Comorbidity is any two or more co-occurring illnesses. With substance abuse, comorbidities encompass both dependency and health complications related to drug usage, making them the most commonly known obstacles to sobriety and reliance. According to Bahji et al. (2019), co-occurring illnesses have historically been disregarded by Western medicine, which has led to fewer patients receiving recovery care and inadequate treatment. However, medical professionals have been investigating their comorbidities in substance dependence throughout the last few decades, which has resulted in dual diagnosis therapies (Manfre et al., 2021). However, there are still particular difficulties in identifying and managing comorbidities. For example, many comorbidities associated with substance dependence have comparable symptoms. Thus, it might be difficult for a doctor to determine the boundary between one ailment and another.
The assigned case study centers on a 53-year-old woman who seeks help for her alcohol and gambling problems. She acknowledged in the assessment that she had issues with alcohol use that began when her father passed away. She adds that even though she occasionally attends Alcoholics Anonymous meetings, she has battled alcoholism for the previous 25 years. However, a local casino that was recently opened has worsened her alcohol intake. According to her report, she feels compelled to drink alcohol to calm herself down when she is gambling because of the anxiety. Despite being aware of the harmful consequences smoking can have on a person, she has increased her smoking over the previous two years. Also, the patient’s comorbidity has caused her to accumulate debt, as she took out a $50,000 loan from her retirement account to settle her gambling bills, which her spouse is unaware of. Besides, her mental state indicates that she knows the time, people, place, and incident. She is dressed appropriately for the day’s weather. Her goal-directed, goal-coherent communication makes her mental assistance seem reasonable. As such, the patient’s cultural background, preferred language, and level of health literacy may all be considered when treating them. In this regard, this paper discusses the treatment decisions selected for the patient, the expected outcomes, and the related ethical implications of the decisions.
Decision One
The most sensible and successful course of treatment for the patient’s illness and associated symptoms was to start the patient on 380 mg of naltrexone injection. Naltrexone is an opioid antagonist that acts by blocking the mu-opioid receptor (Malone et al., 2019). It inhibits the effects of alcohol and opioid medications, avoiding the intoxication caused by the substances. The way the hypothalamus, pituitary, and adrenal glands interact to reduce the amount of alcohol consumed is also altered. Numerous research has demonstrated Naltrexone’s effectiveness in treating alcohol consumption issues. For example, research by Murphy et al. (2021) indicates that extended-release Naltrexone lowers the number of drinking days and heavy drinking days per month. Another study by Kirchoff et al. (2021) also reveals that starting Naltrexone at the time of hospitalization can help improve outcomes related to alcohol use disorders and prevent readmissions among patients with alcohol use disorders who are interested in taking medication to reduce heavy drinking.
Reason for Not Selecting Other Treatment Decisions
Naltrexone was selected over Antabuse because clinical evidence indicates that it can produce neuropathy in less than the standard 500 mg recommended daily dosage (Meier et al., 2021). Therefore, there is a need for healthcare practitioners to recognize neuropathy conditions more due to the current cases that have been revealed on neuropathy development with the medication before making a prescription. In addition, its hepatic toxicity, including hepatic failure, has been associated with it, which is another reason for not selecting it.
Also, Naltrexone was selected over Campral because clinical evidence shows that Campral is taken to maintain abstinence, meaning that they have already overcome excessive alcohol consumption (Sharma et al., 2020). However, in this case, the patient is still consuming alcohol and wants to reduce the frequency and duration of drinking, making Naltrexone the best choice.
Expected Outcomes
The patient’s rate of alcohol consumption is expected to go down after starting her on the medication. The patient’s gambling addiction and cigarette smoking are likely to persist because the treatment selected is only for her alcohol consumption.
Ethical Implication
The patient is expected to respond well to the Naltrexone. However, it is important to engage the patient in making the treatment decisions to ensure that they are aware of the medication they will be taking and consent to it. However, not engaging the patient and seeking her consent could pose an ethical dilemma between the patient’s rights to treatment decisions and nursing clinical judgment.
Decision Two
The second decision was to refer the patient to a counselor to help with her gambling addiction. This decision was selected because the patient has reported that she has not touched a drop of alcohol, which makes her feel wonderful. However, her gambling addiction persists because every once in a while, she goes to the casino and uses the money to gamble. According to Schwarzkopf et al. (2021), counseling is a therapy used to treat gambling issues. It works by educating patients about the effects of gambling on themselves and their families, which encourages them to explore their options in solving their gambling issues.
