Assessing and Treating Patients with Impulsivity, Compulsivity, and Addiction

docx

School

Kenyatta University *

*We aren’t endorsed by this school

Course

5678

Subject

Nursing

Date

Nov 24, 2024

Type

docx

Pages

Uploaded by CaptainPolarBearMaster772

1 Assessing and Treating Patients with Impulsivity, Compulsivity, and Addiction Name Institution

2 Assessing and Treating Patients with Impulsivity, Compulsivity, and Addiction Impulsivity refers to the inclination to act upon certain desires or urges without considering potential outcomes. Impulsive people tend to live in the moment without any regard for the future. On the other hand, compulsivity refers to a behavior in which a person feels motivated to perform as a way of relieving anxiety. Comfort is restored when compulsive behavior is performed. In individuals with substance abuse disorders, the presence of impulsive and compulsive behaviors shows that the individual has experienced changes in the prefrontal cortex. These changes make it difficult for the individual to stop the use of drugs or other substances being abused ( Fineberg et al., 2020). The present case is that of Mrs. Maria Perez, a 53-year-old Puerto Rican female who presents to the clinic with what she calls an “embarrassing problem”. She reveals that she has had an alcohol problem since her late teens after her father died. She reports that her problem worsened in her 20s and has struggled with alcohol since then and has tried to stop, even attending Alcoholics Anonymous “on and off” for the past 25 years. Mrs. Perez also discloses that for the last 2 years, it has become even more difficult to maintain her sobriety after the opening of a casino near her home. She reveals that she got hooked on gambling during the casino’s grand opening, which she attended. According to her, gambling gives her a “high” feeling. She likes having a drink when gambling to calm her down but reveals that this often leads to more drinking and gambling recklessly. Her cigarette smoking has also increased during the past two years and enjoys smoking when she is playing at the slot machines. Mrs. Perez also reports that she has gained weight, which she associates with drinking so much. Her gambling has led to the accumulation of much debt such that she was forced to borrow $50,000 from her retirement account without informing her husband.

3 Decision #1 I selected to start the patient with Antabuse (disulfiram) 250 mg orally daily. According to De Sousa (2019), disulfiram 250mg tablets are FDA-approved for the treatment of alcohol addiction. I selected this medication because it is used as a deterrent to drinking alcohol. The medication works by producing interaction with alcohol. Therefore, if a person drinks alcohol while on this medication, it produces unpleasant effects, such as flushing of the face, headache, and nausea. Saitz (2018) , points out that usually, when alcohol enters the body, it is first converted into acetaldehyde and later into acetic acid. When this medication is taken, it acts by blocking the conversion of acetaldehyde into acetic acid. This leads to a rise in acetaldehyde in the body. This increase is toxic and causes a person to become ill with symptoms, such as headaches, nausea, flushing of the face, vomiting, weakness, tachycardia, hypotension, and sweating among others. The fear of these unpleasant feelings helps deter an individual from drinking alcohol. I did not select the “Campral (acamprosate) 666mg orally three times a day” option because according to Muncie et al. (2022), the administration of acamprosate should start only in patients who have been abstinent from alcohol for a certain period of time. As such, it is recommended that Campral use should begin after the initial medically-assisted detoxification has been achieved. Similarly, I did not select the “Vivitrol (naltrexone) injection, 380 mg intramuscularly in the gluteal region every 4 weeks” option because, like Campral, naltrexone is used only in individuals who have been able to abstain from alcohol for a particular period. In making this decision, I was hoping to help the patient abstain from drinking alcohol. Alcohol addiction is the main problem Mrs. Perez faces. As such, it is important to solve her alcohol use before tackling other problems. Taking disulfiram 250mg daily would help achieve this objective. When treating a patient, it is important to consider all possible

Your preview ends here

Eager to read complete document? Join bartleby learn and gain access to the full version

