Most Common Addictions Research

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.Most Common Addictions Research

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.

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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.

According Marcusson-Clavertz et al., (2019), mental disorders create disturbances to individuals making it difficult to continue with their day-to-day activities. Some of the altered human characteristics includes mood, behavior, and thinking. Currently, such patient’s cases have escalated thereby drawing attention in the health sector as well as stakeholders. This paper will present a case study of Mrs. Perez, a 53-year-old Puerto Rican female who presents herself to the clinic with an “embarrassing problem”. The patient says that she has been fighting with alcoholism since her father passed away in her late teenage. She reports that her alcoholism has recently been boosted by the opening of a casino around their home making it difficult to maintain sobriety. In addition, the client reports to engage in cigarette smoking for the past 2 years making her worry about her health.

Following the client’s mental status examination, Mrs. Maria Perez shows alertness and is oriented to person, event, place and time. More so, she has a coherent and clear speech but her eye contact is somehow avoidant during an interview session. The patient denies auditory hallucinations as well as paranoic thoughts. She currently declined to have suicidal thoughts or homicidal ideation. She is dressed appropriately for the time of the year and weather. This paper provides a clinical assessment and evaluation of mental conditions and addiction using Mrs. Perez’s case.

Decision point 1:  Vivitrol (naltrexone) injection, 380 mg intramuscularly in the gluteal region every 4 weeks

Based on the presented case study, my initial step to treat the patient will be prescription of Vivitrol (naltrexone) injection, 380 mg intramuscularly in the gluteal region every 4 weeks. This decision seeks to assist the patient with the gambling and alcohol addiction problems, and increased use of tobacco. According to Knox et al., (2019), administration of naltrexone inhibit alcoholism receptors thereby lowering alcohol intake by the client. Since the dug suppress the urge to consume alcohol significantly, this treatment is a crucial remedy in alleviating the client’s symptoms. Other probable options considered for this case include Antabuse (disulfiram) 250 mg orally every morning and Campral (acamprosate) 666 mg orally TID. However, naltrexone was the most effective and has less side effects. For instance, the use of Antabuse (Disulfiram) 250 mg orally daily was not viable in this context since it would create serious side effects such as dyspnea, headache, palpitations, coma, seizure, and death (De Sousa, 2019). On the other hand, Campral (acamprosate) 666 mg orally TID option was not applicable since it is used as a combination of social and psychological treatments to patient with full alcoholic addiction (Spruit & Lytras, 2018).

In regard to the proposed decision, the anticipated results were primarily aiming at reducing the patient’s alcoholic levels of abuse, stop alcohol cravings as well as reduce her attendance of the casino. By so doing, Naltrexone is known to reduce alcohol addiction and gambling disorders. Moreover, Mrs. Perez was expected to tolerate the given types of medications as well as not being exposed to any adverse event experience.

In comparison the expected and the outcome results had similarities from the patient progress. This is so, since Naltrexone administration aided the patient to stop alcohol intake as well as minimizing often casino attendance behaviors. In the treatment program the patient could report a difference in experience in that she complained about anxiety feeling. However, this is a common side effect brough about by interacting with Naltrexone medication.Most Common Addictions Research

Ethical considerations impact your treatment plan

The above decision is controlled by some of ethical consideration that impact treatment and patient communication (Schutz et al., 2019). Some of the ethical considerations include beneficence, informed consent, non-maleficence and autonomy. Medical profession should ensure the patient understand the reason behind selecting a certain drug and some of the risk factors associated with such ideas. However, so doing it allows the patient to uphold the idea from their own consent. Secondly, patient’s medical prescription should be done primarily aiming at improving the current condition (Spruit, & Lytras, 2018). This instills patient with confidence that guarantee no harm while taking a certain dosage. Lastly, clients should not be forced to engage to a particular selected drug against their will.

Decision point 2: Refer to a counselor to address gambling issues

My take in third decision is to refer Mrs. Perez to a counselor to address gambling issues. In this case a counselor will offer the patient with variety of therapies that could applicable in treating gambling disorder. For instance, psychodynamic therapy, cognitive therapy, family and group therapies. According to Gadde, Apolzan, & Berthoud (2018) there are no approved FDA approved pharmacotherapies to manage and treat gambling disorders. Even though, application of pharmacotherapies for gambling disorder can be of importance when issued to patients with comorbid psychiatric disorder such as substance abuse as well as obsessive compulsive disorder.

