Co-morbid Addiction
Therapy for Clients WitCo-morbid Addictionh Impulsivity, Compulsivity, and Addiction
Co-morbid Addiction (ETOH and Gambling)
At each decision point stop to complete the following:
Decision #1,#2,#3
Which decision did you select?
Why did you select this decision? Support your response with evidence and references to the Learning Resources.
What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
Explain any difference between what you expected to achieve with Decision #1 and the results of the decision. Why were they different?
BACKGROUND
Mrs. Maria Perez is a 53 year old Puerto Rican female who presents to your office today due to a rather “embarrassing problem.”
SUBJECTIVE
Mrs. Perez admits that she has had “problems” with alcohol since her father died in her late teens. She reports that she has struggled with alcohol since her 20’s and has been involved with Alcoholics Anonymous “on and off” for the past 25 years. She states that for the past two years, she has been having more and more difficulty maintaining her sobriety since they opened the new “Rising Sun” casino near her home. Mrs. Perez states that she and a friend went to visit the new casino during their grand opening at which point she was “hooked.” She states that she gets “such a high” when she is gambling. While gambling, she “enjoys a drink or two” to help calm her during high-stakes games. She states that this often gives way to more drinking and more reckless gambling. She also reports that her cigarette smoking has increased over the past two years and she is concerned about the negative effects of the cigarette smoking on her health.
She states that she attempts to abstain from drinking but that she gets such a “high” from the act of gambling that she needs a few drinks to “even out.” She also notices that when she drinks, she doesn’t smoke “as much” but enjoys smoking when she is playing at the slot machines. She also reports that she has gained weight from drinking so much- she currently weights 122 lbs., which represents a 7 lb. weight gain from her usual 115 lb. weight.
Mrs. Perez is quite concerned today because she has borrowed over $50,000 from her retirement account to pay off her gambling debts. She is very concerned because her husband does not know that she has spent this much money.
MENTAL STATUS EXAM
The client is a 53 year old Puerto Rican female who is alert, oriented to person, place, time, and event. She is dressed appropriately for the weather and time of year. Her speech is clear, coherent, and goal directed. Her eye contact is somewhat avoidant during the clinical interview. As you make eye contact with her, she looks away or looks down. She demonstrates no noteworthy mannerisms, gestures, or tics. Her self-reported mood is “sad.” Affect is appropriate to content of conversation & self-reported mood. She visual or auditory hallucinations, no delusional or paranoid thought processes are readily appreciated. Insight and judgment are grossly intact, however, impulse control is impaired. She is currently denying suicidal or homicidal ideation.
Diagnosis: Gambling disorder, alcohol use disorder
Decision Point One
a) Naltrexone (Vivitrol) injection, 380 mg intramuscularly in the gluteal region every 4 weeks
b) Antabuse (Disulfiram) 250 mg orally daily
c) Campral (Acamprosate) 666 mg orally three times/day
Choose your answer.Please discuss each medication option in detail. Reason
Why did you not select
Decision Point Two
a) Continue current dose of Antabuse and begin Campral (acamprosate) 666 mg orally BID
b) Continue current dose of Antabuse and refer to counseling for ongoing gambling issues
c) Continue current dose of Antabuse and begin Wellbutrin (bupropion) XL 150 mg orally daily
Decision Point Three
a) Explore the issue that Mrs. Perez is having with her counselor, and encourage her to continue attending the Gamblers Anonymous meetings, and discuss smoking cessation options
b) Mrs. Perez to continue seeing her current counselor as well as continuing with the Gamblers Anonymous group, and discuss smoking cessation options
c) Discontinue disulfiram, and encourage Mrs. Perez to continue seeing her counselor, and to continue participating in the Gamblers Anonymous group. This would also be an appropriate time to discuss smoking cessation options