Access to all documents
Unlimited textbook solutions
24/7 expert homework help

4 options and review the pros and cons of each, including the potential impact of each on the welfare of the client and the support system (Cave, 2019). In this case, I considered the pros and cons of the three options and decided on the one I considered best for the present needs of the client and for her welfare and that of her support system, especially her family. Decision #2 For my second decision, I selected the option to continue with the current dose of Antabuse and begin Wellbutrin (bupropion) XL 150 mg orally daily. This decision was influenced by the results of my first decision. After four weeks, Mrs. Perez reports to the clinic for follow-up. She reports that she only had one drink 5 days after starting treatment and the experience was terrible, such that she thought she would die as she felt that her heart would “pound out of her chest”. She also reported experiencing sedation, fatigue, and a “metallic taste” in her mouth which she says is easing. These are the common side effects of using Antabuse; they go away as a patient becomes used to the medication ( Antonelli et al., 2018). I would, however, change the administration time to evening to ensure she does not experience sedation and fatigue during the day. The terrible experience she had as a result of taking one drink is one of the unpleasant effects the medication causes to deter people from taking alcohol. This shows that the medication was working as expected hence the decision to continue with the same dose. However, her smoking has gotten worse; this means she has substituted drinking with smoking. Therefore, she needs medication for her smoking problem, hence the decision to prescribe Wellbutrin (bupropion) XL 150 mg orally daily; this medication is FDA-approved to treat tobacco addiction (Keam, 2022). I did not select the option to “continue the current dose of Antabuse and begin Campral (acamprosate) 666mg orally BID” because it is too soon to assume that Mrs. Perez has abstained from alcohol. Currently, the unpleasant effects of drinking could be what is

5 keeping her away from taking alcohol. Therefore, she should be given more time before drugs, such as Campral can be considered. I also opted agent continuing with the current dose and refer her to counseling for gambling issues because doing so would not address her smoking problem. By making this decision, I was hoping to continue deterring Mrs. Perez from drinking alcohol and also help her quit or reduce her smoking. Maintaining the current dose of Antabuse would help with the drinking part while beginning Wellbutrin (bupropion) XL 150 mg orally daily would help with the smoking part. Marchand et al. (2019) point out that when treating a patient, a clinician must consider holistic well-being. In making this decision, I considered the overall well-being of Mrs. Perez; it is not enough to treat her alcohol problem while letting her smoking get worse. Therefore, the decision was made to enhance her holistic health and well-being. Decision #3 For my third decision, I decided to maintain the current dose of each medication and refer her to counseling for her gambling. This decision is based on the results of my second decision. The client returns to the clinic after four weeks. She reports that the side effects of Antabuse have gone away and that she now feels much better. Although she reports that she is still smoking, she claims to have reduced to only a couple of cigarettes daily. She also reports that although she still visits the casino, she does not spend as much money as in the past. This shows that the medication has worked to help her quit drinking alcohol. It seems that alcohol increased her impulsivity which led to reckless gambling. Gambling on the other hand increased her anxiety which led to the compulsive behavior of drinking more alcohol to calm her down. There is a need to refer her to counseling; a counselor would help her address her gambling problem; for example, cognitive behavioral therapy would help her not only with gambling but also with alcohol abuse and smoking problem (Rizeanu, 2018).

6 I did not select to increase Wellbutrin XL to 300 mg orally daily because first, the medication is working as she has reduced her smoking to a couple of cigarettes daily. According to Keam (2022), this medication may take up to 12 weeks to exert its full therapeutic effect; therefore, there is no need to increase its dosage. Also, it is not wise to discontinue Antabuse at this point; it is too soon to consider discontinuing this medication. If the medication is discontinued, Mrs. Perez may be emptied to take a drink as she would not experience the unpleasant effects. In making this decision, I was hoping to help her continue abstaining from alcohol, reduce her cigarette smoking with the goal of quitting altogether, and also to address her gambling problem. This decision was also based on the need to foster holistic healing of Mrs. Perez (Marchand et al. 2019). The medications prescribed address her alcohol and smoking problems. Therefore, it was important to refer her to counseling for her gambling problem; counseling is the main treatment option for a gambling disorder (Rizeanu, 2018). Conclusion Based on the information provided, the key problem affecting Mrs. Perez is alcohol addiction. Therefore, the initial treatment should focus on helping her abstain from alcohol. To achieve this, I decided to start her treatment with Antabuse (disulfiram) 250 mg orally daily. This medication would help deter her from drinking alcohol. If a patient drinks alcohol while using this drug, it results in a severe interaction with the medication leading to unpleasant effects, such as headaches, nausea, flushing of the face, vomiting, weakness, tachycardia, hypotension, and sweating (De Sousa, 2019). During my second decision point, I opted to continue with the current dose of Antabuse and begin Wellbutrin (bupropion) XL 150 mg orally daily. I made this decision because the results of the first decision showed that Antabuse was effective in helping the patient avoid alcohol. The side effects she experienced were normal and usually go away with time; they are part of what helps deter a patient from

