1-3Assessing and Treating Impulsivity, Compulsivity, and Addiction

Assessing and Treating Impulsivity, Compulsivity, and AddictionAssessing and Treating 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.

Assessing and Treating Impulsivity, Compulsivity, and Addiction.

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)

Assessing and Treating Impulsivity, Compulsivity, and Addiction

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.

ALSO CHECK:  D1 Core Competencies

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Solution

Assessing and Treating Impulsivity, Compulsivity, and Addiction

Although impulsivity and compulsivity are key contributors to behavioral addiction, impulsivity is the initiator of addiction behavior while compulsivity supports the maintenance of the condition. Impulsivity refers to inappropriate behaviors, premature and risky which result in untoward outcomes. Compulsivity refers to a tendency toward repetitive and habitual behaviors, despite their negative consequences. The case study presents a 53- year’s old Puerto-Rican woman diagnosed with habitual gambling and alcoholism.

Gambling disorder is characterized by continuously occurring and persistent gambling actions. This disorder is confirmed when an individual is preoccupied with gambling, spends large sums of money, experiences irritability and unsuccessful efforts to quit the habit, gambles again even after spending a lot of money, and jeopardizes their relationships, work, and education, among others.

Alcohol use disorder is characterized by the incapability of an alcohol addict to control or stop the drinking habit despite their willingness to stop and the harmful effects their behavior causes to their lives. Mrs. Perez states that her gambling and alcohol use disorders are worrying her as well as the increased tobacco smoking. From the conducted mental state examination, the client is seen as sad and constantly avoids direct eye contact with the clinician.

The purpose of this paper is to describe gambling and alcohol use disorders briefly including three therapy options that are chosen for the condition treatment and observing the pharmacokinetics and pharmacodynamics outcomes on the patient.

Decision 1: Administer Naltrexone (Vivitrol) Injection 380 mg Intramuscularly

My first decision is to administer Administer Naltrexone (Vivitrol) Injection of 380 mg intramuscularly in the client’s gluteal region every twenty-eight days. The reason behind choosing this option is due to the effectiveness of Naltrexone Vivitrol. Naltrexone is an established drug as a competitive antagonist at addiction/alcohol receptors. Due to this, Naltrexone inhibits the agonist-induced effects of alcohol such as the effect desired by the alcohol abuser.

Naltrexone is also established as an agent of reducing the desire for alcohol abuse among individuals (Sullivan et al., 2013). Due to these drug effects, Naltrexone Vivitrol is, therefore, the most suitable and appropriate option to manage and treat alcohol use disorder for Ms. Perez. Further, conducted clinical experiments approved the efficacy and appropriateness of this medication in managing and treating alcohol use disorder (Alanis, et al. 2016). The patient is most likely to adhere to the administered medication and achieve the desired objectives as Naltrexone Vivitrol is known to cause minimal and manageable side effects.

The reason for not choosing Antabuse (Disulfiram) 250 mg orally daily is due to its associated side effects including severe headaches, seizures, dyspnea, palpitations, coma, and even death. According to research, Antabuse (Disulfiram) is associated with a high level of patients’ non-adherence and has a high risk of toxicity (Crowley, 2015). In the case of Campral (Acamprosate), the medication was not chosen as it requires other combination treatments for its effectiveness.

Campral (Acamprosate) should be used together with psychological and social treatment to produce the targeted objectives of alcohol use disorder treatment (Crowley, 2015). Also, the first dose of this medication is supposed to be administered one week after the last time of alcohol use which is not applicable as Mr. Perez has not yet withdrawn from alcoholism. The medication is supposed to be administered three times a day which reduces the possibility of patient adherence to this medication.

The expected results from this decision are that Ms. Perez will reduce her alcohol abuse gradually, as well as a controlled desire for alcohol and gambling. I also expect the patient to adhere to the medication and experience no severe side effects. In the patient’s next clinical visit, some of the anticipated outcomes were noted as Ms. Perez stated that she had stopped her alcoholism abuse behavior and that she had reduced her gambling habits. However, Ms. Perez reported that since the initiation of the medication, she had been experiencing anxiety which is an established side effect of Naltrexone Vivitrol.

Decision 2: Add Valium (Diazepam) 5 mg on top of Naltrexone Vivitrol

My second decision is to administer Valium (Diazepam) 5 mg on top of Naltrexone Vivitrol. The rationale behind choosing this medication is to address the anxiety side effect of Naltrexone Vivitrol. Valium (Diazepam) is documented to alleviate anxiety conditions as it influences GABA receptors in a patient’s brain, which regulates anxiety.

The influence Valium causes on the GABA receptors tends to slow the central nervous system which in turn lowers anxiety feeling as well as releases a calming effect reducing the feeling and symptoms of anxiety (Cheng et al., 2018). The medication is also documented as the most effective and appropriate medication in the treatment of anxiety symptoms.

Assessing and Treating Impulsivity, Compulsivity, and Addiction

I did not choose to send Ms. Perez to a counselor who would manage her gambling condition because the counseling therapy would not address the anxiety symptoms. Additionally, the patient has presented with an improvement in her gambling disorder after the administration of Naltrexone Vivitrol. Also, I did not choose to add Chantix (Varenicline) as it is associated with many adverse side effects such as heart conditions, suicide, and insomnia (Davies, et al., 2015).

