (Danio rerio). Progress in Neuro-Psychopharmacology and Biological Psychiatry, 83, 127-136. https://doi.org/10.1016/j.pnpbp.2018.01.012

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NURS-6630: Week 10: Therapy for Patients with Impulsive/Substance Use Disorders (SUD)
Assignment 1: Assessing and Treating Patients with Impulsivity, Compulsivity, and Addiction. DUE ON 8/7/22
Impulsivity, compulsivity, and addiction are challenging disorders for patients across the life span. Impulsivity is the inclination to act upon sudden urges or desires without considering potential consequences; patients often describe impulsivity as living in the present moment without regard to the future (MentalHelp.net, n.d.). Thus, these disorders often manifest as negative behaviors, resulting in adverse outcomes for patients. For example, compulsivity represents a behavior that an individual feels driven to perform to relieve anxiety (MentalHelp.net, n.d.). The presence of these behaviors often results in addiction, which represents the process of the transition from impulsive to compulsive behavior.
In your role as the psychiatric nurse practitioner (PNP), you have the opportunity to help patients address underlying causes of the disorders and overcome these behaviors. For this Assignment, as you examine the client case study in this week’s Learning Resources, consider how you might assess and treat clients presenting with impulsivity, compulsivity, and addiction.
Reference: MentalHelp.net. (n.d.). Impaired decision-making, impulsivity, and compulsivity: Addictions’ effect on the cerebral cortex. https://www.mentalhelp.net/addiction/impulsivity-and-compulsivity-addictions-effect-on-the-cerebral-cortex/
To prepare for this Assignment:
• Review this week’s Learning Resources, including the Medication Resources indicated for this week.
• Reflect on the psychopharmacologic treatments you might recommend for the assessment and treatment of patients requiring therapy for impulsivity, compulsivity, and addiction.
The Assignment: 5 pages
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.
At each decision point, you should evaluate all options before selecting your decision and moving throughout the exercise. Before you make your decision, make sure that you have researched each option and that you evaluate the decision that you will select. Be sure to research each option using the primary literature.
Introduction to the case (1 page)
• Briefly explain and summarize the case for this Assignment. Be sure to include the specific patient factors that may impact your decision making when prescribing medication for this patient.
Decision #1 (1 page)
• Which decision did you select?
• Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
• Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
• What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).
• Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.
Decision #2 (1 page)
• Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
• Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
• What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).
• Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.
Decision #3 (1 page)
• Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
• Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
• What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).
• Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.
Conclusion (1 page)
• Summarize your recommendations on the treatment options you selected for this patient. Be sure to justify your recommendations and support your response with clinically relevant and patient-specific resources, including the primary literature.
Note: Support your rationale with a minimum of five academic resources. While you may use the course text to support your rationale, it will not count toward the resource requirement. You should be utilizing the primary and secondary literature