NURS 6630 Week 8 Assignment: Comorbid Addiction (ETOH & Gambling): Decision Tree for a 53 Year-Old Female of Puerto Rican Origin

NURS 6630 Week 8 Assignment: Comorbid Addiction (ETOH & Gambling): Decision Tree for a 53 Year-Old Female of Puerto Rican Origin

NURS 6630 Week 8 Assignment: Comorbid Addiction (ETOH & Gambling): Decision Tree for a 53 Year-Old Female of Puerto Rican Origin

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.

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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.

A Sample Of This Assignment Written By One Of Our Top-rated Writers

Comorbid Addiction (ETOH & Gambling): Decision Tree for a 53 Year-Old Female of Puerto Rican Origin

            The patient in this case is a 53 year-old Puerto Rican female who has been diagnosed with coexisting alcohol use disorder (AUD) and gambling disorder (APA, 2013; Sadock et al., 2015). She is experiencing an impulsive urge to gamble despite losing large sums of money and getting into debt. The impulse is accompanied by compulsion and she finds it very difficult to resist the urge to gamble (Chamberlain et al., 2018). She has also been having a history of abusing alcohol since she was a teenager. As a matter of fact she has also been a member of Alcoholics Anonymous for a whopping 25 years but has been relapsing every time back to alcohol dependence. The fact that there is a casino close to her home only makes the compulsion to gamble worse. This paper is about a decision tree on the best pharmacotherapeutic agents she may be given to help her condition

Decision Point No. 1

            The choice to be made at this first decision point is that of disulfiram (Antabuse) 250 mg by mouth every day; naltrexone (Vivitrol) 380 mg IM every 4 weeks; or oral acamprosate 666 mg three times every day (Walden University, n.d.). It is decided here that the best option is to start her on disulfiram (Antabuse) 250 mg by mouth every day. This choice is made because according to Winslow et al. (2016), disulfiram compared to the other two has the best safety profile and efficacy. Like the others, it is also FDA-approved to treat alcohol dependence (Stahl, 2017). The others would thus not match disulfiram on safety and therapeutic effect.

            In making the above decision, it was expected that the lady would experience a reduction in her compulsive drinking and subsequently the impulse to gamble. This is because since alcohol lowers a person’s capacity for good judgment, a reduction in its consumption would also mean that she can make better decisions including not to gamble. Selecting for her disulfiram which has the best safety and efficacy profile resected the main ethical consideration that was beneficence (Haswell, 2019). It would do the most good for her compared t the other two.

Decision Point No. 2

            After a period of four weeks on the disulfiram (Antabuse), the woman returns to be reviewed and her progress assessed. She reports fatigue, poor taste in her mouth, and sedation after taking the disulfiram. While on the disulfiram, she admits that she attempted to consume some alcohol and the experience did not end well. She felt palpitations and a feeling of wanting to die. She had to stop her intake of alcohol from that experience. Luckily, she also reported that her habit of gambling has also gone down although she still did it once in a while. In compensation, she reports that she has increased the number of cigarettes that she smokes in a day.

            Three other options are presented for a decision on her medications to be made a second time after the above assessment. They are continuing with disulfiram (Antabuse) at the current dose but adding acamprosate (Campral) 666 mg by mouth twice a day; continuing with the current medication (disulfiram) but referring her for counseling on the matter of gambling disorder; or continuing with the disulfiram as at present but adding bupropion (Wellbutrin) XL 150 mg by mouth every day (Walden University, n.d.). The decision is made to go with the option of maintaining the current dose of disulfiram (Antabuse) but referring the patient for counseling on the gambling disorder. The reason for this decision is that according to Corey (2017) and Hilliard (2020), addictions that include both behavioral addictions and process addictions would respond favorably to cognitive behavioral therapy or CBT.

            The other two options were not considered because the patient was already showing a good therapeutic response to the disulfiram. She was also tolerating it well save for the mistake of trying to take alcohol while on the drug. For this she was given health education that taking alcohol while on the medication will result to unpleasant consequences. The other two choices were also rejected because they were about adding at least another one medication to the regime. This would have been imprudent given that the disulfiram was already having an effect that was positive. Other medications would only have increased the chances of side effects and violated the ethical principle of nonmaleficence. The hope was that she would reduce her gambling frequency and consider stopping taking etoh for good.

Decision Point No. 3

            After a further four weeks the client comes back for reassessment and re-evaluation of response to treatment. She reports progress but states that the counselor to whom she was referred did not strike a therapeutic rapport with her. In other words, she did not like the counselor and so did not wish to continue with them. At the same time she reports that she attended a meeting of the local chapter of Gamblers Anonymous (GA) for the first time and felt welcomed. She even got a chance to speak during the meeting and felt that it was therapeutic. She however still smoked considerably as per her own account. The last decision taken at this last decision point is to investigate the issue that is making her dislike her current counselor, encourage her to consider the various available smoking cessation options, and urge her to continue attending the GA meetings in her area.

            The above decision is taken in the hope that she would embrace her counselor and combine counseling with the GA meetings and the medication (disulfiram) for the best outcomes. The other two options were not taken because they did not make clinical sense. It was in the interest of helping the patient gain more and benefit from the interventions that the above decision was made. This honored the ethical principle of beneficence. her consent was also sought in trying to find out why there was a problem with the current counselor and this too respected the principle of autonomy.

Conclusion

            In the case of this 53 year-old, the disulfiram (Antabuse) worked for the alcohol use disorder. However, there was a hiccup with the counselor rapport at the beginning and this is not uncommon. They should be able to see through their differences of personality and forge a therapeutic relationship a she continues with her GA meetings and the disulfiram.  

References

American Psychological Association [APA] (2013). Diagnostic and Statistical Manual of Mental Disorders (DSM-5), 5^th ed. Author.

Chamberlain, S.R., Stochl, J., Redden, S.A., & Grant, J.E. (2018). Latent traits of impulsivity and compulsivity: Toward dimensional psychiatry. Psychological Medicine, 48(5), 810-821. http://dx.doi.org/10.1017/S0033291717002185

Corey, G. (2017). Theory and practice of counselling and psychotherapy, 10^th ed. Cengage Learning.

Haswell, N. (2019). The four ethical principles and their application in aesthetic practice. Journal of Aesthetic Nursing, 8(4), 177-179. https://doi.org/10.12968/joan.2019.8.4.177

Hilliard, J. (September 17, 2020). Gambling addiction. Addiction Center. https://www.addictioncenter.com/drugs/gambling-addiction/

Sadock, B.J., Sadock, V.A., & Ruiz, P. (2015). Synopsis of psychiatry: Behavioral sciences clinical psychiatry, 11^th ed. Wolters Kluwer.

Stahl, S.M. (2017). Stahl’s essential psychopharmacology: Prescriber’s guide, 6^th ed. Cambridge University Press.

Walden University (n.d.). Comorbid addiction (ETOH and gambling): 53 year-old Puerto Rican female. https://cdn-media.waldenu.edu/2dett4d/Walden/NURS/6630/DT/week_08/index.html

Winslow, B.T., Onysko, M., & Hebert, M. (2016). Medications for alcohol use disorder. American Family Physician, 93(6), 457-465. https://www.aafp.org/afp/2016/0315/p457.html