NURS 6630: Week 10 Comorbid Addiction (ETOH and Gambling)
Week 10
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
Assignment: Assessing and Treating Patients with Impulsivity, Compulsivity, and Addiction
Impulsivity, compulsivity, and addiction are challenging disorders for patients across the life span.
Impulsivity is the inclination to act upon sudden urges or desires without considering potential
consequences; patients often describe impulsivity as living in the present moment without regard to the
future (MentalHelp.net, n.d.). Thus, these disorders often manifest as negative behaviors, resulting in
adverse outcomes for patients. For example, compulsivity represents a behavior that an individual feels
driven to perform to relieve anxiety (MentalHelp.net, n.d.). The presence of these behaviors often
results in addiction, which represents the process of the transition from impulsive to compulsive
behavior.
In your role as the psychiatric nurse practitioner (PNP), you have the opportunity to help patients
address underlying causes of the disorders and overcome these behaviors. For this Assignment, as you
examine the client case study in this week’s Learning Resources, consider how you might assess and
treat clients presenting with impulsivity, compulsivity, and addiction.
Reference: MentalHelp.net. (n.d.). Impaired decision-making, impulsivity, and compulsivity: Addictions’
effect on the cerebral cortex. https://www.mentalhelp.net/addiction/impulsivity-and-compulsivity-
addictions-effect-on-the-cerebral-cortex/
To prepare for this Assignment:
Review this week’s Learning Resources, including the Medication Resources indicated for this week.
Reflect on the psychopharmacologic treatments you might recommend for the assessment and
treatment of patients requiring therapy for 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.
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)
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.
Note: Support your rationale with a minimum of five academic resources. While you may use the course
text to support your rationale, it will not count toward the resource requirement. You should be utilizing
the primary and secondary literature.
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