Impulsivity, Compulsivity, and Addiction

Introduction

Impulsivity is the tendency to act without giving any forethought. Impulsive behaviors occur without planning or consideration of the consequences. Impulsivity has often been associated with addiction, both chemical and non-chemical. Conversely, compulsivity is the tendency to repeat the same acts, disregarding undesirable consequences. Both impulsivity and compulsivity can lead to addiction (Mestre-Bach et al., 2020). Gambling and excessive use of alcohol are examples of common impulsive traits.

This paper discusses the case of a 53-year-old Puerto Rican female who has been struggling with alcohol since her late twenties. She has been attending Alcoholics Anonymous meetings for the last 25 years. She claims that her alcohol use was precipitated by her father’s death, which occurred during her late teenage years. The opening of a casino near her place of residence has worsened her alcoholism. The patient admits that he gambles. To calm her nerves when gambling, she usually takes a few drinks of alcohol. She is concerned as she seems not to be able to control her gambling. She has borrowed money from her retirement account without her husband’s knowledge to feed her gambling habit and to pay off her gambling debts.

Her mental status exam (MSE) shows a 53-year-old female who is alert and well-oriented to person, place, time, and event. She is appropriately dressed and communicates effectively throughout the interview. The patient avoids maintaining eye contact throughout the session but does not display any abnormal tendencies such as tics or any other gestures. Mood and affect are harmonious and appropriate. The patient reports no hallucinations, delusions, suicidal or homicidal ideations. The patient demonstrates sound judgment and insight, though her impulse control is significantly impaired.

The patient is diagnosed with gambling disorder and alcohol use disorder. Several decisions will have to be made to help manage this patient. Various patient-specific factors might affect decision-making. These factors include the patient’s age, gender, and duration of presenting complaints.

Decision 1

The first decision would be to use Vivitrol (naltrexone) injection 380 mg IM. Naltrexone injection is FDA-approved as it addresses the problem of compliance commonly associated with oral medications. It reduces the risk of the patient discontinuing the drug impulsively. It modulates opioid systems, with consequent reduction in the cravings and feelings of euphoria commonly associated with the use of alcohol and other substances (Palpacuer et al., 2018). The amount of alcohol consumed is generally reduced when using naltrexone.

The other treatment choices available are Antabuse (Disulfiram) 250 mg orally daily and Campral (Acamprosate) 666 mg orally three times a day. Both medications are not ideal because they are used for the maintenance of alcohol abstinence. Disulfiram works by producing undesired side effects when alcohol is consumed (Adhikari et al., 2020). Campral is not the treatment of choice because of the patient’s weight. The patient is overweight.

By choosing naltrexone, I hope to achieve a reduction in the patient’s craving for alcohol without experiencing any unpleasant side effects. I also hope to prevent any future relapses of alcohol abuse. The maximum effects of naltrexone can be seen after a few weeks. After four weeks, the client returns to the clinic with positive results. She reports that she feels terrific since she has not touched a single drop of alcohol since receiving the injection. She reports that she still visits the casino occasionally and spends much money. The patient also complains that she hasn’t stopped smoking and still has problems with anxiety.

Decision 2

With the information obtained from the patient’s follow-up, my next decision would be to refer the patient to a counselor who will address her gambling issues. Despite the patient responding to treatment, her gambling is an issue that should be addressed promptly. Quitting gambling is not an easy fete to achieve and can be made easier with the help of a treatment program or a support group. Counseling helps with addressing problems with gambling. Cognitive behavioral therapy can help understand the patient’s feelings and behavior, which might consequently help in addressing the root cause of pathologic gambling (An et al., 2017). The patient should first come to terms with the fact that her gambling is pathological. The counselor can help the patient to identify the predisposing factors to gambling, such as living near a casino. The counselor can also provide education regarding the harmful effects of gambling. The patient also complained of experiencing anxiety, a side effect of naltrexone. The counselor should educate the patient that some of the side effects associated with the drug resolve once the body has adjusted to the drug.

The other treatment options are diazepam 5 mg orally TID/PRN and Varenicline 1 mg orally BID. Diazepam was not preferred because of its potential addictive effects. Diazepam is highly addictive (Soyka, 2017). I did not choose Varenicline because it is used for the cessation of smoking, which is not the main priority. The main priority is to stop gambling. Varenicline would only be appropriate once the gambling has been controlled.

By opting for counseling, I hope the client will report positive results from meeting with the counselor. I expect that the client will also continue with his treatment of naltrexone as well as counseling. The client returns to the clinic after four weeks with no symptoms of anxiety. She reports that she started attending Gamblers Anonymous meetings and feels supported in that group. She says that she spoke in the meeting the previous week. The patient also met with the counselor but did not like her. At this point, the last decision needs to be made.

