The case analysis discusses the details related to Mrs. Maria Perez- a 53-year-old who is Puerto Rican woman with co-morbid addiction. She requires medication to address substance abuse treatment using adaptive procedures for this client. She has a background of alcoholism and excessive gambling behavior; with both having developed more recently but serving to increase her difficulties further. Mrs Perez has associated with Alcoholics Anonymous from time to time for the past 25 years on and off. However, her sobriety tenure ends up in trying to remain above ground by constantly slacking at since initial stage of debuting the casino near her home. She has developed a serious gambling addiction an act that she has acquired rather huge debts due to her addictive behaviors. She has also been overeating which has resulted in gaining weight which is counterproductive and developing further addiction to cigarette smoking.
Mrs. Perez’s mixed Puerto Rican heritage is one of the first things that might affect her pharmacokinetic and pharmacodynamic processes before prescribing a particular medication. The problem is ethnic differences in drug metabolism and response have been rigorously researched underlining the importance of patient-specific treatment approaches. Furthermore, Mrs. Perez is 53 years of age and her new medication selection may be seen by the fact that one’s older person develops various metabolisms of drugs to make an old individual more vulnerable to side effects. Her reoccurring addiction is also another key factor in her new medication that will reflect abuse from alcohol and gambling.
Therefore the examination of the three medication decisions presented in this case study will demonstrate their efficacy, especially the side effects. A deeper perspective of Mrs. Perez’s idiosyncratic concerns will facilitate the choice-making process contributing to better results of treatment for her.
Decision Choice One
Decision Point One was intramuscular injection in the gluteal region using Vivitrol (naltrexone) 380 mg every 4 weeks. Vivitrol is a naltrexone opioid antagonist that can be helpful as it reduces alcohol cravings and prevents relapse in patients suffering from alcoholism (Burnette et al., 2022). The medication also inhibits the rewarding effects of alcohol overdose and deteriorates the conditioned reinforcing properties of gambling. The fact that the client has a comorbid addiction disorder and alcohol dependence as well as gambling, therefore makes Vivitrol an appropriate proposed option since it can block both addictive behaviors at once.
Decision two on adding Valium was not selected since even though it was effective initially by reducing Mrs. Perez’s anxiety factor, she abused Valium and requested further elevation in dose frequency level. Valium is also a benzodiazepine that can cause dependence and abuse worsening her comorbid substance use disorder (Edinoff et al., 2021). Mrs. Perez is facing a Valium dose increase request, hence I do not choose Decision Three of keeping Vivitrol while reducing Valium and referring to the counseling. Therefore since the patient still has anxiety issues implying that her current treatment plan might not be fully effective.
The goal for choosing Vivitrol (naltrexone) was therefore to enable the client to achieve abstinence from alcohol and reduce stimulation since one of its effects gives little reinforcement that would affect her day.
The ethical aspects influence the treatment approach and the way of communication with the patient. The need for disclosure of gambling debts is likely to cause ethical contradictions about patient confidentiality and a husband’s requirement of knowledge. Patient autonomy should dictate all healthcare-related consults and thus the information that clients share with health providers must remain confidential. Maintaining a clear dialogue with the patient should be a discussion of highlighting the possible implications of smoking cigarettes to her health. Brainstorming methods of dealing with the rising debt due to gambling with proper consent is necessary as it would reduce the reported anxiety.
Decision Point Two
Decision Point Two was to use Titrate Q5H EF Valium (diazepam) 5 mg PO TID/PRN as needed for Mrs Perez’s anxiety. The decision was selected due to the initially positive effect Valium had on Mrs. Perez resulting in her significant distress being relieved. Valium is an established benzodiazepine with anxiolytic properties that can help manage sensitive symptoms of anxiety. Benzodiazepines have a significant role in the treatment of anxiety disorders either rated towards generalized anxiety disorder or panic disorder (Edinoff et al., 2021). Therefore it is effective in providing short-term relief from anxiety symptoms associated with her gambling.
I did choose Decision Choice One on continuation in the use of Vivitrol since her concerns regarding future problematic gambling behavior and continued smoking of cigarettes are not solved fully. Vivitrol is an opioid antagonist considered appropriate for the treatment of alcohol use disorder and it does not seem to address gambling or anxiety issues (Burnette et al., 2022). Decision Choice Three was not selected here since it represents the continuation of Vivitrol and discontinuation/tapering off Valium. The decision is not made due to the persistent complaints of Mrs. Perez about adding a higher Valium dosage.
The rationale behind prescribing Valium is that it allows Mrs. Perez to receive relief from her anxiety symptoms while reducing alcohol consumption leading to better sobriety. Mrs. Perez uses alcohol to cope with her anxiety therefore by addressing this source she will reduce overreliance on alcohol.
