Case Study: A Puerto Rican Woman With Comorbid Addiction Assessment

Case Study: A Puerto Rican Woman With Comorbid Addiction Assessment

The focus of this paper is on a patient, Mrs. Perez, a 53-year-old female who reported problems with alcohol addiction that started during her late adolescence when she lost her father. For the last 25 years, she has struggled with alcohol addiction but the problem has worsened for the last 2 years, where she has been having difficulties remaining sober. She also reported problems with gambling addiction ever since a casino was opening in the neighborhood. She admits that gambling worsening her alcohol drinking. The client also stated concerned about weight gain due to increased alcohol intake. She is also concerned that she is using large sums of money in gambling, for example where she spent $50,000 to pay gambling debts without her husband’s knowledge. The client is alert and well oriented. She is also appropriately dressed for her age and weather. The speech is clear, goal-directed, and coherent. During the interview, she avoided direct eye contact. Her mannerisms and gestures are okay and she does not exhibit tics. Her self-reported mood is sad. The assessment does not identify any delusional or paranoid thought process. There is no impairment of insight or judgment. However, her impulse control is notably impaired. The client denies any homicidal or suicidal thoughts. The subjective and assessment identified the diagnosis for the client as gambling disorder, alcohol use disorder. The purpose of this paper is to select suitable treatment decisions for the client and support the decisions using evidence. Moreover, the ethical principle used for each treatment choice for the client will be discussed.

Decision Point One

Naltrexone is a drug used in the treatment of alcohol. The mechanism of action of naltrexone is by reducing an individual’s craving for alcohol as it inhibits the binding of alcohol to the alcohol-mediated receptors (Toljan & Vrooman, 2018). Antabuse is also used in the treatment of alcoholism. The mechanism of action of Antabuse is by making an individual have undesirable side effects when one drinks alcohol while taking Antabuse (Agabio et al., 2016). Campral treats alcoholism by stabilizing chemical signaling within the brain that is normally interrupted when a person withdraws from alcohol (Witkiewitz et al., 2019). The most appropriate decision is for the client to start Antabuse 250 mg. The rationale for choosing Antabuse is to ensure the client abstains from alcohol because if she drinks alcohol while taking the medication, she is likely to experience very unpleasant side effects (Agabio et al., 2016). Naltrexone was not selected as it is associated with side effects like anxiety, dizziness, headache, among other side effects (Toljan & Vrooman, 2018). Campral was not chosen because when used alone the medication is not effective in the treatment of alcoholism as it should be combined with psychosocial support to improve efficacy (Witkiewitz et al., 2019).

The treatment goal of Antabuse is that the client abstains from alcohol. This is because Antabuse is approved by FDA to treat alcohol addiction and the medication’s effectiveness in treating alcoholism has been proved (Agabio et al., 2016).

The treatment outcome was that after four weeks the client complained of fatigue, sedation, and a metallic taste in the mouth. These are side effects of Antabuse. She also reported experiencing very bad effects like a red face and heart palpitations when she drunk alcohol while taking Antabuse. These effects are due to the reaction between Antabuse and alcohol (Mohapatra & Rath, 2017). She also reported reduced gambling but increased smoking.

For this decision, autonomy and informed consent were applied. The client was given all information about the available medications and her ability to choose or refuse treatment was respected.

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Decision Point Two

The decision selected is for the client to continue taking Antabuse 250mg and change administration time to evening and have her referred for counseling for the ongoing gambling issues. The rationale for choosing the decision is because administering the medication in the evening will reduce the side effects the client reported during the daytime (Khalil & Huang, 2020). Additionally, counseling will treat gambling addiction for the client because the efficacy of psychotherapy treatments like counseling in the treatment of gambling addictions has been demonstrated (Ribeiro et al., 2021). The decision for the client to continue taking Antabuse and start Campral was not chosen because Campral should be combined with psychotherapies to ensure the efficacy of the medication in treating alcoholism. Wellbutrin is an antidepressant used in the treatment of major depressive disorder and also facilitates smoke cessation (Solmi et al., 2020). This choice was not chosen because gambling is a priority over smoking, and also there is no clinical reason for the client to begin Wellbutrin.

The treatment goal with the chosen decision was to ensure the client continued abstaining from alcohol and at the same time treat gambling issues through counseling. This is due to the effectiveness of Antabuse in treating alcoholism and the effectiveness of counseling in reducing gambling addictions (Ribeiro et al., 2021).

The treatment outcome for the decision was that the client went for counseling but reported that she did not like the counselor. She also stated she was attending and felt supported by the gambler’s anonymous group. She still complained about smoking.

