Addiction Treatment for Clients
Addiction disorders disorient clients’ thinking and cravings, which makes it hard for them to survive with their families. Condition is characterized by excess cravings for alcohol which becomes difficult to control the client. Social and economic orientations are disoriented, making clients end up broke and lonely. Gambling and alcoholism make it difficult for clients to quit and it requires proper intervention from advanced nurses to manage the conditions. The case study does involve a 53-year-old Puerto Rican woman who started drinking heavily two years ago. It is important to note that the client started drinking when she was a teenager as a result of losing her father, and since then, this has been difficult to quit. The client also gets involved in gambling as she says that every time she goes to the casino that was opened in the neighborhood, she cannot resist the temptation to gamble.
Some of the factors that I will consider when prescribing this patient include contraindications for drugs, side effects, ethical considerations, and age. Assessing some of the diseases that might contraindicate the medications available is essential to avoid damaging the further health of the patient in the case study(Tuchina et al., 2018). The severity of the side effects of the drugs in the case stud will be considered to reduce instances of noncompliance from the patient in the case study. The issues of informed consent and autonomy will be crucial in prescribing the medication that is acceptable for the client. The following is a prescription for Perez and a justification for the same.
Decision #1
The first decision will be to give the client Antabuse (disulfiram) 250 mg orally every morning. The drug is recommended for the addiction of alcohol as it is used in the reduction of the cravings that are experienced by the patient for alcohol. It works by stopping the enzyme that does metabolize the alcoholin the body of the client (Shanmugapriya et al., 2020). The reason for not using Naltrexone (Vivitrol) is because of the injection which the client in the case study might at noncompliant in the long run as it creates pain in the injection area (Saucier, Wolfe&Dasgupta, 2018). The drug is also not appropriate for alcohol as it best works for addiction to opioids. The reason for not choosing the third decision of Campral (acamprosate) is because the drug is associated with impaired thinking as a result of severe drowsiness which can cause noncompliance for the patient.
I expected that the use of this drug would reduce the cravings of the client for alcohol andreduce gambling. The results indicate that the patient experiences sedation, has a metallic taste, and her heart seems to pound out of her heart. However, she reports that she has had only one drink in five days, something she never used to do, and she spends less money in the casino. Research shows that patients are taking Antabuse to experience these side effects, which can be tolerated(Shanmugapriya et al., 2020).
Informed consent should be applied, as patients should be informed of the side effects of every drug available(Tuchina et al., 2018). The information will prepare the client on the onset of side effects that will be felt. The client should also be informed of the choice to change drugs and the repercussions of the same.
Decision #2
The decision, in this case, should be to continue the current dose of Antabuse and refer to counseling for ongoing gambling issues.The first decision shows that the client reduced their intake of alcohol and gambling as well. There is no need to change a drug that achieves therapeutic results on side effects that can be managed with time(Shanmugapriya et al., 2020). The decision to refer the patient to a counselor is important as it allows her to learn new ways of quitting gambling from a professional on that issue, not an advanced nurse. The third decision of mixing both Antabuse and Wellbutrin could also lead to the severe side effect of drowsiness and sedation that could reduce compliance for the patient in the case study. Thefirst decision of continuing the current dose of Antabuse andbeginningCampral (acamprosate) 666 mg orally BID is not appropriate because Campral (acamprosate) 666 mg orally BID and Antabuse can cause severe drowsiness for the client(Saucier, Wolfe &Dasgupta, 2018).
I expect the patient to have reduced smoking and drinking as well as an improved reduction of gambling sessions. Results from the decision show the patient feels confident and can speak in gamblers’ anonymous meetings. She smokes a bit and doesn’t like the counselor as she reports no drinking, meaning that the drug advanced to her is working and the side effects symptoms are improving.
Autonomy ethical consideration should be applied in this case to give the patient a choice to continue with medications or change the same. Changing the drug at this stage might be the wrong idea for the patient, but the nurse should give the client information for her to choose the best decision to make(Tuchina et al., 2018). If the client is tolerating the symptoms, the nurse should advise her to continue with the same.
Decision #3
The third decision should be to explore the issues that Mrs. Perez is having with her counselor and encourage her to continue attending the Gambling Anonymous meeting and discuss smoking cessation.The fact that the primary chief complaint of alcohol addiction and gambling has been significantly reduced means that referring the patient to discuss smoking cessation in an anonymous group helps manage to smoke. The same medication used in the management of comorbidity of gambling and alcohol abusecan be used to reduce smoking for patients. The reason for not choosing the decision to need to discontinue the use of Antabuse medication is that it has achieved therapeutic outcomes, and stopping it would make a relapse for the patient in a case study on alcohol addiction(Shanmugapriya et al., 2020). The reason for not choosing to stick with the counselor that the patient is complaining about without addressing the issue is that it would reduce compliance with therapeutic instructions, thus making a relapse to gambling and addiction to alcohol eventually.
I expect that after four weeks, the patient would have quit smoking, stopped completely gambling, and no more intake of alcohol after this decision. It is because the use of Antabuse drug can be used beyond an eight weeks period to reduce the symptoms suffering by the client. The results show that the patient improved on gambling, reduced smoking cessation, and no more drinking alcohol was witnessed.
Ethical consideration, in this case, is beneficence, as the nurse should prescribe a therapy that improves the client’s good. The best action here is to continue with the Antabuse and anonymous group as well as address the issue being experienced by the client with the counselor (Tuchina et al., 2018). It helps the patient to recuperate well without the side effects that come with the other two options.
Conclusion
Comorbiditydisorder of alcohol addiction and gambling can be devastating for the patient, and the use of an FDA-approved medication of Antabuse is essential to manage the condition. However, the nurse needs to collaborate with a counselor to contain the gambling problem, as there is no FDA-approved drug to contain the habit. The nurse should address the issue that the client is having with the counselor to ensure that there is a smooth recovery of the client in the case study. The nurse practitioner needs to consider the side effects experienced by the patients after the advancement of the drugs to improve compliance for quick recovery. Joining the anonymous group for gambling for the client is essential as it does expose the patient to clients suffering from similar disorders, which gives her confidence to quit the condition.Consideration of informed consent when approving the prescription use is essential for the approval of the patient of the drug and toleration of the side effects that come with the prescription. The use of autonomy as well as beneficence ethical consideration is relevant for the compliance of the medication offered to improve the health outcomes of the patient.
References
Saucier, R., Wolfe, D., &Dasgupta, N. (2018). Review of case narratives from fatal Overdoses
associated with injectable naltrexone for opioid dependence. Drugsafety, 41(10), 981-988.
Shanmugapriya, V., Karthikeyan, D., Ravish, H., &Srinivas, H. (2020). Impact of Antabuse
Treatment on Dyslipidemia and Oxidative Stress Levels in Chronic Alcoholism. Journal of Stress Physiology & Biochemistry, 16(4), 113-118.
Tuchina, O. D., Agibalova, T. V., Shustov, D. I., Shustova, S. A., Buzik, O. Z., &Petrosyan, Y.
E. (2018). Use of the placebo effect in the psychotherapy of narcology patients: therapeutic and ethical aspects. Neuroscience and Behavioral Physiology, 48(4), 392-398.
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