Assessing and Treating Clients With Impulsivity, Compulsivity, and
Addiction Essay
Assessing and Treating Clients With Impulsivity, Compulsivity, and Addiction
EssayAssessing and Treating Clients With Impulsivity, Compulsivity, and Addiction
EssayCo-morbid Addiction (ETOH and Gambling)53-year-old Puerto Rican
FemaleBACKGROUNDMrs. Maria Perez is a 53-year-old Puerto Rican female who presents
to your office today due to a rather “embarrassing problem.”SUBJECTIVEMrs. 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 two years, she has
been having more and more difficulty maintaining her sobriety since they opened the new
“Rising Sun” casino near her home. Mrs. Perez states that she and a friend went to visit the
new casino during their 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 two years and she is concerned about the negative effects of the cigarette smoking
on her health. Assessing and Treating Clients With Impulsivity, Compulsivity, and Addiction
Essay.She states that she attempts to abstain from drinking but that 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 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 has borrowed over $50,000 from
her retirement account to pay off her gambling debts. Assessing and Treating Clients With
Impulsivity, Compulsivity, and Addiction Essay. She is very concerned because her husband
does not know that she has spent this much money.ORDER NOW FOR CUSTOMIZED,
PLAGIARISM-FREE PAPERSMENTAL STATUS EXAMThe client is a 53-year-old Puerto Rican
female who is alert, 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. As 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 &

self-reported mood. She visual or auditory hallucinations, 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.
Assessing and Treating Clients With Impulsivity, Compulsivity, and Addiction
EssayDiagnosis: Gambling disorder, alcohol use disorderDecision Point OneSelect what the
PMHNP should do:Naltrexone (Vivitrol) injection, 380 mg intramuscularly in theNaltrexone
(Vivitrol) injection, 380 mg intramuscularly in the gluteal region every 4 weeksgluteal
region every 4 weeksAntabuse (Disulfiram) 250 mg orally dailyAntabuse (Disulfiram) 250
mg orally dailyCampral (Acamprosate) 666 mg orally three times/dayCampral
(Acamprosate) 666 mg orally three times/dayTo prepare for this Assignment:• Review this
week’s Learning Resources. Consider how to assess and treat adolescent clients requiring
therapy for impulsivity, compulsivity, and addiction.Go to:NURS 6630 SyllabusWeek 8
AssignmentCase Study AssignmentThe AssignmentExamine 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 stop to
complete the following:Decision #1Which decision did you select?Why did you select this
decision? Support your response with evidence and references to the Learning
Resources.What were you hoping to achieve by making this decision? Support your
response with evidence and references to the Learning Resources.Explain any difference
between what you expected to achieve with Decision #1 and the results of the decision.
Why were they different?Decision #2Why did you select this decision? Support your
response with evidence and references to the Learning Resources.What were you hoping to
achieve by making this decision? Support your response with evidence and references to
the Learning Resources.Explain any difference between what you expected to achieve with
Decision #2 and the results of the decision. Why were they different?Decision #3Why did
you select this decision? Support your response with evidence and references to the
Learning Resources.What were you hoping to achieve by making this decision? Support
your response with evidence and references to the Learning Resources.Explain any
difference between what you expected to achieve with Decision #3 and the results of the
decision. Why were they different?Note: Support your rationale with a minimum of three
academic resources. While you may use the course text to support your rationale, it will not
count toward the resource requirement.In each decision please discuss reason why the
other 2 medication were not used, there should be an introduction and a
conclusion.Assessing and Treating Clients with Impulsivity, Compulsivity, and Addiction
Sample PaperIntroductionThe subject of this assignment is Mrs. Maria Perez, a 53-year-old
Puerto Rican woman who has been treated for alcohol use and gambling disorders.
Gambling disorder is characterized by recurrent and persistent maladaptive gambling
behavior that includes lying to family members, endangering relationships, employment,
education, and more. It is characterized by preoccupation with gambling, the need to wager
larger sums of money to experience the desired thrill, persistently unsuccessful attempts to
control or stop gambling, irritability when trying to stop gambling, and going back to it even
after losing money to gambling, among other symptoms (Calado & Griffiths, 2016). On the

