The focus of the case is addressing the physical and mental health challenges encountered by Mrs. Maria Perez, a 53-year-old Puerto Rican woman who got the diagnoses of alcohol use disorder and gambling disorder. Alcohol use disorder, which ranges from mild to severe, refers to the harmful pattern of continuous alcohol use, the inability to control the drinking, using the substance even when it causes problems, having to drink more to get the same effect, and having withdrawals. Gambling disorder, or compulsive gambling, signifies the uncontrollable urge to keep gambling despite the adverse effects that it has on one’s life. Gambling is a problem because it enables an individual to risk valuable thinks in hope of getting something of higher value. The two diagnoses apply to Mrs. Perez because she indicated getting a “high” from gambling and having the urge to have several drinks to “even out” her state. The patient has lied to her relatives repeatedly because of her gambling and has been unable to curb the intake of alcohol on her own. Thus, to address Mrs. Perez’s health issues, three decisions are made regarding her treatment, considering the possible effects of pharmacological interventions.
Decisions and Rationale
The first decision point is to administer vivitrol (naltrexone) injection, 380 mg intramuscularly in the gluteal region every four weeks. The decision was made because naltrexone represents a competitive antagonist for targeting the effects of opioids, including the feelings of well-being or pain relief that leads to the abuse of opioid substances. Vivitrol has been widely used as a part of a pharmacological intervention to treat drug and alcohol dependence in individuals. An injection of naltrexone can be helpful in preventing a relapse in alcohol use by the patient once she stops consuming the substances. It can help Mrs. Perez keep away from the “need” to use alcohol. Moreover, important findings were made by Mouaffak et al. (2017) regarding the use of naltrexone for treating broadly-defined behavioral addictions. The researchers found that the drug had an overall positive impact on treating such behavioral addiction as pathological gambling (Mouaffak et al., 2017), which points to the multidimensional benefits of the drug’s administration to the patient.
The administration of Antabuse (disulfiram) 250 mg orally daily was not chosen because the medication has been associated with several serious side effects including headaches, vomiting, dyspnea, seizures, heart palpitations, and sympathetic over-activity (Stokes & Abdijadid, 2021). Moreover, the use of Campral (acamprosate) 666 mg orally three times a day was not suitable because the medication works best when combined with social and psychological interventions as parts of treating alcohol abuse. Besides, the regimen of having to take the dose three times a day reduces the likelihood of medication adherence. Overall, the decision to administer vivitrol (naltrexone) by injection was expected to gradually reduce Mrs. Perez’s cravings for alcohol and the desire to gamble. In addition, the expectation was that the patient would tolerate the medication well, with the number of adverse events being low.
As the patient returns to the healthcare facility feeling “wonderful” and abstaining from alcohol use after her injections, she mentions that the gambling is still an issue alongside with smoking and anxiety problems. The second decision made for Mrs. Perez is to refer her to a counsellor to address issues of gambling. The rationale for this recommendation is that cognitive-behavioral therapy (CBT), which is often embedded into counseling, can help the patient address the factors that contributed to the development of gambling addiction (Rizeanu, 2018). Anxiety can also be a part of the patient’s psychological challenge According to Rizeanu (2018), the combination of behavioral and cognitive-behavioral therapy creates noticeable improvements in the behavior of a gambler, and these are preserved at the follow-up evaluation carried out three months posttreatment. Besides, a counselor may recommend Mrs. Perez to join Gamblers Anonymous groups and attend meetings as a part of group therapy.
Adding Valium (diazepam) 5 mg orally for TID/PRN/anxiety was not selected because of the risk of abuse of the medication, especially considering the fact that the patient has history of addiction disorders. Giving Mrs. Perez access to the diazepam in pill form may create potential inclinations of misusing and overusing the drug. There are also risks of adverse side effects influencing the patient, including confusion and forgetfulness, fatigue, continuous drowsiness, impaired judgment, and others (Votaw et al., 2020). The choice of adding Chantix (varenicline) 1 mg orally BID was not recommended because of the potential severe side effects it may cause, including sleep disturbance, suicide, and cardiovascular events. Because Mrs. Perez mentioned struggling with anxiety, the mentioned side effects represent a challenge to her well-being.
Making the decision to recommend counseling to Mrs. Perez was expected to add a new intervention dimension into her treatment. It was intended to help the patient get deeper into the issue of her gambling addiction and recognize factors, ranging from individual to socioeconomic, which enabled her participate in gambling. Besides, Mrs. Perez will get an opportunity to communicate with other people who have struggled with gambling addiction, which can give her more confidence in addressing her issue.
The third and final decision for Mrs. Perez is to explore the problem that Mrs. Perez was having with her counselor and encourage her to continue attending Gambling Anonymous meetings. The rationale for this decision is illustrated in the patient reporting that her anxiety went away and that she felt very supported when attending Gambling Anonymous as she finally found others with the same problem. However, it is important to communicate with the patient’s counselor to determine the problem between them. If the patient and the counselor are incompatible, which happens, Mrs. Perez will be referred to a different professional to continue her therapy (Kallergis, 2019).
The other two decisions were not chosen because they force the patient to continue seeing her existing counselor despite the negative feelings. Besides, vivitrol should not be discontinued because it is unclear whether the alcohol addiction was cured, and more consistency is needed in treatment administration. Through the decision made, it was expected that Mrs. Perez would get accustomed to the combination treatment that involved behavioral and pharmacological treatment, which could help her have consistency.
To conclude, the combination of pharmacological and psychotherapeutic treatment has been chosen as the targeted intervention for Mrs. Perez. While the administration of vivitrol will suppress the urges that contribute to addictive consumption behaviors, counseling and Gambling Anonymous offer the patient an opportunity to dig deeper into the reasons for her addicting behaviors and learn how to deal with them. In addition, Mrs. Perez now has support from peers in her Gambling Anonymous group and she is not let alone to deal with the daily struggles.
Kallergis, G. (2019). The contribution of the relationship between therapist-patient and the context of the professional relationship. Psychiatriki, 30(2), 165-174. Web.
Mouaffak, F., Leite, C., Hamzaoui, C., Benyamina, A., Laqueille, X., & Kebir, O. (2017). Naltrexone in the treatment of broadly defined behavioral addictions: A review and meta-analysis of randomized controlled trials. European Addiction Research, 23, 204-210. Web.
Rizeanu, S. (2018). Cognitive-behavioral therapy for gambling addiction. In Ö. Şenormancı & G. Şenormancı (Eds.), Cognitive behavioral therapy and clinical applications (pp.161-181). InTech Open Science.
Stokes, M., & Abdijadid, S. (2021). Disulfiram. Web.
Votaw, V. R., Geyer, R., Rieselbach, M. M., & McHugh, R. K. (2019). The epidemiology of benzodiazepine misuse: A systematic review. Drug and Alcohol Dependence, 200, 95–114. Web.