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Comorbid Addiction (ETOH and Gambling) 53-year-old Puerto Rican Female
BACKGROUND Mrs. Maria Perez is a 53 year old Puerto Rican female who presents 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 o�” for the past 25 years. She states that for
the past 2 years, she has been having more and more di�culty maintaining her sobriety
since the opening of the new “Rising Sun” casino near her home. Mrs. Perez states that
she and a friend went to visit the new casino during its 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
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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 2 years and she is
concerned about the negative e�ects of the cigarette smoking on her health.
She states that she attempts to abstain from drinking but 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 she 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 borrowed over $50,000 from her
retirement account to pay o� her gambling debts, and her husband does not know.
MENTAL STATUS EXAM The client is a 53 year old Puerto Rican female who is alert and 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. When 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.” A�ect is appropriate to content of conversation and self-
reported mood. She denies visual or auditory hallucinations, and 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 Select what you should do:
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Addictions that coexist (ETOH and Gambling) Female Puerto Rican, 53 years old
BACKGROUND Mrs. Maria Perez, a 53-year-old Puerto Rican female, presents today due to a pretty serious illness.
“embarrassing issue.”
SUBJECTIVE Mrs. Perez admits to having “issues” with drinking since her father died in her childhood.
late twenties She claims to have struggled with alcohol since her twenties and has been sober since then.
For the past 25 years, I’ve been “on and off” with Alcoholics Anonymous. She claims that for
She has found it increasingly difficult to maintain her sobriety over the last two years.
since the new “Rising Sun” casino near her home opened According to Mrs. Perez,
her and a pal