My choice for the client was critically thought by disqualifying addition on Valium (diazepam) 5 mg orally TID/PRN/anxiety and addition of Chantix (varenicline) 1 mg orally BID (Knox et al., 2019). The other option was both valid but not effective according to the patient condition. For instance, Varenicline 1 mg orally BID option was not approved since it was higher than recommended starting dosage. Besides, giving the client this dose, it would translate to creating more adverse effects such as vomiting, nausea, and agitation. On the other hand, addition of Diazepam option still would not be applicable since Valium act as an addictive benzodiazepine that have longer side effects (Knox et al., 2019). Importantly, applying this option would not be viable since the client’s history of substance use shows that Valium could cause more harm to the patient.

According to the expected result and the outcome there were similarities since the patient returned in clinic with reports of having no anxiety experiences. Besides, the patient reports that she did not like the therapies plan but joined gambling anonymous groups.

Ethical considerations impact your treatment plan

Patient confidentiality is an ethical consideration in the second phase of treating the client with counselling plan. Confidentiality rule ensures patient’s medical history is maintained to prevent getting accessible by an authorized individual in the health sector (Moore & Frye, 2019). The consideration is overruling with only patient’s consent. More so, beneficence ethical rule in this context applies where the counsellor gives alternative measures that will narrow patient addiction to go to gamble. By so doing, professional counselor will give exact information that will benefit and manage her issue comfortably. Secondly, patient voluntary participation is an ethical consideration that allows patient to freely engage in treatment program without being coerced by medical professional (Ienca & Vayena, 2020). Besides, this guideline allows patient to freely comply with medical requirement thereby fastening the healing process.

Decision point 3: Explore the issue that Mrs. Perez is having with her counselor, and encourage her to continue attending the Gamblers Anonymous meetings

The chosen decision for third choice is to Explore the issue that Mrs. Perez is having with her counselor, and encourage her to continue attending the Gamblers Anonymous meetings. This proposal is as result of Mrs. Lopez interaction ending with a bad relationship but she continuously aims at fighting her addiction as seen in joining Gamblers Anonymous Group. Still, counselling remedial remain a significant approach that will offer an outstanding result to the patient. Still, this exploration intervention will give room to give Mrs. Lopez an alternative next step in treatment process (Ienca & Vayena, 2020). The patient will to stop cigarette smoking is a clear indication that she is ready to quit the behavior as a tobacco user. More so, by understanding the patient’s smoking perspective is a vital step that will provide treatment with useful assistance.Most Common Addictions Research

In addition, by choosing this decision, it eliminated other preferable options such as encouraging Mrs. Perez to continue seeing her current counselor as well as continuing with the Gamblers Anonymous group and discontinuing with Vivitrol, encourage Mrs. Perez to continue seeing her counselor and to continue participating in the Gamblers Anonymous group. The other two option were disqualified according to the current stage of the patient condition. This is so, since the patient at this stage is willing to stop visiting casino and is much willing to stop cigarette smoking.

The anticipated outcome and the actual result had close similarities. This is so, since after the patient started visiting a counsellor, she started having the need to quit smoking and gambling by herself. This made her to join anonymous gambling groups that would enable her exit from her current behaviors. The only difference occurred in the process is that the patient stated cooperating rather than objecting the idea by herself drive.

Ethical considerations impact your treatment plan

In the third decision ethical considerations arises to optimize care for the patient to start refraining from substance abuse disorders. By so doing, medics are encouraged to offer encouragement to learn new ideas as well as appropriately knowing how to apply routine screen plans, brief interventions, laboratory test, and treatment referrals (Graves et al., 2020). For instance, from the context it would be helpful to offer the patient with CAGE questionnaire whenever the patient is having alcohol dependence characteristic. This would be most important idea to approach such a patient for treatment plan. More so, patient confidentiality and autonomy must be upholding before prescribing medication to treat such addiction issues. In such cases where medical obligations take place, medics should test clients for substance use condition thus following a health responsibility to acknowledge the client for testing positive as well as making trials to obtain their informed consent (Aarons et al., 2017).

