Assessing and Treating Patients With Impulsivity, Compulsivity, and Addiction

Paper details
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.
To prepare for this Assignment:
• Reflect on the psychopharmacologic treatments you might recommend for the assessment and treatment of
patients requiring therapy for impulsivity, compulsivity, and addiction.
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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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:
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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