other hand, alcohol use disorder is the inability of a person to manage or control their
alcohol-intake behaviors in spite of the desire to stop or the alcohol intake jeopardizing
their relationships, work, education etc. (Yau & Marc, 2015). The client reported of alcohol
and gambling addiction and is also worried about her increased tobacco smoking. MSE for
the client indicates that the client is avoiding direct eye contact and is sad as well.
Accordingly, in this paper, three decisions will be made on the client’s treatment while
considering the pharmacokinetic and pharmacodynamics effects on the client. Assessing
and Treating Clients With Impulsivity, Compulsivity, and Addiction Essay.Decision Point
OneThe first decision that was selected is to administer the client with Naltrexone (Vivitrol)
injection, 380 mg intramuscularly in the gluteal region every 4 weeks. The rationale for
selecting this decision is based on the fact that naltrexone is a competitive antagonist at
addiction/alcohol receptors and therefore inhibits alcohol agonist-induced effects,
including the effects the alcohol abusers desire. The medication also represses the desire for
alcohol intake (Sullivan et al, 2014). Therefore, Naltrexone (Vivitrol) is an appropriate
choice to treat alcohol addiction for the client. Additionally, clinical trials demonstrate the
efficacy of Naltrexone in treating alcoholism (Alanis-Hirsch et al, 2016). Assessing and
Treating Clients With Impulsivity, Compulsivity, and Addiction Essay. Moreover, the
medication has minimal side effects and therefore the client is likely to tolerate the
administered dose with the targeted efficacy.The option of Antabuse (Disulfiram) 250 mg
orally daily was not selected because the medication is associated with numerous serious
side effects such as a headache, dyspnea, sympathetic over-activity, palpitations, vomiting,
seizure, coma, and even death. Moreover, there is a high risk of toxicity with the medication
in addition to the high rate of non-adherence with Disulfiram (Crowley, 2015). On the other
hand, the option of Campral (Acamprosate) was not selected because evidence recommends
Campral to be used in combination with psychological and social treatment as a component
of a full alcohol addiction treatment (Crowley, 2015). In addition, guidelines recommend the
medication to be started 5-7 days after the last drink yet the client has not withdrawn from
the alcohol. In addition, the 3-times daily dosing regimen with Campral can reduce its
adherence (Crowley, 2015). Assessing and Treating Clients With Impulsivity, Compulsivity,
and Addiction Essay.With this decision, the expectation was that the client will gradually
reduce her alcohol abuse, and stop craving for alcohol and desire to gamble as well. This is
because studies demonstrate the efficacy of Naltrexone (Vivitrol) in lowering the desire to
take alcohol as well as in reducing gambling cravings in individuals with gambling disorder.
The other expectation was that the client would tolerate the medication and therefore she
would not experience any adverse event.The outcome that was hoped for and the results of
the decision were almost similar. This is because after starting Naltrexone (Vivitrol)
injection, the client did stop alcohol intake and also there was a reduction in gambling. The
only difference is that the client reported complaints about anxiety. The anxiety is a
common side effect of Naltrexone (Vivitrol) medication.Decision Point TwoFor decision 2,
the decision that was chosen is to add valium (diazepam) 5 mg. This reason for choosing
this decision is to treat the anxiety for the client. The medication was selected because
valium influences GABA receptors within the brain; the receptors regulate anxiety. Valium
influences GABA receptors by slowing the central nervous system which reduced the

feelings of anxiety and produces a calming effect and therefore reduced anxiety symptoms
(Calcaterra & Barrow, 2014). A study conducted by Warren et al (2016) indicated the
efficacy of valium in the treatment of anxiety symptoms. Assessing and Treating Clients
With Impulsivity, Compulsivity, and Addiction Essay.The choice to have the client attend
counseling for gambling issue was not chosen because this option would not address the
anxiety the client is currently manifesting and also the client is already manifesting
improvement in regard to gambling. The option of adding Chantix (varenicline) was not
chosen due to the many adverse and side effects associated with varenicline, for example,
suicide, sleep disturbance, cardiovascular events etc. (Davies et al, 2015).Selection of this
decision aimed to ensure that the symptoms of anxiety that the client is manifesting would
improve. This is because the evidence demonstrates the efficacy of valium in improving
anxiety symptoms (Warren et al, 2016). Another expectation was that the client would not
have a dependency on the medication.There were no notable differences between the
expected results and the actual outcome of the decision. Assessing and Treating Clients
With Impulsivity, Compulsivity, and Addiction Essay. The actual outcome was that the
symptoms of anxiety considerably improved. The only difference is that the client was
asking for higher and frequent doses of the medication indicating a dependency on the
medication. The dependency the client is manifesting on valium is because of the addictive
effect of valium as a benzodiazepine (Tvete et al, 2016).Decision Point ThreeThe chosen
decision point three is for the client to continue with Vivitrol dose; taper Valium with the
aim to discontinue the medication within the next two weeks and to have the client to
counseling for the gambling issue. The reason for selecting the decision to taper valium is to
gradually withdraw the medication and discontinue it in two weeks because the client is
showing symptoms of dependency on the medication. According to Tvete et al (2016)
benzodiazepines such as valium are not supposed to be taken for more than two-four weeks
of continuous use since individuals can develop dependency and tolerance even after a
short period. The decision to not discontinue valium immediately is because sudden
withdraw might have led to the client developing withdrawal symptoms. Evidence and
guidelines recommend gradual withdrawal of benzodiazepines in order to avoid patients
from experiencing withdrawal symptoms (Fluyau et al, 2018). In addition, this option also
involved the client being referred to counseling to help in her gambling addiction. Assessing
and Treating Clients With Impulsivity, Compulsivity, and Addiction Essay. Evidence shows
that counseling is effective in managing gambling addiction and therefore counseling would
have addressed gambling addiction for the client (Choliz, 2018).Options to continue with
the existing Vivitrol dose and maintain or increase the current valium dose were not chosen
because the client needs to be tapered off the valium medication because she is already
showing dependency on the medication and therefore there is need to gradually withdraw
the medication (Warren et al, 2016).Selecting the decision to continue with Vivitrol dose
and taper Valium medication hoped to gradually withdrawal valium for the patient and
ensure the client does not develop any valium dependency. Another expectation was that
the counseling would address the gambling issue for the client and help reduce the
gambling addiction. Assessing and Treating Clients With Impulsivity, Compulsivity, and
Addiction Essay.ConclusionThe first decision point for the client was to administer

Naltrexone (Vivitrol) injection every four weeks. This decision was selected because Vivitrol
has been shown to be effective in the treatment of alcohol addiction. Just like it was
expected, the client stopped drinking alcohol and also she stop gambling as frequently as
before. Nonetheless, the client manifested anxiety and this was attributable to the side
effects of Vivitrol. The second decision was the addition of valium (diazepam) for the
treatment of the client’s anxiety symptoms. Just as expected, the anxiety levels for the client
reduced. However, the client exhibited a dependency on valium as indicated by her request
to increase the valium dose. Assessing and Treating Clients With Impulsivity, Compulsivity,
and Addiction Essay. Due to the evidence dependency on valium, the third decision that was
selected was to have the current dose of naltrexone maintained while gradually tapering
valium dose. This decision was chosen because even though the client is showing
dependency on the medication, sudden withdrawal would result in withdrawal symptoms
for the client. The third decision also involved referring the client to a counselor to have her
gambling addiction issue addressed. Finally, the therapist should maintain the
confidentiality of all information that the client disclosed and not divulge the information to
any other party without the client’s consent. Assessing and Treating Clients With
Impulsivity, Compulsivity, and Addiction Essay.ReferencesAlanis-Hirsch K, Coff R, Ford J,
Johnson K, Mady C, Laura S & Dennis M. (2016). Extended-release naltrexone: A qualitative
analysis of barriers to routine use. J Subst Abuse Treat. 1(62), 68–73Calado F & Griffiths M.
(2016). Problem gambling worldwide: An update and systematic review of empirical
research (2000–2015). J Behav Addict. 1; 5(4), 592–613.Calcaterra N & Barrow J. (2014).
Classics in Chemical Neuroscience: Diazepam (Valium). ACS Chem Neurosci. 5(4), 253–260.
Assessing and Treating Clients With Impulsivity, Compulsivity, and Addiction Essay.Choliz
M. (2018). Ethical Gambling: A Necessary New Point of View of Gambling in Public Health
Policies. Front Public Health. 6(12).Crowley P. (2015). Long-term drug treatment of patients
with alcohol dependence. Aust Prescr. 38(2), 41–43.Davies N, Taylor G, Taylor A, Thomas K,
Frank W, Martin R & Munafo M. (2015). What are the effects of varenicline compared with
nicotine replacement therapy on long-term smoking cessation and clinically important
outcomes? Protocol for a prospective cohort study. BMJ Open. 5(11): e009665. Assessing
and Treating Clients With Impulsivity, Compulsivity, and Addiction Essay.Fluyau D,
Revadigar N & Brittany M. (2018). Challenges of the pharmacological management of
benzodiazepine withdrawal, dependence, and discontinuation. Ther Adv
Psychopharmacology. 8(5), 147–168.Sullivan M, Adam B, Mariani J, Glass A, Levin F, Comer
S & Nunes E. (2014). Naltrexone treatment for opioid dependence: Does its effectiveness
depend on testing the blockade? Drug Alcohol Depend. 133(1), 80–85.Tvete I, Trine B & Tor
S. (2016). A 5-year follow-up study of users of benzodiazepine: starting with diazepam
versus oxazepam. Br J Gen Pract. 66(645), e241–e247.Warren A, Cowen G & Harmer C.
(2016). Cognitive mechanisms of diazepam administration: a healthy volunteer model of
emotional processing. Psychopharmacology (Berl). 1(233), 2221–2228.Yau Y & Marc P.
(2015). Gambling Disorder and Other Behavioral Addictions: Recognition and
Treatment. Harv Rev Psychiatry. 23(2), 134–146. Assessing and Treating Clients With
Impulsivity, Compulsivity, and Addiction Essay.University of Michigan Health System.
(2016). Childhood trauma linked to worse impulse control in adulthood, study finds.

Retrieved from
https://www.sciencedaily.com/releases/2016/01/160120201324.htmNote: Retrieved
from Walden Library databases.NURS 6630 – Psychopharmacologic Approaches to
Treatment of Psychopathology Essay AssignmentGrant, J. E., Odlaug, B. L., & Schreiber, L. N.
(2014). Pharmacological treatments in pathological gambling. British Journal of Clinical
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