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

2/2/22, 7:51 PM Psychopharmacologic Approaches to Treatment of Psychopathology

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

Decision Point One

Vivitrol (naltrexone) injection, 380 mg intramuscularly in the

gluteal region every 4 weeks

RESULTS OF DECISION POINT ONE � Client returns to clinic in four weeks

� Mrs. Perez says she feels “wonderful” as she has not “touched a drop” of alcohol since receiving the injection

2/2/22, 7:51 PM Psychopharmacologic Approaches to Treatment of Psychopathology

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� Client reports that she has not been going to the casino, as frequently, but when she does go she “drops a bundle” (meaning, spends a lot of money gambling)

� Client She is also still smoking, which has her concerned. She is also reporting some problems with anxiety, which also has her concerned

Decision Point Two

Refer to a counselor to address gambling issues

RESULTS OF DECISION POINT TWO � Mrs. Perez returns in 4 weeks and reports that the anxiety

that she had been experiencing is gone.

� She reports that she has met with the counselor, but she did not really like her.

� She also started going to a local meeting of Gamblers Anonymous. She states that last week, for the �rst time, she spoke during the meeting. She reports feeling supported in this group.

Decision Point Three

Explore the issue that Mrs. Perez is having with her counselor,

and encourage her to continue attending the Gamblers Anonymous

meetings

2/2/22, 7:51 PM Psychopharmacologic Approaches to Treatment of Psychopathology

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Guidance to Student

Although controversy exists in the literature regarding how long to

maintain a client on Vivitrol, 8 weeks is probably too soon to

consider discontinuation. The psychiatric mental health nurse

practitioner should explore the issues that Mrs. Perez is having

with her counselor. As will be covered in more depth in future

courses, ruptures in the therapeutic alliance can result in clients

stopping therapy. Clearly, if the client does not continue with

therapy, the likelihood of the gambling problem spontaneously

remitting is lower (than had the client continued to receive

therapy). Recall that there are no FDA-approved treatments for

gambling addiction. The mainstay of treatment for this disorder is

counseling. Since Mrs. Perez reports good perceived support from

the Gamblers Anonymous meetings, she should be encouraged to

continue her participation with this group.

You need to discuss smoking cessation options with Mrs. Perez in

order to address the totality of addictions, and to enhance her

overall health.

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