Reason for Not Selecting Other Treatment Decisions
Referring the patient to a counselor to address gambling issues was selected over adding valium because the clinical evidence indicates that valium is addictive and its withdrawal symptoms can be severe (Powers, 2022). Also, it was not chosen because the patient is responding well to Naltrexone, and there is no indication of an additional medication to relieve her alcohol symptoms.
Referring the patient to a counselor to address her gambling addiction was selected over adding Chantix because clinical evidence indicates the patient may find it challenging to manage withdrawal symptoms when using this medication (Marley Vea DeVoss, 2019). It was not chosen because the main comorbidities in the patient are gambling and alcohol use, which must be addressed first before starting off the treatment on the smoking issue the patient is having.
Expected Outcomes
The patient’s gambling addiction is expected to go down upon seeing the counselor recommended. Her alcohol consumption is also likely to improve further because of the continued use of Naltrexone.
Ethical Implication
The patient is responding well to the Naltrexone prescribed, based on her report after starting the medication. However, she is still concerned with her gambling addiction because every time she goes to the casino, she puts much money into gambling. Therefore, the nurses have the responsibility to share with her other optional treatments to capsize her addiction, like counseling. Before recommending the patient to counsel, it is essential to talk to her about it as well as its benefits on her gambling issue. However, not engaging the patient can cause a conflict between the patient’s right to proper treatment and the nurse’s role in providing effective treatment.
Decision Three
The third treatment decision selected for the patient was to explore Mr. Perez’s issue with her counselor and encourage her to continue attending the Gamblers Anonymous meetings. This decision was chosen because the patient reported her dislike of the counselor she met as a recommendation. The other reason is that she started attending a local meeting of the Gambling Anonymously group, which she claimed that she felt supported, making it a good treatment option.
Reason for Not Selecting Other Treatment Decisions
Exploring the issue of the patient disliking the counselor and encouraging her to continue her attendance with Gamblers Anonymous was selected over enabling the patient to continue seeing the counselor and continue Gamblers Anonymous meetings because clinical evidence indicates that a breakdown in therapy alliance between patient and psychiatric can cause a patient’s mistrust in therapeutic process or misinterpretation of something the therapists say about the patient’s condition hence resulting to poor treatment outcomes (Kotera et al., 2019). Therefore, selecting those options could have affected the patient’s treatment negatively.
In addition, exploring the issue of the patient disliking the counselor and encouraging her to continue her attendance with Gamblers Anonymous was selected over discontinuing Vivitrol, enabling the patient to continue seeing the counselor and attending the Gamblers Anonymous groups because there are no indications that the Naltrexone is having any side effects in the patient. Also, encouraging the patient to continue seeing the counselor might cause the patient to lose trust in the healthcare practitioner’s responsibility for her treatment, hence abandoning the entire treatment, which later prevents her healing process.
Expected Outcomes
The patient’s gambling issues are expected to be resolved based on her continued gambling anonymous meetings. The patient’s alcohol consumption is likely to improve with 90% improvement because of continued naltrexone intake.
Ethical Implication
The patient is still responding well to the Naltrexone. However, she dislikes the counselor she was recommended to. The patient must continue the counseling session to get well with her gambling issues. However, the patient disliking the counselor affects the goal of improving the patient’s gambling addiction. Therefore, forcing the patient to continue the therapy against her will might cause an ethical conflict between the patient’s autonomy and the clinical judgment made by the nurse practitioner.
Conclusion
The patient presented in the case study has a comorbidity of alcohol use disorder and gambling addiction, which have had an impact on her finances. Therefore, starting her on Naltrexone was the best treatment option because this medication is known to reduce heavy alcohol consumption by blocking the opioid receptors. After starting the medication, the patient reported that the medication was helping with her alcohol condition because she had not even tried a drop of alcohol. However, her gambling addiction was still persistent. As a result, recommending a counselor alongside her naltrexone prescriptions was the best decision. Counseling was expected to improve her gambling issues as her alcohol consumption rates continued to improve. However, the patient disliked the counselor she was recommended to, posing an effect on the potential positive outcomes the treatment could have on her gambling issues. The patient also reported her attendance in the Gambling Association group meeting and encouraged her to continue attending the meetings as her issue with the counselor being under investigation was the best decision. The patient is expected to improve further her gambling addiction with the help of these meetings.
However, not engaging the patient in making the right treatment decisions in the first treatment options could conflict with the patient’s rights to treatment decisions and nursing clinical judgment. As for the second treatment option, not engaging the patient could cause a conflict between the patient’s right to proper treatment and the nurse’s role in providing effective treatment. Additionally, forcing the patient to continue the therapy despite disliking the counselor in the third treatment decision could cause an ethical conflict between the patient’s autonomy and the clinical judgment made by the nurse practitioner.
References
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