NURSING

Nursing: Assessing and Treating Patients with Impulsivity, Compulsivity, and Addiction

Case Introduction

The current case concerns a 53-year-old Puerto Rico female, Mrs. Maria Perez. She suffers from embarrassing problem, which is gambling addiction and alcoholism. She frequently smokes as well; however, this is on certain occasions.

According to the clients self-reports, alcoholism started during her late teenage years after her fathers death. She stated that she had tried several times to get rid of the nasty habit; however, she has been experiencing more difficulty doing so for two years. She was involved with Alcoholics Anonymous, but all in vain. The past two years changed her significantly since a new casino opened near her home. Mrs. Perez visited Rising Sun with her friend, after which it became impossible to offload her addiction to gambling and the ever-increasing alcoholism.

She admitted that she needed alcohol, often one or two drinks, when gambling to keep down her high movement while in the game. She also mentioned smoking during playing with the slot machines. She smoked less and drank more. She gained weight in these two years, knowing it was due to her habit of drinking. Her current weight is 122 pounds, a straight 7-pound weight gain from drinking. Her normal weight was 115 pounds before this scenario.

Another troubling factor is she borrowed $50,000 from her retirement account to pay off her gambling debts. Her husband is not aware of the action she has already taken. Her fear and awkwardness were evident in how she sat, such as looking away or down when someone was making eye contact. Otherwise, her mental state seems normal as she was goal-directed, wearing appropriate clothes according to the weather, and showed clear speech signs. Her discernment and understanding were unimpaired, while the overall mood was distressed and sad.

Decision 1

The first selected decision is to refer the client to a counselor to address gambling issues. It is selected because she has mentioned improving her curbing of the addition of alcohol. Still, the problem remains with the gambling issue. She knows she cannot stop spending money once she is inside the casino. However, she has experienced anxiety lately. It is presumed it could be with the use of Vivitrol as it is its common side effect (Thornton, 2022).

The other two options were not selected since it was assumed that drug interactions might cause further complications in her condition. Research has suggested that Vivitrol and Valium might cause pain in extremities in females for anxiety treatment; valium is recommended along with Naltrexone (eHealthme, n.d.-a). Also, prescribing Chantix could have worked better for smoking cessation, yet, anxiety problems might have stayed. It could not be ignored that for certain females, drug interaction of Chantix and Vivitrol might be serious, resulting in kidney disease when a decrease in creatinine renal clearance is observed (eHealthme, n.d.-b). Therefore, it was not deemed effective to focus only on smoking or anxiety; rather, an entire behavioral change might be essential.

It is hoped that face-to-face psychological interventions would effectively address the impulsivity for gambling (Mental help.net, n.d.). Anxiety might have also risen from the continuing embarrassment noted in the first session. She might think that medications are not healing her completely, and she can still not control her guilt. Cognitive-behavioral therapies and motivational interviewing (MI) would effectively teach her self-control strategies to activate self-help organization (Rodda et al., 2018). It could be more helpful with...

…pharmacological and psychological treatments for addressing gambling issues, anxiety, embarrassment, and suicide intention, behavioral counseling seems to be an inevitable solution. It is inevitable as the drugs are proven not to produce optimistic results alone. Psychological empowerment must show its validation as it is the specific loss of control towards gambling for which the patient seeks treatment.

Only behavioral alterations can work effectively when inhibition of impulsivity is witnessed. The consequences of actions are causing distress for the patient, which might lead her to more serious behavioral problems. It is said so because, during her first visit, she could not make eye contact due to embarrassment and further indulgence in taking loans to pay off her gambling debts. It is predicted if the same patterns persist, she might have marital problems or social exclusion due to the inability to face people. The uncomfortable feelings are not solely treated with medications; hence, behavioral intervention becomes mandatory.

Some part should be fulfilled with patient education since the client must know what medications she would be taking, how they would produce results, and what initial side effects her body might face. For example, extreme drowsiness was one of the cases that troubled her. She needs to be completely aware of how her body would react according to her condition. Also, it is necessary not to harm her, and keeping her informed are the two primary ethical implications of the entire practice. It is evident that the client does want to get rid of her addiction and wants to lead herself to recovery; the brain regions would have to be managed carefully with medications for limiting powerful urges and letting the brain adjust with corrective measures and adaptations resulting from…