Addiction, compulsivity and impulsivity are correlated psychiatric disorders affecting a significant population across the U.S. As such, mental health practitioner nurses should comprehend the forms of addiction and their corresponding treatment. Furthermore, alcohol addiction is a disorder according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-V). Treatment differs from one client to the other. The nurse practitioner, however, should use a patient-centered approach in making treatment decisions for a client. This paper will review the symptoms of a client with addiction based on assessment and make three treatment decisions with their rationales.
Decision One
The client will begin treatment with Naltrexone (Vivitrol) injection, 380mg in the gluteal region in a span of every four weeks. The rationale behind selection of Naltrexone stems from its relation to naloxone. Besides it is an opioid receptor antagonist. Naltrexone helps eliminate the urge or rather craving associated with alcohol addiction. Aboujaoude & Salame in their study reveals that Naltrexone has been used in evidence-based clinical trials and it helps reduce chances of relapsing to heavy drinking as well as the urge to gamble and related behaviors (2016). According to (Aboujaoude & Salame), Naltrexone blocks the receptors of opioid to achieve reduced consumption. By making this decision, I was hoping to achieve reduced or completely eliminate the client’s desire to drink and gamble.
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A follow-up revealed actual outcomes such as complete reduction of drinking and fewer visits to the Casino. Side effects of Naltrexone on the client also include vomiting, reduced appetite, and nausea. The client also reported increased smoking where they spent a lot of money. Expectations and actual outcomes differ in that the client has developed a side effect and also increased his rate of smoking.
Decision 2
Based on the developed issue of anxiety on the client, she will be referred to a counselor. This is particularly because they stem from gambling issues. Research reveals that the gambling disorder is mostly associated with the use of tobacco (Ritchie, Hodgins & McGrath, 2019). This explains why the client has resulted to heavy smoking. As such the best way to address the issue of gambling is through cognitive and behavioral therapy. According to Hoffman & Otto (2017) cognitive behavioral therapy is considered the best for treating individuals with smoking and anxiety issues.
In four weeks’, time, the expected outcome would be to reduce anxiety, smoking and gambling by the client. The actual outcome is reduced anxiety and attending of a local support group to help with gambling. It is expected that in the long the group will be beneficial in coping or completely doing away with the problem. The expected and actual outcome were similar in that in both, the client has reduced anxiety.
Decision 3
Discontinuing the client from Naltrexone would not be the right decision because it would trigger a relapse in drinking. The best approach for the third decision would be to have a conversation with the client regarding her milestones so far. After which I would encourage her to continue attending the anonymous gambling support group. The expected outcome for this decision would be for the client to continue with the cognitive behavioral therapy sessions as well as attend the local support group. The rationale for this treatment is based on the need for having a client understand and have an input in the treatment plan regardless of their condition (Reus et al., 2018). The expected outcome and the actual outcome are similar in that the client has continually attended the meetings as well as cognitive behavioral therapy for four weeks in a row.
In conclusion, clients such as Puerto who have a combination of addictions require various treatment methods. Nurses should be at the forefront of providing patient-centered treatment where the client’s input should be considered. This enables adherence to treatment and eventually recovery.
References
Aboujaoude, E., & Salame, W. O. (2016). Naltrexone: a pan-addiction treatment? CNS drugs , 30 (8), 719-733.
Hofmann, S. G., & Otto, M. W. (2017). Cognitive behavioral therapy for social anxiety disorder: Evidence-based and disorder specific treatment techniques . Routledge.
Reus, V. I., Fochtmann, L. J., Bukstein, O., Eyler, A. E., Hilty, D. M., Horvitz-Lennon, M., ... & McIntyre, J. (2018). The American Psychiatric Association practice guideline for the pharmacological treatment of patients with alcohol use disorder. American Journal of Psychiatry , 175 (1), 86-90.
Ritchie, E. V., Hodgins, D. C., & McGrath, D. S. (2019). Comorbid Smoking and Gambling Disorder: Potential Underlying Mechanisms and Future Explorations. In Neuroscience of Nicotine (pp. 393-401). Academic Press.