The main objective of choosing Valium is to address the anxiety complaints reported by the patient. This is deemed a feasible option as it is established as an appropriate and effective medication for anxiety symptoms (Warren et al., 2016). It is expected that from this decision, the patient will have reduced anxiety symptoms and that she will not have a dependency on this medication.

Assessing and Treating Impulsivity, Compulsivity, and Addiction

In her next clinical visit, the patient presented with improved symptoms of anxiety after the initiation of the dosage. However, the patient had developed a dependency on the medication as she requested an increased dosage of valium medication. The dependency can be attributed to the fact that Valium is a benzodiazepine that is associated with addictive effects (Tvete et al., 2016).

Decision 3: Continue with Naltrexone Vivitrol and taper Valium Diazepam

My third decision is to continue with Naltrexone Vivitrol medication and reduce the valium dosage. The reason behind this decision is due to the noted improvements with Naltrexone Vivitrol medication and taper Valium with the aim of discontinuing the medication after fourteen days. After the discontinuation of Valium medication, I will have the patient attend a counseling session to deal with the gambling problem. Gradually withdrawing Valium medication is to address the noted dependency on the drug.

Also, research shows that benzodiazepines should be used for at most four weeks as they are highly addictive. The gradual discontinuation of Valium medication was arrived at due to the associated consequences of sudden withdrawal including the development of withdrawal symptoms. Also, the preference of referring Ms. Perez to counseling is to address her gambling condition. Counseling is an effective way of managing and controlling gambling and hence an appropriate decision for the client. Combining the already presented gambling improvements from Naltrexone Vivitrol and counseling, there are high chances of achieving higher improved outcomes.

The decision to continue with Naltrexone Vivitrol is due to the improvements which the client presented both for alcohol use disorder and gambling problems. I did not choose to increase valium dosage because the patient is developing a dependency on the drug and needs to be discontinued. The expected result is that Naltrexone Vivitrol and counseling will both address gambling addiction as well as completely curb alcohol addiction. It is also expected that the patient will experience a gradual withdrawal of valium and not experience valium dependency.

Ethical Considerations

Care providers must communicate with the client about the effectiveness and downsides of medications and medication modifications and support the patient in making treatment decisions to minimize the influence of ethical concerns on their care. Therapists should also ensure to inform the patient reasons behind choosing a certain medication. Also, the treatment chosen should be aimed at managing health conditions which ensures client confidence and adherence to the prescribed medication.

Assessing and Treating Impulsivity, Compulsivity, and Addiction

Therapists should also seek the patient’s consent before administering any medication. It is the responsibility of the therapist to preserve the confidentiality of any information disclosed by the patient and not share it unless under the patient’s consent. Additionally, the patient’s health should remain a priority and paramount before medication prescription. The therapist should engage in a trustworthy, respectful, and appropriate treatment plan with the full consent of the client. They should also be updated on the current empirical findings of psychiatric treatments including the adverse effects and possible complications.

Conclusion

Impulsivity and compulsivity go hand in hand and are key contributors to addiction. From the case presented, the first decision was to initiate Naltrexone Vivitrol for 28 days. This was based on the effectiveness of this medication in addressing alcohol addiction. The medication was effective as the patient presented with stopped alcohol use and reduced gambling habits.

The patient was however diagnosed with anxiety as a side effect of Vivitrol which lead to the decision of adding valium diazepam 5 mg on top of Vivitrol. The initiation of valium diazepam was aimed at reducing anxiety symptoms and its effectiveness was as expected. However, the patient presented with a developing dependency on valium diazepam which was addressed by discontinuing the medication as our decision three.

The third decision also entailed continuing naltrexone medication and referring the patient to counseling. The counseling was to facilitate the reduction of gambling habits. The treatment plan also involved observance of health care ethics as well as consideration of legal issues.

 

References

Alanis-Hirsch, K., Croff, R., Ford II, J. H., Johnson, K., Chalk, M., Schmidt, L., & McCarty, D. (2016). Extended-release naltrexone: A qualitative analysis of barriers to routine use. Journal of substance abuse treatment, 62, 68-73.

Cheng, T., Wallace, D. M., Ponteri, B., & Tuli, M. (2018). Valium without dependence? Individual GABAA receptor subtype contribution toward benzodiazepine addiction, tolerance, and therapeutic effects. Neuropsychiatric disease and treatment, 14, 1351.

Crowley, P. (2015). Long-term drug treatment of patients with alcohol dependence. Australian prescriber, 38(2), 41.

Davies, N. M., Taylor, G., Taylor, A. E., Thomas, K. H., Windmeijer, F., Martin, R. M., & Munafò, M. R. (2015). What are the effects of varenicline compared with nicotine replacement therapy on long-term smoking cessation and clinically important outcomes? Protocol for a prospective cohort study. BMJ sOpen, 5(11), e009665.

Pringle, A., Warren, M., Gottwald, J., Cowen, P. J., & Harmer, C. J. (2016). Cognitive mechanisms of diazepam administration: a healthy volunteer model of emotional processing. Psychopharmacology, 233(12), 2221-2228.

Sullivan, M. A., Bisaga, A., Mariani, J. J., Glass, A., Levin, F. R., Comer, S. D., & Nunes, E. V. (2013). Naltrexone treatment for opioid dependence: does its effectiveness depend on testing the blockade?. Drug and alcohol dependence, 133(1), 80-85.

Tvete, I. F., Bjørner, T., & Skomedal, T. (2016). A 5-year follow-up study of users of benzodiazepine: starting with diazepam versus oxazepam. British Journal of General Practice, 66(645), e241-e247.

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