Decision 1: Naltrexone (Vivitrol) injection, 380 mg intramuscularly in the gluteal region every 4 weeks
Naltrexone is recommended for patients who have a heavy and ongoing alcohol abuse disorder, with a similar risk of suffering various consequences from this persistent use. It is prescribed to patients who are motivated to reduce alcohol intake and who do not have any contraindications for the drug. Mrs. Perez is a heavy drinker who has tried the anonymous alcoholic approach without any success. The drugs aids in the modulation of opioid systems in the body, thereby enhancing abstinence. Antabuse was rejected because it has diverse adverse effects such as nausea, vomiting, a metallic taste and tachycardia. Mrs. Perez would struggle to cope with her daily life amidst such experiences. It is recommended for patients who have attained abstinence. Acamprosate, on the other hand, is not recommended for patients with heavy drinking and in search of self-control. According to Grant, Odlaug, & Schreiber (2014), it should be used by abstinent patients; hence, it could not be selected in this case either.
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When choosing this drug, I expected that it would decrease Mrs. Perez's alcohol consumption or empower her to attain total abstinence. I also sought the route with the least side effects as I did, she was still staying at home and taking care of her family, where side effects would interrupt that (Grant, Odlaug, & Schreiber, 2014). I also sought to have her bring back her life into control. I was worried about how the drug might affect her anxiety, which was the main side effect of this Naltrexone.
The results of the decisions were satisfactory and following my expectations. The primary intention was to promote abstinence, and this was realized. She is making great progress, and everything seems optimistic. Anxiety was an expected side effect, which I seek to address during the next visits (Grant, Odlaug, & Schreiber 2014). The client also reported smoking and persisted addiction to gambling. Even though the first intervention was not meant to address the two issues, they are of urgency and need to be attended to promptly.
Decision 2: Refer to a Counselor for Gambling Issues
A gambling disorder can be addressed by several types of therapy, such as cognitive behavior, psychodynamic, group and family therapy. There is no pharmacotherapeutic approach approved by the FDA, even though it is argued that addressing the associated issues such as substance abuse can help. She was also concerned about her continued smoking. I could have prescribed Chantix (varenicline), which would have addressed the issue of smoking, but the dosage option available was too high. The recommended starting dose id 0.5mg/day, which should then be increased after three days to 1mg/day (Vinay, Lakshmi, & Math, 2016). This decision would have exposed her to a lot of adverse effects, such as nausea and agitation. On the other hand, Valium would be a good way to address the increased anxiety. However, it is a highly addictive benzodiazepine with various other side effects (Vinay, Lakshmi, & Math, 2016). My main concern was the addiction. Mrs. Perez's history of substance abuse and addiction thwarted me from prescribing another addictive substance, hence my decision to settle with a counsellor.
When making this decision, I hoped to ensure that Mrs. Perez's gambling problem was addressed. It was contributing to her substance abuse besides bringing her financial constraints, which could potentially lead her marriage into jeopardy. She had reported increased spending at the casino, and this would bring other issues later on. As such, this decision was solely to address the gambling problem.
The results of this decision were satisfactory. She reported that her anxiety was gone, which would indicate that her body was getting acclimatized to Naltrexone. Her mood was significantly better, even though she reported not liking her therapist (Salmon, & Forester, 2012). I did not expect her anxiety to be gone and was hoping to offer a pharmacotherapeutic intervention. Her decision to going to a local meeting of gamblers anonymous is prudent, and the intervention seems to be currently working perfectly (Sanches et al., 2014). Her comfort and passion for the group will be productive towards her recovery.
Decision 3: Explore the issue that Mrs. Perez is having with her counsellor, and encourage her to continue attending Gamblers Anonymous meetings
Mrs. Perez is still addicted to gambling, and counselling is the primary approach towards addressing it. It is her only hope towards completely abstaining from the vice. The relationship with her counsellor is flawed, but her determination to get her lifestyle under control is evident from her decision to join the local gamblers, anonymous group. It is a step that indicates that all is not lost for her. Before any intervention can be made towards addressing her smoking problem, Grant, Odlaug, & Schreiber (2014), recommend an assessment of her willingness to quit. Her perspective towards the issue and dedication to addressing it will be central to the provision of useful assistance. There might be side effects and personal struggles in the process, hence understanding her readiness and solving her relationship issues with the counsellor will come in handy.
The expectation of this decision was that Mrs. Perez would understand why she did not like her counsellor before finding a different one. In addition to that, it is essential that she goes into smoking cessation very determined (Salmon, & Forester, 2012). Even though there are other health goals to achieve, she must defend and maintain the progress she has made so far. Her approach to smoking cessation options is also essential in ensuring that she does not suffer any further adverse effects of sink into a different kind of addiction.
Ethical Considerations in Treatment Planning and Communication with Clients
Patients with substance use disorder are also susceptible to various pharmacotherapeutic remedies that they are offered. For optimized care, any counsellor should ensure that the appropriate medical precautions such as laboratory screening brief interventions, referrals and periodic reviews of their parents are practiced. The treatment approach should be guided by evidence-based practice and reliable methods such as the use of CAGE questionnaire in alcohol use psychotherapy. The ethical codes of conduct demand the promotion of patient autonomy and confidentiality. Patients should be allowed to make medical decisions that affect them on their own, without coercion. Often, there are legal and medical obligations that come up and demand client testing to ascertain their condition in various occurrences. The therapist has to maintain an ethical responsibility to communicate and deliberate this information between the authorities, the healthcare personnel and the client. The therapist should defend his or her clients and make an effort to obtain client consent without thwarting the legal course. Lastly, according to Loreck, Brandt, & DiPaula' (2016), patients with mental issues as a result of substance abuse should be perceived, attended to and treated like any other patients. It is critical to separate personal business, emotions of bias from counsellor's professional work because it is not only ethical to do so but also because it can be counterproductive in the long-run.
References
Grant, J. E., Odlaug, B. L., & Schreiber, L. R. (2014). Pharmacological treatments in pathological gambling. British journal of clinical pharmacology, 77(2), 375-381.
Loreck, D., Brandt, N. J., & DiPaula, B. (2016). Managing opioid abuse in older adults: Clinical considerations and challenges. Journal of gerontological nursing, 42(4), 10-15.
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, 8(1), 74-84.
Sanches, M., Scott-Gurnell, K., Patel, A., Caetano, S. C., Zunta-Soares, G. B., Hatch, J. P., ... & Soares, J. C. (2014). Impulsivity in children and adolescents with mood disorders and unaffected offspring of bipolar parents. Comprehensive psychiatry, 55(6), 1337-1341.
Vinay, B., Lakshmi, J., & Math, S. B. (2016). Ethical and legal issues in psychotherapy. In Ethical Issues in Counselling and Psychotherapy Practice (pp. 199-217). Springer, Singapore.
