Attention Deficit Hyperactivity Disorder A Young Girl With ADHD

Assessment and treatment of clients with Co-Morbid Addiction

Pharmacotherapy associated practice to the treatment of substance utility illnesses are usually defined as medication assisted treatment. In the identified practice, various medications that are approved by FDA are usually utilized in combination with linked counseling along with behavioral therapies in ensuring treatment of a substance use illness. Medications are considered to be vital in the minimization of the cravings as well as other symptoms related with withdrawal from any substance through occupation of receptors in the human brain related with the utility of the drug, blocking the identified rewarding sensation that arises with the use of the substance or arouse negative feeling when there is intake of the substance (In Butts & In Rich, 2015). The following paper comprehensively uses pharmacotherapy approaches to offer treatment to alcohol utility disorder as well as gambling disorder and a smoking addiction regarding a 53 year old female associated with Puerto origin.

Decision Number one;

Naltrexone (Vivitrol) injection, 380 mg intramuscularly in gluteal region every four weeks

Pharmacotherapy ought to be utilized in patients that have alcohol utility disorder and who are identified with current as well as heavy utility and ongoing risk for the effects of substance utility, motivated to minimize alcohol intake and do not possess medical contraindications to the drug choice. As the patient in the case scenario has admitted that she has an issue with taking alcohol as well as she has utilize the psychosocial approach with the prominent alcoholic anonymous without attaining any success, addition of medication like naltrexone can be a suitable step (Breitbart & Poppito, 2014). In the identified random clinical associated trails, the naltrexone type of medication has been revealed to minimize heavy drinking as well as enhances the probability of abstinence.

Naltrexone is identified as a mu opioid receptor type of antagonist and can either be in oral or injection form (Stahl,2017). It is FDA approved to be used in the treatment of alcohol dependence along with blockade implications regarding exogenously administered types of opioids and helps in the prevention of relapse effects to opioid reliance. Naltrexone injection ia administered month to be slowly released into the body system for a month. Naltrexone is effective in the reduction of alcohol consumption via modulation regarding opioid systems thus minimizing the reinforcement of the various implications associated with alcohol and opioids (Stahl,2017). It’s given at 380mg every 4 week intramuscularly. It reduces alcohol and opioid consumption by diminishing their reinforcing properties (Stahl,207). The month to month Naltrexone injection, medication compliance is less of a factor as patient must be willing and ready to be compliant with pills which is not feasible in this client as she will probably go gambling where she usually drinks. Special considerations dictate that vivitrol ought to not be administered to patients that are taking opioids and in cases whereby they are needed enhance treatment of pain, naltrexone must be discontinued. Naltrexone is considered to be contraindicated in liver failure along with acute hepatitis.

Antabuse was the first medication approved by FDA for the treatment of alcohol abuse and alcohol dependency. It irreversibly inhibits aldehyde dehydrogenase, the involve in second stage of alcohol metabolism (Stahl,2017). The effect of Antabuse if felt about 10 minute after alcohol enter the body. The individual taking it has wait for 12 hours after the consumption of alcohol before taking the first dose. It could be an effective deterrent because it causes an extremely unpleasant reaction if the person drinks but its effectiveness dependent on the person’s continuous use of the medication. The reason disulfiram is not selected is because it’s a daily pill and this patient can simply stop and start taking alcohol few weeks later since he drinks when she goes gambling and also it should solely be utilized by the abstinent patients when the intent of treatment is to maintain abstinence. Acamprosate on the other hand according to Stahl (2017), reduces excitatory glutamate neurotransmission and increases inhibitory gamma-aminobutyric acid (GABA). Campral is given in two tablets of 333mg three times daily. Campral the physical distress and emotional discomfort people usually experience when they quit drinking. According to research, the treatment should only be utilized once abstinence has been accomplished (Breitbart & Poppito, 2014). The treatment does not work if the patient still drinks and, in this client, there is no possibility that she will not drink if she goes gambling and for the pill to be effective, the patient must remember and be willingly to take the medication each day.. Also, campral is not a standalone treatment for alcohol addiction. The key goal regarding the prescription of medication for undertaking treatment of alcohol utility disorder is considered to be abstinence which is considered to remain a basic treatment focus. However, it is essential to not that the decrement regarding heavy drinking can be used as an alternative treatment type of goal especially if there is reduction of unwanted risks.

The client returned four weeks after receiving the injections. The results were amazing as she has been able to remain sober ever since she received the injection. She states that she has no side effects from the prescribed medications. The key complaint is gambling issue; however the client is worried about her smoking habit as well as anxiety.

