Assignment 1: Assessing and Treating Patients With Impulsivity, Compulsivity, and Addiction

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Comorbid Addiction (ETOH and Gambling) 53-year-old Puerto Rican Female

BACKGROUND Mrs. Maria Perez is a 53 year old Puerto Rican female who presents today due to a rather

“embarrassing problem.”

SUBJECTIVE Mrs. 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 o�” for the past 25 years. She states that for

the past 2 years, she has been having more and more di�culty maintaining her sobriety

since the opening of the new “Rising Sun” casino near her home. Mrs. Perez states that

she and a friend went to visit the new casino during its 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

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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 2 years and she is

concerned about the negative e�ects of the cigarette smoking on her health.

She states that she attempts to abstain from drinking but 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 she 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 borrowed over $50,000 from her

retirement account to pay o� her gambling debts, and her husband does not know.

MENTAL STATUS EXAM The client is a 53 year old Puerto Rican female who is alert and 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. When 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.” A�ect is appropriate to content of conversation and self-

reported mood. She denies visual or auditory hallucinations, and 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.

Diagnosis: Gambling disorder, alcohol use disorder

Decision Point One Select what you should do: