Assessing and Treating Patients with Impulsivity, Compulsivity, and Addiction – Solved

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Assessing and Treating Patients with Impulsivity, Compulsivity, and Addiction

Introduction to the Case

The case involves a 53-year-old Puerto Rican who presents with alcohol. Her name is Mrs Maria Perez. She reveals that she has had a drinking problem following her father’s demise in her 20s. She has been with Alcoholics Anonymous inconsistently in the last 25 years. In the last two years, she hasn’t been able to maintain sobriety. She attributes this habit to a new casino in her neighborhood whose grand opening she attended attracted her. Mrs Perez reveals that when she gambles and drinks a lot to calm her whenever she stakes big, leading to more alcohol consumption and irresponsible gambling.

She further reveals that she has increasingly smoked in the last two years, leading to her concern about the consequences of cigarettes on her wellbeing. Her attempts to quit drinking have been futile since her gambling habit compels her to drink more. She reports weight gain, currently weighing 122lbs up from her usual weight of 115lbs. Significantly, she is concerned about the amount of $50 000 she took from her savings account to offset her gambling debts without her husband’s knowledge.

Mental examinations show that she is alert and shows awareness of herself, the surrounding, the occasion, and the time. Her dressing is appropriate but does not maintain direct eye contact. She demonstrates clarity and coherency in her speech, which is also goal-directed. She displays no mannerism though she reports a good mood. Besides, she denies any auditory or visual delusion, hallucination, or paranoia. Her insight and personal judgment are generally intact though her impulsivity is impaired. She also denies suicidal ideation. She is diagnosed with gambling and alcohol use disorder.

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Decision One

The first decision selected is Vivitrol (Naltrexone) injection, 380 mg every four weeks. In this case, Mrs Perez has tried a psychological approach with the Anonymous Alcoholics in vain. Therefore, a pharmacological approach is relevant for alcohol abuse treatment. The U.S Food and Drug Administration recommends Naltrexone as a treatment intervention for adults with risky or hazardous drinking behaviors (Winslow et al., 2016).

Naltrexone has been shown in studies to decrease alcohol intake and improve relapse rates (Garbutt et al., 2014). Naltrexone inhibits the stimulating effects of alcohol and opioids by modulating opioid systems (Stahl, 2017). Furthermore, Naltrexone suppresses ethanol intake by altering the hypothalamic-pituitary-adrenal axis.

The option to select Antabuse (disulfiram) 250 mg orally every morning was not selected because the evidence supporting the efficacy of disulfiram in treating alcohol abuse disorder is inconsistent (Winslow et al., 2016). On the other hand, acamprosate is recommended for maintaining alcohol abstinence in people who are currently not taking alcohol (Maisel et al., 2013). In this sense, acamprosate is effective for patients who have completed inpatient treatment of alcohol dependence and are concerned about relapse (Cayley, 2011). Further, studies have shown that acamprosate carried a higher risk of diarrhea (Cayley, 2011).

Following the Naltrexone prescription, I expected that Mrs Perez would abstain from alcohol consumption and gambling. According to Ward et al. (2018), Naltrexone has a significant outcome in reducing gambling cravings. I also expected that the client’s smoking habit would reduce. This is because she initially admitted gambling to cause her increased smoking habit. Ward et al. (2018) argue that Naltrexone treats addictions by endogenous binding opioids stimulated by gambling. In this sense (Ward et al., 2018), I expect Naltrexone to reduce the client’s gambling addiction.

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Decision Two

The second decision was to refer Mrs Perez to a counselor for her gambling issues. The U.S Food and Drug Administration recommends using Naltrexone with brief behavioral counseling to reduce alcohol misuse (Winslow et al., 2016). Though pharmacotherapy is an approved solution to gambling, a direct effect can be achieved through an intervention to solve the comorbid condition, which is smoking. According to the American Psychiatric Association, counseling therapy is crucial for gambling cessation and smoking (American Psychiatric Association, 2016). Standard therapies include psychodynamic therapy, group or family therapy, cognitive-behavioral therapy.

I did not select the option to add Valium 5mg orally because it is an addictive benzodiazepine. Besides, it has long-lasting effects; this would cause the client more harm considering she has a history of smoking and alcohol abuse. Besides, Valium has been shown to induce several sensations and mood effects similar to those induced by alcohol (Swift et al., 1998). On the other hand, I did not choose to add Chantix 1mg orally because the dosage is slightly higher than the recommended daily dosage of 0.5mg per day, titrated to 1mg per day after days (Stahl, 2017). Starting at a higher dosage could lead to side effects of nausea, agitation, and vomiting.

My expectation following Mrs Perez’s referral to a counselor is that she will receive therapy aimed at reducing her gambling and smoking habits. My expectations were supported by the fact that Pathological gamblers who smoke cigarettes regularly need unique or enhanced care intervention, including counseling (Grant et al., 2008). Besides, I expected that Mrs Perez would continue to adhere and respond positively to medication leading to complete alcohol and gambling cessation.

Decision Three

I selected the decision to explore the issue that Mrs Lopez is having with her counselor. I also advised her to continue with the meeting involving Gamblers Anonymous. According to Cayley (2011), counseling for smoking cessation should not be stopped whether the patient perceives herself ready or not. Therefore, it was crucial to solving the problems that Mrs Perez had against the counselor as she continues her counseling sessions. Besides, the issues seemed to be minimal, considering Mrs Perez continued going for the Gambler’s Anonymous meetings.