Decision 3

The third decision would be to explore the patient’s issue with her counselor and encourage her to continue attending her support meetings with Gamblers Anonymous. This is because the client is making progress with treatment. Counseling has proven helpful in addressing her concerns. The Gamblers Anonymous has proven to be fruitful. The other option of encouraging the patient to continue seeing her counselor without first addressing her issues is not appropriate as it may result in the patient quitting counseling. Stopping counseling may result in a relapse. The other option to discontinue Vivitrol was not taken because discontinuation after eight weeks is considered too soon. The patient should continue with her participation with the Gamblers Anonymous.

By exploring her issues with the counselor, I am hoping that the patient will be free from her gambling and alcohol addiction. I am also hoping that the patient will continue her treatment with naltrexone and also continue attending the support meetings.

Ethical considerations

When treating patients, various ethical considerations need to be factored in. Ethics form the basis for potential conflicts of interest among healthcare professionals and patients. The fundamental values in medical ethics include patient autonomy, non-maleficence, beneficence, and informed consent. Autonomy is the patient’s right to accept or refuse treatment. The patient also has the option to choose the treatment they want (Ballack et al., 2020). This should be made possible after informed consent is obtained from the patient. Informed consent can only be obtained after the nurse has educated the patient on her condition and all the available treatment options, including the potential risks and benefits. This information should be relayed truthfully and honestly. Any changes during treatment should also be communicated effectively. After informed consent is obtained, the next ethical consideration should be beneficence. The nurse should be able to weigh whether the patient’s decision is harmful or beneficial. Patients can choose decisions that have fatal consequences. This is important because the nurse must first not harm even as the patient’s desires are met. These decisions should be considered in all diagnostic and therapeutic steps.

Conclusion.

In conclusion, both impulsivity and compulsivity play a role in both chemical and non-chemical addiction. This paper discusses the case of a 53-year-old Puerto Rican woman who struggles with both alcohol and gambling addiction. A series of decisions are made to help manage this patient. The first decision is to start the patient on a Naltrexone injection of 380 mg IM. This yields positive results as the patient abstains from alcohol. The next decision made is to refer the patient to a counselor and join a Gamblers Anonymous group to help her address her gambling issues. This also helps with her gambling addiction, but the patient reports having issues with her counselor. This leads to the third decision, to encourage the patient to address her issues with her counselor. Finally, ethical considerations have to be made when managing this patient. These include patient autonomy, informed consent, non-maleficence, and beneficence.

References

Adhikari, S., Tulachan, P., Ojha, S. P., Chapagai, M., Dhungana, S., & Pant, S. B. (2020). Comparison of Disulfiram and Naltrexone in Cases of Alcohol Dependence Syndrome. Journal of Nepal Health Research Council, 18(1), 75–81. https://doi.org/10.33314/jnhrc.v18i1.1921

An, H., He, R. H., Zheng, Y. R., & Tao, R. (2017). Cognitive-Behavioral Therapy. Advances in experimental medicine and biology, 1010, 321–329. https://doi.org/10.1007/978-981-10-5562-1_16

Balak, N., Broekman, M., & Mathiesen, T. (2020). Ethics in contemporary health care management and medical education. Journal of evaluation in clinical practice, 26(3), 699–706. https://doi.org/10.1111/jep.13352

Mestre-Bach, G., Steward, T., Granero, R., Fernández-Aranda, F., Mena-Moreno, T., Vintró-Alcaraz, C., Lozano-Madrid, M., Menchón, J. M., Potenza, M. N., & Jiménez-Murcia, S. (2020). Dimensions of Impulsivity in Gambling Disorder. Scientific reports, 10(1), 397. https://doi.org/10.1038/s41598-019-57117-z

Palpacuer, C., Duprez, R., Huneau, A., Locher, C., Boussageon, R., Laviolle, B., & Naudet, F. (2018). Pharmacologically controlled drinking in the treatment of alcohol dependence or alcohol use disorders: a systematic review with direct and network meta-analyses on nalmefene, naltrexone, acamprosate, baclofen, and topiramate. Addiction (Abingdon, England), 113(2), 220–237. https://doi.org/10.1111/add.13974

Soyka M. (2017). Treatment of Benzodiazepine Dependence. The New England journal of medicine, 376(12), 1147–1157. https://doi.org/10.1056/NEJMra1611832

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Question

https://mym.cdn.laureate-media.com/2dett4d/Walden/NURS/6630/DT/week_08/index.html
Introduction to the case (1 page)

Impulsivity, Compulsivity, and Addiction

Briefly explain and summarize the case for this Assignment. Be sure to include the specific patient factors that may impact your decision-making when prescribing medication for this patient.
Decision #1 (1 page)

Which decision did you select?
Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).
Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.
Decision #2 (1 page)

Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).
Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.
Decision #3 (1 page)

Summarize your recommendations on the treatment options you selected for this patient. Be sure to justify your recommendations and support your response with clinically relevant and patient-specific resources, including the primary literature.

Impulsivity, Compulsivity, and Addiction