Conclusion

The initial decision was issued to patient to start Naltrexone injection after four weeks. The decision was critically made since the medication is an effective remedy for treating alcohol addiction. This was effective since the patient notably changed gambling behaviors as compared prior starting dosage. Nevertheless, the patient clinical manifestation after initial step reported experiencing anxiety as a side effect of the prescribed drug. More so, the second decision was anchored by referring to a counselor to address gambling issues. This decision was equally important since the counsellor would lower the remaining urge for the client to attend casinos as well as stopping cigarette smoking. This decision was fruitful since even though the client did not uphold for counselling step, the client voluntarily joined Gambling Anonymous Groups to aid stopping her current behaviors.

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Lastly, Explore the issue that Mrs. Perez is having with her counselor, and encourage her to continue attending the Gamblers Anonymous meetings decision was to know more about difficulties that the patient is undergoing even after having a poor relationship with her counselor. This decision aided the patient to completely leave her former disorders. Finally, the employed therapist in the context should keep all the information safe being disclosed to other individuals without the client’s permission.

References

Aarons, G. A., Ehrhart, M. G., Moullin, J. C., Torres, E. M., & Green, A. E. (2017). Testing the leadership and organizational change for implementation (LOCI) intervention in substance abuse treatment: a cluster randomized trial study protocol. Implementation Science, 12(1), 29.

De Sousa, A. (2019). Disulfiram. Springer Singapore.

Gadde, K. M., Apolzan, J. W., & Berthoud, H. R. (2018). Pharmacotherapy for patients with obesity. Clinical chemistry, 64(1), 118-129.

Graves, L., Carson, G., Poole, N., Patel, T., Bigalky, J., Green, C. R., & Cook, J. L. (2020). Guideline No. 405: Screening and counselling for alcohol consumption during pregnancy. Journal of Obstetrics and Gynaecology Canada, 42(9), 1158-1173.

Ienca, M., & Vayena, E. (2020). “Hunting Down My Son’s Killer”: New Roles of Patients in Treatment Discovery and Ethical Uncertainty. Journal of Bioethical Inquiry, 1-11.

Knox, J., Hasin, D. S., Larson, F. R., & Kranzler, H. R. (2019). Prevention, screening, and treatment for heavy drinking and alcohol use disorder. The Lancet Psychiatry, 6(12), 1054-1067.

Marcusson-Clavertz, D., West, M., Kjell, O. N., & Somer, E. (2019). A daily diary study on maladaptive daydreaming, mind wandering, and sleep disturbances: Examining within-person and between-persons relations. PloS one, 14(11), e0225529.Most Common Addictions Research

Moore, W., & Frye, S. (2019). Review of HIPAA, part 1: history, protected health information, and privacy and security rules. Journal of nuclear medicine technology, 47(4), 269-272.

Schutz, D. D., Busetto, L., Dicker, D., Farpour-Lambert, N., Pryke, R., Toplak, H., … & Schutz, Y. (2019). European practical and patient-centred guidelines for adult obesity management in primary care. Obesity facts, 12(1), 40-66.

Spruit, M., & Lytras, M. (2018). Applied data science in patient-centric healthcare: Adaptive analytic systems for empowering physicians and patients.

LINK TO CASE STUDY

https://mym.cdn.laureate-media.com/2dett4d/Walden/NURS/6630/DT/week_08/index.html

// Comorbid Addiction (ETOH and Gambling)

Comorbid Addiction (ETOH and Gambling)

53-year-old Puerto Rican Female

Puerto Rican female

BACKGROUND

Mrs. Maria Perez is a 53 year old Puerto Rican female who presents today due to a rather “embarrassing problem.”

SUBJECTIVE

Mrs. Perez admits that she has had “problems” with alcohol since her father died in her late teens. She reports that she has struggled with alcohol since her 20’s and has been involved with Alcoholics Anonymous “on and off” for the past 25 years. She states that for the past 2 years, she has been having more and more difficulty maintaining her sobriety since the opening of the new “Rising Sun” casino near her home. Mrs. Perez states that she and a friend went to visit the new casino during its grand opening at which point she was “hooked.” She states that she gets “such a high” when she is gambling. While gambling, she “enjoys a drink or two” to help calm her during high-stakes games. She states that this often gives way to more drinking and more reckless gambling. She also reports that her cigarette smoking has increased over the past 2 years and she is concerned about the negative effects of the cigarette smoking on her health.

