Assessing and Treating Patients with Impulsivity, Compulsivity, and Addiction
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Assessing and Treating Patients with Impulsivity, Compulsivity, and Addiction
Introduction
The case study focuses on a 53-year-old Puerto Rican female with gambling disorder and alcohol use disorder. The disorders indicate impulsivity, compulsivity, and addiction. Alcohol use and behavioral addictive disorders are closely linked, and treatment will help reduce and prevent impulsive and compulsive behavior. Receiving pharmacotherapy and psychotherapy will result in alcohol abstinence, smoking, and gambling cessation, leading to improved psychological functioning.
Disulfiram, naltrexone, and acamprosate are three pharmacotherapies approved for treating people with alcohol use disorder (Winslow et al., 2016). Acamprosate increases abstinence rates, and naltrexone decreases alcohol consumption. Ideally, the effect of the treatment ought to persist, so alcohol dependence and co-occurring gambling disorder no longer persist. The likelihood of successful alcohol use remission and smoking cessation increases when counseling and behavioral therapies besides pharmacotherapy.
The three decisions are Antabuse (Disulfiram) 250 mg orally daily, continuing the current dose of Antabuse, and referring to counseling for ongoing gambling issues. The third choice is for Mrs. Perez to work with a counselor and encourage her to attend Gamblers Anonymous (GA) meetings and discuss smoking cessation options.
Decision #1: Antabuse (Disulfiram) 250 mg orally daily
The preferred choice is Antabuse (Disulfiram) 250 mg orally daily. De Sousa & De Sousa (2004) reported that Disulfiram was more effective than naltrexone in preventing relapse among men with alcohol addiction and family support. Disulfiram is associated with a lower relapse rate and increased abstinence. Disulfiram “inhibits the liver enzyme aldehyde dehydrogenase” (Pedersen et al., 2018). Alcohol consumption, when treated with Disulfiram, is linked to the accumulation of acetaldehyde, but pharmacotherapy is preferred for individuals seeking abstinence (Pedersen et al., 2018).
The option “Vivitrol (naltrexone) injection, 380 mg intramuscularly in the gluteal region every four weeks” was not chosen. Naltrexone and Disulfiram are among the most commonly used medications to reduce alcohol consumption and improve for promoting abstinence. While naltrexone reduces heavy drinking, it is less effective in maintaining alcohol abstinence.
The third option, “Campral (acamprosate) 666 mg orally three times/day,” was not selected. Acamprosate was not chosen as notable side effects such as nausea, suicidal ideation, and anxiety. The client’s main concern is controlling alcohol addiction that often leads to gambling and impulsive behaviors.
I expected there would be reduced alcohol use and remission over time. Ideally, there ought to be smoking cessation because of less craving after treatment and greater time to relapse. There are no approved pharmacotherapies for gambling addiction, and the top prioritY…
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