NURS 6630 Assessing and Treating Patients With Impulsivity, Compulsivity, and Addiction
NURS 6630 Assessing and Treating Patients with Impulsivity, Compulsivity, and Addiction
Addiction is characterized by behavioral, psychological, and physical symptoms caused by a person having inadequate control over the use of a substance. One of the addiction disorders is gambling, characterized by frequent and repetitive involvement in gambling. Affected persons are unable to resist the urge to gamble, and this dominates, making them neglect their educational, occupational, and social obligations. The purpose of this assignment is to describe a patient with an addiction disorder and discuss the treatment interventions.
Introduction to the Case
The case depicts Mrs. Perez, a 53-year-old woman who reports having problems with alcohol since she was in her 20s. She states that the problems began when her father died in her late teens and has severally attended Alcoholics Anonymous meetings. According to Perez, the last two years have been challenging for her in her efforts to remain sober after a casino was opened near her place of residence. She gambles at the casino, which makes her high. She mentions that she takes some drinks to calm her when gambling, particularly in intense games. The few drinks lead to more drinking and make her gamble irresponsibly. The irresponsible gambling has left her in debt of over $50,000.
Mrs. Perez is worried about her smoking pattern, which has worsened in the past two years. She mostly smokes when gambling but rarely smokes when taking alcohol. Her presentation leads to diagnoses of Gambling disorder and alcohol use disorder (AUD). Patient factors that can influence decisions when developing a treatment plan include comorbid medical conditions, the patient’s previous response to AUD therapy, the patient’s level of motivation to achieve abstinence, and treatment adherence.
Decision #1
Vivitrol (Naltrexone) injection, 380 mg IM in the gluteal region every four weeks.
Why I Selected This Decision
Naltrexone was the drug of choice because it effectively reduces alcohol consumption by decreasing alcohol cravings. Ray et al. (2019) found that Naltrexone reduces craving, reduces stimulation, increases sedation, and increases negative mood, which results in decreased alcohol intake. Besides, a monthly injection formulation would foster treatment adherence, leading to better treatment outcomes.
Why I Did Not Select the Other Two Options
Antabuse (Disulfiram) was not ideal because it causes disulfiram ethanol reaction (DER) when a patient takes alcohol and thus requires supervised use. DER is characterized by flushing, tachycardia, hypotension, tachypnea, palpitations, headache, sweating, nausea, vomiting, giddiness, and a sense of impending doom associated with severe anxiety (Castrén et al., 2019). Campral (acamprosate) was not the drug of choice because it is primarily indicated to attain and maintain complete abstinence instead of reducing or preventing relapse in regular alcohol use (Stokłosa et al., 2023). It also requires three times daily dosing, which may lead to challenges with compliance.
What I Was Hoping to Achieve
The clinician hoped that Naltrexone would suppress the patient’s craving for alcohol, leading to reduced intake. Stokłosa et al. (2023) explain that Naltrexone suppresses the reward system and reduces the pleasure experienced after consuming alcohol products.
Ethical Considerations That May Impact the Treatment Plan and Communication
Ethical principles of beneficence and nonmaleficence may impact the treatment plan since the clinician has to consider a treatment intervention linked with the best outcomes and least harm for patients with AUD. Communication may be affected by the patient’s right to autonomy, given that the clinician has to discuss the treatment plan with the patient.
Decision #2
Refer Mrs. Perez to a counselor to address gambling issues.
Why I Selected This Decision
The patient was referred to a counselor because psychological intervention is effective in treating gambling addiction, and there is no approved drug to treat the disorder. Eriksen et al. (2023) found that cognitive behavioral therapy (CBT) has the strongest evidence supporting its effectiveness in managing gambling addiction. Besides, Cognitive-behavioral approaches are simple and effective.
Why I Did Not Select the Other Two Options
Adding Valium to treat the patient’s anxiety was not ideal because it is a dose-dependent side effect of Naltrexone (Ray et al., 2019). Counseling can help the client identify and manage her causes of anxiety through effective coping mechanisms (Higueruela-Ahijado et al., 2023). Moreover, Chantix (varenicline) was not ideal for the patient’s smoking habit since it is linked with gambling. Thus, it is essential to first address gambling addiction, which will lead to reduced smoking (Eriksen et al., 2023).
What I Was Hoping to Achieve
The NP hoped that counseling would help the patient identify the causes of her gambling disorder and address these issues, which would reduce his gambling and smoking and prevent alcohol relapse. In the initial stages, including during detoxification, patients are given supportive psychotherapy in counseling to encourage them and enhance their motivation (Higueruela-Ahijado et al., 2023).
Ethical Considerations That May Impact the Treatment Plan and Communication
Beneficence may impact treatment because the NP has to identify the best measure to address the patient’s gambling disorder to avoid a relapse of alcohol use. Furthermore, the NP has to obtain the patient’s consent when initiating a treatment intervention, which may impact communication with the client.
Decision #3
Explore Mrs. Perez’s issue with her counselor and encourage her to continue attending GA meetings.