She states that she attempts to abstain from drinking but she gets such a “high” from the act of gambling that she needs a few drinks to “even out.” She also notices that when she drinks, she doesn’t smoke “as much,” but she enjoys smoking when she is playing at the slot machines. She also reports that she has gained weight from drinking so much. She currently weights 122 lbs., which represents a 7 lb. weight gain from her usual 115 lb. weight.

Mrs. Perez is quite concerned today because she borrowed over $50,000 from her retirement account to pay off her gambling debts, and her husband does not know.

MENTAL STATUS EXAM

The client is a 53 year old Puerto Rican female who is alert and oriented to person, place, time, and event. She is dressed appropriately for the weather and time of year. Her speech is clear, coherent, and goal directed. Her eye contact is somewhat avoidant during the clinical interview. When you make eye contact with her, she looks away or looks down. She demonstrates no noteworthy mannerisms, gestures, or tics. Her self-reported mood is “sad.” Affect is appropriate to content of conversation and self-reported mood. She denies visual or auditory hallucinations, and no delusional or paranoid thought processes are readily appreciated. Insight and judgment are grossly intact; however, impulse control is impaired. She is currently denying suicidal or homicidal ideation.

Diagnosis: Gambling disorder, alcohol use disorder

 Decision Point One

Select what you should do:

Vivitrol (naltrexone) injection, 380 mg intramuscularly in the gluteal region every 4 weeks

Antabuse (disulfiram) 250 mg orally daily

Campral (acamprosate) 666 mg orally three times/day

RESULTS OF DECISION POINT ONE

Client returns to clinic in four weeks

Mrs. Perez says she feels “wonderful” as she has not “touched a drop” of alcohol since receiving the injection

Client reports that she has not been going to the casino, as frequently, but when she does go she “drops a bundle” (meaning, spends a lot of money gambling)Most Common Addictions Research

Client She is also still smoking, which has her concerned. She is also reporting some problems with anxiety, which also has her concerned

Decision Point Two

Select what you should do next:

Add on Valium (diazepam) 5 mg orally TID/PRN/anxiety

Refer to a counselor to address gambling issues

Add on Chantix (varenicline) 1 mg orally BID

RESULTS OF DECISION POINT TWO

Mrs. Perez returns in 4 weeks and reports that the anxiety that she had been experiencing is gone.

She reports that she has met with the counselor, but she did not really like her.

She also started going to a local meeting of Gamblers Anonymous. She states that last week, for the first time, she spoke during the meeting. She reports feeling supported in this group.

Decision Point Three

Select what you should do next:

Explore the issue that Mrs. Perez is having with her counselor, and encourage her to continue attending the Gamblers Anonymous meetings

Encourage Mrs. Perez to continue seeing her current counselor as well as continuing with the Gamblers Anonymous group

Discontinue Vivitrol. Encourage Mrs. Perez to continue seeing her counselor and to continue participating in the Gamblers Anonymous group

Guidance to Student

Although controversy exists in the literature regarding how long to maintain a client on Vivitrol, 8 weeks is probably too soon to consider discontinuation. The psychiatric mental health nurse practitioner should explore the issues that Mrs. Perez is having with her counselor. As will be covered in more depth in future courses, ruptures in the therapeutic alliance can result in clients stopping therapy. Clearly, if the client does not continue with therapy, the likelihood of the gambling problem spontaneously remitting is lower (than had the client continued to receive therapy). Recall that there are no FDA-approved treatments for gambling addiction. The mainstay of treatment for this disorder is counseling. Since Mrs. Perez reports good perceived support from the Gamblers Anonymous meetings, she should be encouraged to continue her participation with this group.

You need to discuss smoking cessation options with Mrs. Perez in order to address the totality of addictions, and to enhance her overall health.

PLEASE INCLUDE ADDITIONAL INTRODUCTION ON  ADDICTION, THEN CASE STUDY INTRODUCTION AND CONCLUSION. ETHICAL CONSIDERATIONS ARE FOR EACH DECISIONS PLEASE.

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.Most Common Addictions Research

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. Most Common Addictions Research