Ethical considerations influence treatment planning and patient-centered communication. Mrs. Perez should be informed of possible side effects and benefits associated with Valium at hand. Informed consent must be obtained and a thorough risk assessment of her substance abuse and addiction predictors shall be performed. An open and honest communication with Mrs. Perez about the intention of treatment as well as the potential side effects (Mapes et al, 2020). She will require counseling which should be mentioned to secure understanding and compliance with this treatment regimen. Patient involvement in decision-making therefore helps in maintaining a therapeutic relationship that promotes recovery.
Decision Point Three
Decision Point Three was selected to continue the same amount of Vivitrol and lower/taper Valium with a focus on withdrawing in two weeks. The choice was made simply because Mrs. Perez obtained sobriety by using Vivitrol since injection one month ago. The most effective pharmacotherapy is Vivitrol which represents an extended-release formulation of naltrexone that works by reducing alcohol cravings and blocks the pleasurable effects of alcohol. According to Burnette et al. (2022), heavy drinking and relapse rates among heavy drinkers with Alcohol Use Disorder have been found to decline after the administration of Vivitrol resulting in soberness.
I did not choose Decision Choice One to be bonded with Vivitrol because it is being implemented and has proved to augment Mrs Perez’s alcohol consumption reduction. Continuity in dosing enables the retention of consistency for her alcohol recovery (Oesterle et al., 2019). Furthermore, Decision Choice Two to add on Valium would not solve the core problem of the gambling disorder but has increased risks that being dependent on Valium worsening Mrs. Perez’s history of habitual abuse and dependence. Valium cannot be thought of as a primary treatment for gambling disorder since it does not address directly the underlying causes that can lead to addictive behaviors.
The goal of decision Point Three is to ensure a holistic perspective in dealing with Mrs. Perez’s alcohol use disorder and gambling disorder by moving back to Vivitrol. The medication allows her to maintain her sobriety from alcohol thus reducing the chances of relapsing (Burnette et al., 2022). The decision to taper off Valium also accepts the fact that though Valium is an effective medication for Mrs. Perez’s anxiety, it is not ideal among other treatment options. Directing her to use counseling services to counter gambling will help her gain therapeutic support.
Ethical considerations contribute a great deal to the appropriate treatment plan and interaction with patients (Mapes et al, 2020). Mrs. Perez’s information should be kept safe and autonomy decisions about the direction of treatment she needs should be addressed. Communication of evidence-based data concerning risks to benefits analysis of various treatment alternatives is crucial. Explaining the limitations of Valium in dealing with underlying problems and having to combine this type of treatment with counseling can help her figure out her decision-making process. Informed consent is also required before starting and subsequently modifying her drug regimen by ensuring she fully understands the adverse effects of the treatment plan.
Conclusion
To sum up, the case study of Mrs. Maria Perez who has alcohol use disorder combined with gambling disorder leads to recommendations involving an integrated treatment approach centered on her set with her consent. The chosen treatment measures such as Vivitrol injection administration Valium yet tapering offs and a referral to counseling are designed within a larger integrated framework that would treat Mrs. Perez’s disorders holistically.
Vivitrol is an ideal option for Mrs. Perez’s alcohol use disorder as it helps reduce the cravings regarding consuming alcohol and prevents relapse inhibiting of euphoric action of alcohol consumption. Since there is a concern that Mrs. Perez may be abusing and even dependent on Valium tapering off is recommended as a treatment (Burnette et al., 2022). Valium will help her begin with but long-term usage can make her addicted to it and further kick in some more negative tendencies that could increase dependability.
The key to dealing with the gambling issue with Mrs. Perez is referring her to counseling because it targets what caused her addiction and she ultimately gets therapeutic support. The effectiveness of counseling in controlling gambling has been established and has shown a promising index toward behavioral change (Ede et al.,2020). Therefore, these treatment plans create a patient-centric approach given the unique requirements and situation in Mrs. Perez’s case. The plans not only help in therapeutic terms but also address the underlying issues and provide a support system for Mrs. Perez. Therefore there is a high probability for recovery with an overall sense of wellness.
References
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Ede, M. O., Omeje, J. C., Ncheke, D. C., Agah, J. J., Chinweuba, N. H., & Amoke, C. V. (2020). Assessment of the effectiveness of group cognitive behavioural therapy in reducing pathological gambling. Journal of Gambling Studies, 36(4), 1325-1339. https://doi.org/10.1007/s10899-020-09981-y
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Mapes, M. V., DePergola, P. A., & McGee, W. T. (2019). Patient-centered care and autonomy: Shared decision-making in practice and a suggestion for practical application in the critically ill. Journal of Intensive Care Medicine, 35(11), 1352-1355. https://doi.org/10.1177/0885066619870458
Oesterle, T. S., Thusius, N. J., Rummans, T. A., & Gold, M. S. (2019). Medication-assisted treatment for opioid-use disorder. Mayo Clinic Proceedings, 94(10), 2072-2086. https://doi.org/10.1016/j.mayocp.2019.03.029
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