Why I Selected This Decision
It was crucial to identify the issues the patient has with her counselor to help address them and motivate the client to continue with therapy. Ruud and Friis (2022) explain that continuity of care and therapeutic relationships (TRs) are considered essential factors by clients in mental health. Addressing issues can help establish and maintain a good TR between Perez and her counselor.
Why I Did Not Select the Other Two Options
It would be inappropriate to persuade the client to continue attending counseling without addressing the reasons why she did not like the counselor. This can affect their TR and limit the patient from getting the best from the counseling sessions (Ruud & Friis, 2022). Stopping Vivitrol was inappropriate at this point since it can lead to a relapse, especially when the client has not addressed her gambling issue (Stokłosa et al., 2023).
What I Was Hoping to Achieve
The NP hoped that the patient would continue with therapy after exploring and addressing the issues she has with her counselor. The NP also hoped that encouraging Perez to continue attending GA meetings would help her address her addiction problem. Group therapy, such as GA sessions, provides counseling and support to deal with common issues (Eriksen et al., 2023). The groups use educational and operational principles to explain drug abuse as a disease and various methods used to avoid drug-seeking behaviors.
Ethical Considerations That May Impact the Treatment Plan and Communication
The NP had to uphold confidentiality when exploring issues with the client, which may impact treatment and communication. For instance, the NP must assure the patient that what will be discussed will be kept confidential to encourage the client to express her concerns with the counselor.
Conclusion
Mrs. Perez was diagnosed with Gambling disorder and alcohol use disorder. She started on Naltrexone monthly injection since it decreases alcohol use by reducing craving, reducing stimulation, increasing sedation, and increasing negative mood (Ray et al., 2019). Disulfiram was not prescribed because it requires supervised use due to the disulfiram ethanol reaction (DER) that occurs when a patient takes alcohol (Castrén et al., 2019). Acamprosate was also not selected because it is indicated for patients who are maintaining complete abstinence e (Stokłosa et al., 2023).
Naltrexone led to alcohol abstinence, but the patient’s gambling problem persisted. Consequently, she was referred for counseling since psychological intervention is effective in treating gambling addiction, and there is no medication for addiction (Eriksen et al., 2023). However, the patient reported disliking her counselor but enjoyed Gamblers Anonymous meetings. The NP explored the issues Perez has with her counselor to help her have a good and effective therapeutic relationship, which is fundamental to achieving the desired therapy outcomes (Ruud & Friis, 2022). She was also encouraged to continue attending GA sessions as they provide counseling and support clients with addictions to deal with common issues. Furthermore, the patient was continued on Vivitrol to avoid relapse in alcohol use until she addresses her gambling issues through counseling.
References
Castrén, S., Mäkelä, N., & Alho, H. (2019). Selecting an appropriate alcohol pharmacotherapy: Review of recent findings. Current Opinion in Psychiatry, 32(4), 266-274. doi:10.1097/yco.0000000000000512
Eriksen, J. W., Fiskaali, A., Zachariae, R., Wellnitz, K. B., Oernboel, E., Stenbro, A. W., Marcussen, T., & Petersen, M. W. (2023). Psychological intervention for gambling disorder: a systematic review and meta-analysis. Journal Of Behavioral Addictions, 12(3), 613–630. https://doi.org/10.1556/2006.2023.00034
Higueruela-Ahijado, M., López-Espuela, F., Caro-Alonso, P. Á., Novo, A., & Rodríguez-Martín, B. (2023). Efficacy of cognitive-behavioral therapy in improving the quality of life of people with compulsive gambling, a systematic review. Archives Of Psychiatric Nursing, 43, 127–142. https://doi.org/10.1016/j.apnu.2022.12.014
Ray, L. A., Green, R., Roche, D. J. O., Magill, M., & Bujarski, S. (2019). Naltrexone effects on subjective responses to alcohol in the human laboratory: a systematic review and meta-analysis. Addiction Biology, 24(6), 1138–1152. https://doi.org/10.1111/adb.12747
Ruud, T., & Friis, S. (2022). Continuity of care and therapeutic relationships as critical elements in acute psychiatric care. World Psychiatry: Official Journal Of The World Psychiatric Association (WPA), 21(2), 241–242. https://doi.org/10.1002/wps.20966
Stokłosa, I., Więckiewicz, G., Stokłosa, M., Piegza, M., Pudlo, R., & Gorczyca, P. (2023). Medications for the treatment of alcohol dependence-current state of knowledge and future perspectives from a public health perspective. International Journal of Environmental Research And Public Health, 20(3), 1870. https://doi.org/10.3390/ijerph20031870
Tigh, J., Daniel, K., & Balasanova, A. A. (2022). Impact of Hospital-Administered Extended-Release Naltrexone on Readmission Rates in Patients With Alcohol Use Disorder: A Pilot Study. The Primary Care Companion for CNS Disorders, 24(6), 43569. https://doi.org/10.4088/PCC.21m03213
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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/
Resources
Be sure to review the Learning Resources before completing this activity.
Click the weekly resources link to access the resources.
Learning Resources
Required Readings
- Stahl, S. M. (2021). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (5th Ed.) Cambridge University Press.
