Comorbid Addiction (ETOH and Playing)
53-year-old Puerto Rican Feminine
BACKGROUND
Mrs. Maria Perez is a 53 yr previous Puerto Rican feminine who presents in the present day as a consequence of a fairly “embarrassing downside.”
SUBJECTIVE
Mrs. Perez admits that she has had “issues” with alcohol since her father died in her late teenagers. She studies that she has struggled with alcohol since her 20’s and has been concerned with Alcoholics Nameless “on and off” for the previous 25 years. She states that for the previous 2 years, she has been having increasingly problem sustaining her sobriety for the reason that opening of the brand new “Rising Solar” on line casino close to her dwelling. Mrs. Perez states that she and a pal went to go to the brand new on line casino throughout its grand opening at which level she was “hooked.” She states that she will get “such a excessive” when she is playing. Whereas playing, she “enjoys a drink or two” to Help calm her throughout high-stakes video games. She states that this typically provides option to extra ingesting and extra reckless playing. She additionally studies that her cigarette smoking has elevated over the previous 2 years and he or she is anxious in regards to the adverse results of the cigarette smoking on her well being.
She states that she makes an attempt to abstain from ingesting however she will get such a “excessive” from the act of playing that she wants a couple of drinks to “even out.” She additionally notices that when she drinks, she doesn’t smoke “as a lot,” however she enjoys smoking when she is taking part in on the slot machines. She additionally studies that she has gained weight from ingesting a lot. She presently weights 122 lbs., which represents a 7 lb. weight achieve from her standard 115 lb. weight.
Mrs. Perez is kind of involved in the present day as a result of she borrowed over $50,000 from her retirement account to repay her playing money owed, and her husband doesn’t know.
MENTAL STATUS EXAM
The consumer is a 53 yr previous Puerto Rican feminine who’s alert and oriented to particular person, place, time, and occasion. She is dressed appropriately for the climate and time of yr. Her speech is obvious, coherent, and purpose directed. Her eye contact is considerably avoidant through the medical interview. Once you make eye contact together with her, she seems to be away or seems to be down. She demonstrates no noteworthy mannerisms, gestures, or tics. Her self-reported temper is “unhappy.” Have an effect on is acceptable to content material of dialog and self-reported temper. She denies visible or auditory hallucinations, and no delusional or paranoid thought processes are readily appreciated. Perception and judgment are grossly intact; nonetheless, impulse management is impaired. She is presently denying suicidal or homicidal ideation.
Analysis: Playing dysfunction, alcohol use dysfunction
Resolution Level One
Choose what you need to do:
Vivitrol (naltrexone) injection, 380 mg intramuscularly within the gluteal area each four weeks
Antabuse (disulfiram) 250 mg orally each day
Campral (acamprosate) 666 mg orally thrice/day
Resolution Level One
Vivitrol (naltrexone) injection, 380 mg intramuscularly within the gluteal area each four weeks
RESULTS OF DECISION POINT ONE
• Shopper returns to clinic in 4 weeks
• Mrs. Perez says she feels “great” as she has not “touched a drop” of alcohol since receiving the injection
• Shopper studies that she has not been going to the on line casino, as steadily, however when she does go she “drops a bundle” (which means, spends some huge cash playing)
• Shopper She can be nonetheless smoking, which has her involved. She can be reporting some issues with anxiousness, which additionally has her involved
Resolution Level Two
Choose what you need to do subsequent:
Add on Valium (diazepam) 5 mg orally TID/PRN/anxiousness
Seek advice from a counselor to handle playing points
Add on Chantix (varenicline) 1 mg orally BID
Resolution Level Two
Seek advice from a counselor to handle playing points
RESULTS OF DECISION POINT TWO
• Mrs. Perez returns in four weeks and studies that the anxiousness that she had been experiencing is gone.
• She studies that she has met with the counselor, however she didn’t actually like her.
• She additionally began going to an area assembly of Gamblers Nameless. She states that final week, for the primary time, she spoke through the assembly. She studies feeling supported on this group.
Resolution Level Three
Choose what you need to do subsequent:
Discover the difficulty that Mrs. Perez is having together with her counselor, and encourage her to proceed attending the Gamblers Nameless conferences
Encourage Mrs. Perez to proceed seeing her present counselor in addition to persevering with with the Gamblers Nameless group
Discontinue Vivitrol. Encourage Mrs. Perez to proceed seeing her counselor and to proceed taking part within the Gamblers Nameless group
Resolution Level Three
Discover the difficulty that Mrs. Perez is having together with her counselor, and encourage her to proceed attending the Gamblers Nameless conferences
Steerage to Pupil
Though controversy exists within the literature concerning how lengthy to keep up a consumer on Vivitrol, eight weeks might be too quickly to think about discontinuation. The psychiatric psychological well being nurse practitioner ought to discover the problems that Mrs. Perez is having together with her counselor. As can be coated in additional depth in future programs, ruptures within the therapeutic alliance can lead to purchasers stopping remedy. Clearly, if the consumer doesn’t proceed with remedy, the chance of the playing downside spontaneously remitting is decrease (than had the consumer continued to obtain remedy). Recall that there aren’t any FDA-approved remedies for playing habit. The mainstay of therapy for this dysfunction is counseling. Since Mrs. Perez studies good perceived Help from the Gamblers Nameless conferences, she must be inspired to proceed her participation with this group.
You should talk about smoking cessation choices with Mrs. Perez with a purpose to handle the totality of addictions, and to reinforce her total well being.
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Addictions that coexist (ETOH and Playing)
Feminine Puerto Rican, 53 years previous
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BACKGROUND
Mrs. Maria Perez, a 53-year-old Puerto Rican feminine, arrives in the present day with a “embarrassing situation.”
SUBJECTIVE
Mrs. Perez admits to having “points” with ingesting since her father died whereas she was in her late teenagers. She claims to have suffered with alcohol since her twenties and has been a member of Alcoholics Nameless “on and off” for the previous 25 years. She claims that for the reason that building of the brand new “Rising Solar” on line casino close to her dwelling two years in the past, she has had growing difficulties protecting her sobriety. Mrs. Perez claims that she and a pal went to the brand new on line casino’s grand opening at