Decision Two;

Refer to a Counselor for Gambling Issues

There are numerous forms of therapy that are usually utilized in the treatment of gambling disorder entailing cognitive behavior associated therapy as well as psychodynamic therapy, family and group therapy. In the current times, there is no approval of pharmacotherapy for treatment of gambling disorder by the FDA. However, pharmacotherapy associated strategies for the issue of gambling can be appropriate when it is directed toward the comorbid psychiatric condition regarding the patient for instance bipolar disorder along with substance abuse and even obsessive compulsive type of disorder.

The patient showed concern regarding her smoking habit and seemed to be highly motivated to halt the habit Chantix medication would have been the medication to help her in quitting as well as help her with the alcohol addiction even though experiencing the desired effect of Naltrexone. Chantix according to Stahl (2017), is an FDA approved medication for nicotine addiction/ dependence. It works as a partial agonist at alpha 4 beta 2 nicotine acetylcholine receptor, it activates these receptors to a lesser extent that the full agonist nicotine and also prevent nicotine from binding to these receptors (Stahl,2017). Initial dose should is 0.5mg /day, after 3 days can increased to 2 mg per day in two divided doses and 4 days increases to 2mg per day in 2 divided doses. This would have been an appropriate step to help in the prevention of health problems that are related with smoking. However, I did not choose this treatment method since the starting dosage was a bit higher than is recommended for a starting dose. A higher starting dose would have led to increment in the probabilities regarding fatal implications like nausea along with agitation. Addition of Diazepam is not an appropriate step since Valium is considered to be an addictive benzodiazepine and has longer-lasting impacts than all the other identified drugs in the class it belongs to. In the case of this client, it is not advisable to add another addictive substance like valium as it can cause harm (In Santos & In Cutcliffe, 2018). The client came back after four weeks and reported that she had no more anxiety. She reported not liking the therapist and had joined Gamblers anonymous group.

Decision Three

Explore the issue that Mrs. Lopez is having with her counselor, and encourage her to continue attending Gamblers Anonymous meetings

Despite the fact that the client stated that she did not like her counselor, she remained determined to fighting her prevailing addiction by joining the prominent Gamblers Anonymous Group. Counseling remains the key step in this decision in helping the client fight her gambling addiction. Exploration of the various issues that the client had with the counselor is essential in offering guidance to the next step to be undertaken in the treatment plan. There is also the need to explore smoking cessation at this moment. Assessment of the willingness of the client to quit is considered the first step since smokers are different when it comes to their readiness to stop their habit therefore comprehension of the perspective of the client is vital in offering essential help (In Santos & In Cutcliffe, 2018).  Encouraging the patient to continue seeing her counselor could be frustration and could result into the stopping her treatment abruptly and the patient will relapse. Gambler anonymous is a support group and does not take the place of her medication. They provide the client emotional support that will help and guide them through while they quit gambling and also asking the client to discontinue his medication and continue with her counselor and GA will only result in alcohol relapse as vivitrol is solely for alcohol addiction.

Ethical and Legal Implications in Prescribing Medications to Treat Substance Use Disorders

Healthcare professionals are usually encouraged to learn as well as appropriately utilize routine screening types of techniques as well as clinical lab tests, treatment associated referrals and brief types of interventions to attain optimized care for their patients. Use of screening instruments like CAGE questionnaires for the purpose of alcohol utility dependence is essential in offering guidance to the treatment approach. Nonetheless, the autonomy of the client along with confidentiality ought to be maintained prior to prescription of medications to enhance treatment of an addiction case (In Holland & International Psycho-Oncology Society, 2015). Whenever a legal or a medical type of obligation is present for the healthcare profession to undertake testing of the client for substance abuse disorder, ethical responsibility needs to be applied in this case and is achieved by notifying the client about the testing to attain informed consent from them.

References

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Breitbart, W., & Poppito, S. R. (2014). Meaning-centered group psychotherapy for patients with advanced cancer: A treatment manual. Oxford: Oxford University Press.

In Butts, J. B., & In Rich, K. L. (2015). Philosophies and theories for advanced nursing practice.

In Holland, J. C., American Psychosocial Oncology Society,, & International Psycho-Oncology Society. (2015). Psycho-oncology: A quick reference on the psychosocial dimensions of cancer symptom management.

In Santos, J. C., & In Cutcliffe, J. R. (2018). European psychiatric/mental health nursing in the 21st century: A person-centred evidence-based approach.Bottom of Form