embarrasing problem

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

BACKGROUND

Mrs. Maria Perez is a 53 year old Puerto Rican female who presents to your office 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 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.

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. She is very concerned because her husband does not know that she has spent this much money.

MENTAL STATUS EXAM

The 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. Her visual or auditory hallucinations, no delusional or paranoid thought processes are readily appreciated. Insight and judgment are

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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 the PMHNP should do:

Naltrexone (Vivitrol) injection, 380 mg intramuscularly in the gluteal region every 4 weeks

Antabuse (Disulfiram) 250 mg orally daily

Campral (Acamprosate) 666 mg orally three times/day

Decision Point One

Campral (acamprosate) 666 mg orally TID

RESULTS OF DECISION POINT ONE

 Client returns to clinic in four weeks  Mrs. Perez states that she has noticed that she has been having suicidal ideation over the

past week, and it seems to be getting worse  Clientis She is also reporting that she is having “out of control” anxiety

Decision Point Two

Discontinue Campral and begin Antabuse (disulfiram) 250 mg orally daily

RESULTS OF DECISION POINT TWO

 Client returns to clinic in four weeks

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 Mrs. Perez states that the suicidal thoughts have abated, but reports that she has been feeling tired for several hours after taking the drug

 reports that she has not been going to the casino, because she is afraid that she may be tempted to drink, and noticed that the last time she drank, she felt nauseous, and began to vomit, she also reported that it felt like her heart would “pound right out” of her chest. She does report that she is smoking more, however

Decision Point Three

Continue Antabuse in the morning and discuss smoking cessation options

Guidance to Student

Sedation occurs in many people taking disulfiram. Mrs. Perez is experiencing adverse effects when she consumes alcohol with this drug- which is the expected/intended therapeutic effect. As a “side effect”- she is avoiding the casino which is also helping. At this point, it is not appropriate to discontinue disulfiram. Despite the fact that controversy exists regarding how long someone should remain on this medication, she has only been on this drug for 4 weeks. Additional time on the medication would be prudent.

In order to treat the side effect of sedation, the drug should be changed to bedtime to minimize this side effect.

In all cases, the PMHNP needs to discuss smoking cessation options with Mrs. Perez in order to address the totality of addictions, and to enhance her overall health.

Additionally, it should be noted that although Mrs. Perez reports that she has been avoiding the casino secondary to her fear that she will drink, this “fear” has not actually treated her gambling addiction. This particular addiction has resulted in considerable personal financial cost to Ms. Perez. Mrs. Perez needs to be referred to a counselor who specializes in the treatment of gambling disorder, and should also be encouraged to establish herself with a local chapter of gamblers anonymous.

This study source was downloaded by 100000795183161 from CourseHero.com on 05-08-2021 17:30:45 GMT -05:00

https://www.coursehero.com/file/84770921/Wk8NOTESNURS-6630-53-yr-old-Puerto-Ricofemale-Co-morbid-Addiction-ETOH-and-Gamblingdocx/

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