Furthermore, counseling has been considered a significant intervention for gambling and smoking addictions. The counselor would assess her readiness to quit and devise effective ways to help her achieve her healthcare goals. Besides, understanding her perceptions is crucial in helping her accept counseling.

I did not choose to encourage Mrs Perez to continue seeing her counselor. My decision was guided by the fact that the patient’s perception of her counselor was not positive. Therefore, it was crucial to talk to her and solve the issues she has about the counselor. Consequently, she would positively view her counsellor positively and work with her towards her cessation of gambling and smoking habits. On the other hand, I did not choose to discontinue Vivitrol since the client had not fully regained her thought process and kindled her addiction.

I expected that Mrs Perez would change her attitude towards her counselor and work together to achieve a positive outcome. Equally, I expected that Mrs Perez would completely cease gambling and continue attending and contributing to the Gamblers Anonymous meeting. Lastly, I expected that Mrs Perez would stop alcohol abuse and smoking completely.

Communication and Ethical Consideration

The ethical consideration, in this case, is that of nonmaleficence. As a practitioner, it is critical to act so that the chosen medical intervention does not intentionally cause harm to the patient. According to the American Medical Code of ethics, a practitioner should act in the patient’s best interest to achieve positive health outcomes (Haddad & Geiger, 2018). Furthermore, Garbutt (2014) argues that optimal care for substance-addicted patients necessitates caregivers to learn and appropriately apply acceptable intervention measures and treatment referral to achieve a positive outcome when appropriate.

Moreover, the attending practitioner should consider effective communication strategies while attending to the patient, i.e., communicating in a culturally and developmentally appropriate manner (American Counselling Association, 2014). It is vital to note that the client, in this case, does not perceive her counselor positively. Therefore, devising an appropriate communication strategy is crucial in solving her issues with the counselor, thereby enabling her to attend counseling sessions leading to positive health.

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Assessing and Treating Patients with Impulsivity
Assessing and Treating Patients with Impulsivity


Gambling is common among people with alcohol abuse disorder and smoking habits. Pharmacological and psychological interventions are crucial treatment measures for gambling, smoking, and alcohol abuse disorders. In this case, Naltrexone was identified as the absolute pharmacological intervention for alcohol abuse cessation. The US FDA approves Naltrexone as one of the best medications for alcohol abuse. Besides, Naltrexone does not have significant side effects.

The intervention strategy for smoking and gambling cessation, counseling, has been chosen in this case. The USA FDA recommends behavioral therapy such as counseling as an adjunctive measure with Naltrexone to treat alcohol abuse, gambling, and smoking problems. Besides, intervention measures are effective when they directly tackle the underlying comorbid factors.

The last intervention involved tackling issues that the client had with her counselor. For an effective health outcome to be achieved, healthcare personnel must develop trust and rapport with the patient. Consequently, patients can adhere to the provided treatment interventions/measures to achieve complete positive wellbeing. Furthermore, it crucial to consider ethical and communication factors that can influence medical prescription and adherence. In this case, the practitioners ought to have considered the ethical value of nonmaleficence to restrain from causing harm to the patient. Equally, the practitioner should consider cultural and development-oriented communication strategies to achieve trust and good rapport with the patient.


American Counseling Association. (2014). ACA Code of Ethics: As Approved by the ACA Governing Council... American Counseling Association. Retrieved 31 March 2021 from

American Psychiatric Association. (2016). What Is Gambling Disorder? Retrieved from

Cayley Jr, W. E. (2011). Effectiveness of acamprosate in the treatment of alcohol dependence. American family physician83(5), 522. 

Garbutt, J. C., Greenblatt, A. M., West, S. L., Morgan, L. C., Kampov-Polevoy, A., Jordan, H. S., & Bobashev, G. V. (2014). Clinical and biological moderators of response to Naltrexone in alcohol dependence: a systematic review of the evidence. Addiction, 109(8), 1274-1284. Retrieved from

Grant, J. E., Kim, S. W., Odlaug, B. L., & Potenza, M. N. (2008). Daily tobacco smoking in treatment-seeking pathological gamblers: clinical correlates and co-occurring psychiatric disorders. Journal of Addiction Medicine2(4), 178.

Haddad, L. M., & Geiger, R. A. (2018). Nursing ethical considerations.

Maisel NC, Blodgett JC, Wilbourne PL, Humphreys K, Finney JW. Meta-analysis of Naltrexone and Acamprosate for treating alcohol use disorders: when are these medications most helpful? Addiction. 2013;108(2):275–293.

Niaura, R. (2017). Learning From Our Failures in Smoking Cessation Research | Nicotine & Tobacco Research | Oxford Academic. Retrieved from

Stahl, S. M. (2017). Essential psychopharmacology: The prescriber’s guide: antipsychotics and mood stabilizers. Cambridge: Cambridge University Press.

Swift, R., Davidson, D., Rosen, S., Fitz, E., & Camara, P. (1998). Naltrexone effects on diazepam intoxication and pharmacokinetics in humans. Psychopharmacology135(3), 256-262.

Ward, S., Smith, N., & Bowden-Jones, H. (2018). The use of Naltrexone in pathological and problem gambling: A UK case series. Journal of behavioral addictions7(3), 827-833. https://doi.10.1556/2006.7.2018.89

Winslow, B. T., Onysko, M., & Hebert, M. (2016). Medications for alcohol use disorder. American family physician93(6), 457-465.  

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