The privacy and autonomy of the client were respected. The ability of the client to make decisions regarding her treatment was respected. Additionally, information about her addictions was not disclosed to an unauthorized party. The principle of beneficence was also applied where the selected decision did not have any harm and ensured the best health outcomes for the client (Varkey, 2021).

Decision Point Three

The appropriate decision is for the client to continue with Antabuse dose and investigate the issues she has with the counselor. She will also be encouraged to continue attending gambling group meetings and have the issue of smoking cessation explored. This decision will ensure that the client continues abstaining from drinking alcohol, the problem the counselor has with the counselor is addressed and also gambling and smoking issues are addressed. Decisions to discontinue Antabuse were not considered because the client needs to continue with the medication until she totally recovers from alcoholism. Antabuse is effective in helping people abstain from alcohol (Agabio et al., 2016).

The treatment goal with this decision is that the client will completely recover from alcoholism. This is due to the efficacy of Antabuse in treating alcohol addiction (Agabio et al., 2016). It is also expected that the relationship with the counselor will improve leading to improved treatment outcomes through reduced gambling. Lastly, it is expected that an appropriate treatment plan for smoking cessation will be identified for this client.

For this decision, the autonomy of the client was respected. Her decision to continue the treatment with the counselor was respected. Moreover, beneficence and non-maleficence were used by ensuring that no harm occurred to the client and the selected decisions led to the best health outcomes for the client (Varkey, 2021).

Conclusion

The first decision was for the client to start Antabuse 250 mg. This is because Antabuse helps people abstain from drinking alcohol where someone experiences a very unpleasant side effect of drinking alcohol while on Antabuse. With this decision, the client reported she was having side effects like sedation and fatigue. She also reported having very severe side effects when she took alcohol while taking Antabuse. The second decision was for the client to continue taking Antabuse 250mg and change administration time to evening and have her referred for counseling for the ongoing gambling issues. This is to reduce side effects from Antabuse during the daytime and also ensure she stopped gambling. However, the client reported not liking the counselor. Therefore, the last decision was having the client continue taking Antabuse, exploring the problem with the counselor, and encouraging attendance of gambling anonymous meetings, while exploring the appropriate smoking cessation interventions for the client. These decisions hoped that all addictions that include alcoholism, gambling addiction, and tobacco smoking would improve. Various ethical principles such as autonomy, informed decision, decision-making ability, beneficence, and non-maleficence when developing the treatment plan for this client.

References

Agabio, R., Pani, P. P., Preti, A., Gessa, G. L., & Franconi, F. (2016). Efficacy of medications approved for the treatment of alcohol dependence and alcohol withdrawal syndrome in female patients: a descriptive review. European addiction research, 22(1), 1-16.

Khalil, H., & Huang, C. (2020). Adverse drug reactions in primary care: a scoping review. BMC health services research, 20(1), 1-13.

Mohapatra, S., & Rath, N. R. (2017). Disulfiram Induced Psychosis. Clinical psychopharmacology and neuroscience: the official scientific journal of the Korean College of Neuropsychopharmacology, 15(1), 68–69. https://doi.org/10.9758/cpn.2017.15.1.68

Ribeiro, E. O., Afonso, N. H., & Morgado, P. (2021). Non-pharmacological treatment of gambling disorder: a systematic review of randomized controlled trials. BMC psychiatry, 21(1), 1-15.

Solmi, M., Miola, A., Croatto, G., Pigato, G., Favaro, A., Fornaro, M., … & Carvalho, A. F. (2020). How can we improve antidepressant adherence in the management of depression? A targeted review and 10 clinical recommendations. Brazilian Journal of Psychiatry, (AHEAD).

Toljan, K., & Vrooman, B. (2018). Low-Dose Naltrexone (LDN)-Review of Therapeutic Utilization. Medical sciences (Basel, Switzerland), 6(4), 82. https://doi.org/10.3390/medsci6040082

Varkey, B. (2021). Principles of clinical ethics and their application to practice. Medical Principles and Practice, 30(1), 17-28.

Witkiewitz, K., Litten, R. Z., & Leggio, L. (2019). Advances in the science and treatment of alcohol use disorder. Science advances, 5(9), eaax4043.

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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.

 

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.

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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.

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Decision 1

Begin Antabuse (Disulfram) 250mg orally every morning

 

Decision 2

Continue with Antabuse 250mg and change administration time to evening. Refere client to counseling for ongoing gambling issues.

 

Decision 3

Continue current dose of Antabuse and find out what isuues the client is having with her counselor. Encourage client to continue attending gambling meetings and discuss smoking cessation options.
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