The patient is a 53-year-old Puerto Rican woman; her name is Maria Perez. The patient complains of alcohol and gambling addiction. The situation worsened after a casino opened near where Mrs. Perez lives, where she began to drink and smoke frequently. The patient reported that the process of gambling makes her immensely exalted. She has to drink alcohol to reduce the stress. Mrs. Perez reported that she had had an alcohol problem since her twenties and periodically attended an Alcoholics Anonymous group. In addition, the patient has started to smoke a lot more in the last two years. She also attributes this to going to the casino. However, according to the patient’s observations, her cravings for smoking are much lessened when she drinks. It can be concluded that smoking and alcohol act as interchangeable factors. In addition, Mrs. Perez reported that she often smokes when she plays slot machines. This implies that the cravings for both alcohol and smoking occur in the patient’s moments of extreme emotional arousal.
The patient also attributed her dramatic weight gain to her alcohol consumption, recently putting on 7 pounds. Ms. Perez believes her main problem is gambling addiction. She had withdrawn a large sum from her savings account without telling her husband. Psychologically, gambling addiction could also be considered a major problem. Based on her medical history, it was associated with an exacerbation of alcohol and nicotine addiction. The patient’s critical thinking is fully retained, but impulse control is impaired. Based on the fact that the patient avoids eye contact with the therapist when discussing her problem, it can be concluded that she considers alcohol and gambling addictions unacceptable for her. This conclusion is essential for therapy because it indicates that the patient understands the consequences of addiction and voluntarily wants to undergo treatment. Regarding other psychiatric disorders, the patient denies suicidal and homicidal thoughts and the presence of visual and auditory hallucinations.
My first therapeutic solution would be to inject Vivitrol (naltrexone) in a dose of 380 mg intramuscularly into the gluteal area at intervals of every four weeks. I chose this medication because the active ingredient is naltrexone, classified as an opiate receptor blocker (Bujarski et al., 2018). The important thing is that the drug itself is not addictive. By using Vivitrol, I wanted to make sure that the patient can control their substance intake during the initial phase of treatment. As a result of the treatment, Mrs. Perez reported that she could control her alcohol intake and felt well. The patient also said that she had reduced the number of times she went to the casino but still left a decent amount of money there during her infrequent visits. The patient’s complaints included smoking cravings and anxiety.
I did not choose Antabuse for the patient because of its unpleasant side effects. Antabuse (disulfiram) blocks an enzyme that is involved in the metabolism of alcohol consumption. This medicine can help get rid of drinking mainly because of the unpleasant side effects of consuming alcohol while taking it (Bujarski et al., 2018). I could not be sure that the patient would not take alcohol during treatment, so I could not prescribe her this medication. Treatment aims at a mild withdrawal from addiction, not an abrupt termination due to painful side effects. Also, the patient could have linked the effects to the medication and would have started drinking alcohol again once the medication had been withdrawn. I also did not choose Campral as it reduces the release of neurotransmitters. These are actively secreted when alcohol is consumed, which gives an excitatory or inhibitory effect (Bujarski et al., 2018). Campral controls the release of these substances so that the expected reaction after alcohol intake does not occur. Because of this, the patient could start taking alcohol in even higher doses to achieve the desired effect.
My second therapeutic solution would be to refer the patient to a counselor to work through her gambling addiction problems. A counselor will help the patient understand the psychological cause of gambling addiction and provide mechanisms for overcoming gambling cravings. Therapeutic treatment is very effective in these situations because it is done through a dialogue between the therapist and the patient. When I prescribed this treatment, I expected the client to analyze the nature of her problem better and find the best possible solutions.
As a result of this treatment, the patient reported being able to get rid of her anxiety. In addition, she started going to Gamblers Anonymous meetings and was even able to talk about her story there. She reports feeling supported in this group. However, Mrs. Perez also reported that she did not enjoy working with a therapist.
I did not choose Valium as it has a potent anticonvulsant, sedative effect. Mrs. Perez has not reported any pathological anxiety or any other symptoms suggestive of an anxiety-depressive disorder. At this stage, such a strong medication could only have been detrimental. I also did not choose Chantix to treat the patient as psychotherapy can have the same effect as quitting smoking. The efficacy of Chantix as a treatment for nicotine dependence is due to its partial antagonism to α4β2 n-choline receptors, binding to which reduces the craving for smoking and eases the onset of withdrawal (Savelle-Rocklin & Akhtar, 2019). However, the patient’s nicotine dependence was not too severe, so using this drug is pointless. In addition, the drug has the unpleasant side effect of nausea.
My third solution would be to discuss with Mrs. Perez the reason for the disagreement with her counselor and encourage her to continue attending the Gamblers Anonymous group. The need to discuss the problem with the counselor is that Mrs. Perez may consider the therapy useless and stop it if this is not done. Since therapy is the only treatment for gambling addiction, it should not be discontinued (Sun, 2018). Also, because Mrs. Perez feels supported by the Gamblers Anonymous group, she should continue attending that. She should also continue therapy with a counselor, but only after clarification of the problem. I have not chosen to discontinue Vivitrol because the patient is still on it too soon. Besides, this drug has shown its positive effect on Mrs. Perez. I also did not encourage her to continue seeing the counselor because it can only worsen if she does not discuss the problem. This could lead to Mrs. Perez deciding to stop therapy and her addiction returning.
When treating patients with addictions, ethical considerations strongly influence the doctor’s work. For example, it is essential not to demonstrate judgmental attitudes towards patients’ addictions. As one can see from Mrs. Perez’s situation, these patients are usually self-conscious about their problems. Starting therapy is already a big step outside their comfort zone. Secondly, it is vital to listen to their wishes. For example, when a patient says that they are uncomfortable working with a therapist, it is crucial to discuss and solve this problem immediately. For the entire course of treatment, I prescribed the patient a course of Vivitrol and counseling with a psychotherapist and sessions in a Gamblers Anonymous group. This treatment proved to be effective and fulfilled all necessary functions. Vivitrol blocked the opioid receptors and thereby helped the patient to stop drinking alcohol. The therapy helped the patient to feel more comfortable talking about her problems and finding the best way to solve them.
References
Bujarski, S., Lim, A. C., & Ray, L. A. (2018). Prevalence, causes, and treatment of substance use disorders: A primer. The Judges Journal, 57(1), 1-23. Web.
Savelle-Rocklin, N., & Akhtar, S. (Eds.). (2019). Beyond the Primal Addiction: Food, Sex, Gambling, Internet, Shopping, and Work (1st Ed.). Routledge. Web.
Sun, A. (2018). Treating Addictions: The Four Components (1st Ed.). Routledge. Web.