Your preview ends here

Eager to read complete document? Join bartleby learn and gain access to the full version

Access to all documents
Unlimited textbook solutions
24/7 expert homework help

7 alcohol while using the medication ( Antonelli et al., 2018). I added Wellbutrin because her smoking got worse. Wellbutrin would help her to lower or even abstain from smoking as it is indicated for tobacco addiction among other conditions (Keam, 2022). Given the results of the second decision showed that Antabuse was working effectively, I decided to continue with it. Also, the patient had started experiencing the therapeutic effects of Wellbutrin as her rate of smoking had decreased; however, she is yet to experience the full effects of the medication, which can take even up to 12 weeks; hence there is no need to discontinue this medication or change the dose (Keam, 2022). I also referred her for counseling, especially to undergo cognitive behavioral therapy. There is no medical treatment for gambling addiction; counseling is considered the mainstay treatment of gambling disorder; in addition, counseling would also help her with her alcohol and tobacco use problems (Rizeanu, 2018).

8 References Antonelli, M., Ferrulli, A., Sestito, L., Vassallo, G. A., Tarli, C., Mosoni, C., ... & Addolorato, G. (2018). Alcohol addiction-the safety of available approved treatment options. Expert opinion on drug safety , 17 (2), 169-177. Cave, E. (2019). Selecting treatment options and choosing between them: Delineating patient and professional autonomy in shared decision-making. Health Care Analysis , 28 (1), 4-24. https://doi.org/10.1007/s10728-019-00384-8 De Sousa, A. (2019). Disulfiram in the management of alcohol dependence. Disulfiram , 21- 30. https://doi.org/10.1007/978-981-32-9876-7_3 Fineberg, N. A., Van Ameringen, M., Drummond, L., Hollander, E., Stein, D. J., Geller, D., ... & Dell'Osso, B. (2020). How to manage obsessive-compulsive disorder (OCD) under COVID-19: A clinician's guide from the International College of Obsessive Compulsive Spectrum Disorders (ICOCS) and the Obsessive-Compulsive and Related Disorders Research Network (OCRN) of the European College of Neuropsychopharmacology. Comprehensive psychiatry , 100 , 152174. Keam, S. J. (2022). Dextromethorphan/Bupropion: First approval. CNS Drugs , 36 (11), 1229- 1238. https://doi.org/10.1007/s40263-022-00968-4 Marchand, K., Beaumont, S., Westfall, J., MacDonald, S., Harrison, S., Marsh, D. C., Schechter, M. T., & Oviedo-Joekes, E. (2019). Conceptualizing patient-centered care for substance use disorder treatment: Findings from a systematic scoping review. Substance Abuse Treatment, Prevention, and Policy , 14 (1). https://doi.org/10.1186/s13011-019-0227-0 Mason, B. J., & Heyser, C. J. (2021). Alcohol use disorder: the role of medication in recovery. Alcohol Research: Current Reviews , 41 (1).

9 Muncie, H. L., Anderson II, G., & Oge, L. (2022). Care of the Alcoholic Patient. In Family Medicine: Principles and Practice (pp. 807-823). Cham: Springer International Publishing. Rizeanu, S. (2018). Cognitive-behavioral therapy for gambling addiction. Cognitive Behavioral Therapy and Clinical Applications . https://doi.org/10.5772/intechopen.72671 Saitz, R. (2018). Medications for alcohol use disorder and predicting severe withdrawal. JAMA , 320 (8), 766. https://doi.org/10.1001/jama.2018.10061

Your preview ends here

Eager to read complete document? Join bartleby learn and gain access to the full version

Access to all documents
Unlimited textbook solutions
24/7 expert homework help

Assessing and Treating Patients with Impulsivity, Compulsivity, and Addiction

Related Documents