- Chapter 13, “Impulsivity, Compulsivity, and Addiction” (pp. 538-578)
- Substance Abuse and Mental Health Services Administration. (1999). Treatment of adolescents with substance use disorders: Treatment improvement protocol series
- Links to an external site., no. 32. http://www.ncbi.nlm.nih.gov/books/NBK64350/
- Chapter 1, “Substance Use Among Adolescents”
- Chapter 2, “Tailoring Treatment to the Adolescent’s Problem”
- Chapter 7, “Youths with Distinctive Treatment Needs”
- University of Michigan Health System. (2016). Childhood trauma linked to worse impulse control. Journal of Psychosocial Nursing & Mental Health Services
- Links to an external site., 54(4), 15.
- Grant, J. E., Odlaug, B. L., & Schreiber, L. N. (2014). Pharmacological treatments in pathological gambling. British Journal of Clinical Pharmacology
- Links to an external site., 77(2), 375–381. https://doi.org/10.1111/j.1365-2125.2012.04457.x
- Hulvershorn, L. A., Schroeder, K. M., Wink, L. K., Erickson, C. A., & McDougle, C. J. (2015). Psychopharmacologic treatment of children prenatally exposed to drugs of abuse. Human Psychopharmacology
- Links to an external site., 30(3), 164–172. https://doi.org/10.1002/hup.2467
- Loreck, D., Brandt, N. J., & DiPaula, B. (2016). Managing opioid abuse in older adults: Clinical considerations and challenges. Journal of Gerontological Nursing
- Links to an external site., 42(4), 10–15. https://doi.org/10.3928/00989134-20160314-04
- Salmon, J. M., & Forester, B. (2012). Substance abuse and co-occurring psychiatric disorders in older adults: A clinical case and review of the relevant literature. Journal of Dual Diagnosis
- Links to an external site., 8(1), 74–84. https://doi.org/10.1080/15504263.2012.648439
- Sanches, M., Scott-Gurnell, K., Patel, A., Caetano, S. C., Zunta-Soares, G. B., Hatch, J. P., Olvera, R., Swann, A. C., & Soares, J. C. (2014). Impulsivity in children and adolescents with mood disorders and unaffected offspring of bipolar parents. Comprehensive Psychiatry
- Links to an external site., 55(6), 1337–1341. https://doi.org/10.1016/j.comppsych.2014.04.018
Medication Resources
- U.S. Food & Drug Administration. (n.d.). Drugs@FDA: FDA-approved drugs
- Links to an external site.. https://www.accessdata.fda.gov/scripts/cder/daf/index.cfm
Links to an external site.
Note: To access the following medications, use the Drugs@FDA resource. Type the name of each medication in the keyword search bar. Select the hyperlink related to the medication name you searched. Review the supplements provided and select the package label resource file associated with the medication you searched. If a label is not available, you may need to conduct a general search outside of this resource provided. Be sure to review the label information for each medication as this information will be helpful for your review in preparation for your Assignments.
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Required Media
- Links to an external site.
Note: This case study will serve as the foundation for this week’s Assignment.
Optional Resources
- Lupi, M., Martinotti, G., Acciavatti, T., Pettorruso, M., Brunetti, M., Santacroce, R., Cinose, E., Di Iorio, G., Di Nicola, M., & Di Giannantonio, M. (2014). Pharmacological treatments in gambling disorder: A qualitative review. Biomed Research International, 2014
- Links to an external site.. https://doi.org/10.1155/2014/537306
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.
Reminder : The College of Nursing requires that all papers submitted include a title page, introduction, summary, and references. The Sample Paper provided at the Walden Writing Center provides an example of those required elements (available at https://academicguides.waldenu.edu/writingcenter/templates/general#s-lg-box-20293632). All papers submitted must use this formatting
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Rubric
NURS_6630_Week10_Assignment1_Rubric
| Criteria | Ratings | Pts | ||||
|---|---|---|---|---|---|---|
| This criterion is linked to a Learning Outcome 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. |
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10 pts | ||||
| This criterion is linked to a Learning Outcome Decision #1 (1–2 pages)• 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. |
|
20 pts | ||||
| This criterion is linked to a Learning Outcome Decision #2 (1–2 pages)• 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. |
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20 pts | ||||
| This criterion is linked to a Learning Outcome Decision #3 (1–2 pages)• 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. |
|
20 pts | ||||
| This criterion is linked to a Learning Outcome 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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15 pts | ||||
| This criterion is linked to a Learning Outcome Written Expression and Formatting – Paragraph Development and Organization: Paragraphs make clear points that support well-developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused—neither long and rambling nor short and lacking substance. A clear and comprehensive purpose statement and introduction are provided that delineate all required criteria. |
|
5 pts | ||||
| This criterion is linked to a Learning Outcome Written Expression and Formatting – English writing standards: Correct grammar, mechanics, and proper punctuation |
|
5 pts | ||||
| This criterion is linked to a Learning Outcome Written Expression and Formatting – The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, parenthetical/in-text citations, and reference list. |
|
5 pts | ||||
| Total Points: 100 | ||||||