Essay Example on Comorbidity of Alcoholism & Gambling: A Dangerous Combination

Introduction

When two illnesses or disorders occur in the same individual, sequentially or simultaneously they can be said to be comorbid (Grant, Odlaug, & Schreiber, 2014). Alcoholism and gambling are a perfect example of how comorbid can occur. Although it not always clear whether gambling leads to alcoholism, the two are more likely to occur together forming a dangerous combination. In 2013, the American Psychiatric Association (APA) categorized gambling as an addition terming it as "impulse control disorder (Grant et al., 2014). One clear thing is that the two conditions can create major health concerns for many people. The current case study looks at Ms. Perez, a Puerto Rican woman who has comorbid addition of gambling and alcohol from the way she describes her history. This paper will aim to discuss different treatment methods Ms. Perez can undergo. The paper will discuss the most appropriate treatment among Naltrexone, Antabuse, and Campral giving out reasons and finally look at ethical issues concerning the treatment of Ms. Perez as an addict.

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Antabuse

Antabuse is a deterrent medication that prompts an adverse reaction when an individual drink and is one of the oldest and first medications to be approved to treat alcoholism (Loreck, Brandt & DiPaula, 2016). When a patient takes in this drug, their blood has an increase of acetaldehyde levels since the inhibitor aldehyde dehydrogenase stops total metabolism of ethanol (Mohammad, Irizarry, Shub, & Sarkar, 2017). Normally, when a person takes in alcohol, it first converted into acetaldehyde which is later converted to acetate but when one takes in Antabuse, the second step does not occur. This creates side effects such as acne eruption, metallic aftertaste, nausea, headache, tiredness, sedation, and mild drowsiness (Mohammad et al., 2017). This treatment option is designed for those patients willing to abstain from alcohol.

Campral

Campral or calcium acetylaminopropane sulfonate is a medication that is to treat alcohol dependence when it is combined with counseling (McCracken, McCracken & Harris, 2016). Campral or Acamprosate is designed to alleviate chemical signaling in a patient's brain when they attempt alcohol withdrawal. This treatment method, however, works best with therapy, and in some cases, it might fail when used alone (McCracken et al., 2016). Campral can have serious side effects such as high or low blood pressure, abnormal heart rhythms, allergic reactions while other side effects can include impotence, insomnia, headaches, diarrhea (Grant et al., 2014). People with kidney problems are advised not to take the drug (McCracken et al., 2016).

Naltrexone

Naltrexone is an opioid antagonist meant to reduce alcohol dependency by reducing alcohol consumption among the patients. The drug was invented in 1965, but its medical use began in 1984 (Garegnani, & Kanniyappan, 2016). This treatment reduces the desire of the patient to consume alcohol when they are injected with the drug in four weeks with 380mg in every injection (McCracken et al., 2016). However, naltrexone should be given only after detoxification is done (Grant et al., 2014). Some of the major symptoms include headaches, nausea, anxiety, and trouble sleeping (Loreck et al., 2016).

Decision Point 1

Among the three choices of treatment, I selected to start Antabuse (Disulfiram) 250mg orally daily. All three of these medications are used to treat alcohol dependence, but the reason why I choose Antabuse is that the client only has to be sober for 24 hours before initiating treatment (Stahl, 2013). Secondly, Antabuse has been successful in treating alcohol abuse because of the intense side effect individuals get if they consume alcohol while taking Antabuse (Skinner, Lahmek, Pham, & Aubin, 2014). Antabuse as earlier stated intercepts the second stage of alcohol metabolism causing acetaldehyde a high toxin carcinogen to build up causing an unpleasant feeling for the client like tachycardia, flushing, nausea, and vomiting (Skinner et al., 2014). Hence; due to the unpleasant feeling individuals get for consuming alcohol while on the medication make them stop consuming alcohol. I did not select Campral and Naltrexone because the client must be in complete abstinence to commence treatment with these medications (Stahl, 2018). Moreover, I was hoping for the client to stop drinking and reduce gambling.

The outcome of my decision is that the client returned to the clinic in four weeks, and report feeling sedated, fatigue, and has a metallic taste in her mouth but seems to be going away. The client also reports that she has a drink five days after starting the medication and felt like she was going to die. The client reacts to a red face and tachycardia. Additionally, client report she continues to visit the casino but spends less than before, but her cigarette smoking has reduced. This was my expectation because the client has stopped drinking because of an unpleasant side effect with Antabuse; also her gambling has reduced. So now let work towards getting total abstinence from alcohol and gambling.

Decision Point 2

For decision number two, I selected to continue the current dose of Antabuse and begin Wellbutrin (bupropion) XL 150 mg orally daily. I selected this decision because Antabuse is doing what it is supposed to do, and the side effects reported are typical side effects associated with Antabuse and as for the metallic taste, it will eventually go away as evidenced by client statement "seems to be going away" so this is no cause for alarm. I also decided to add Wellbutrin (bupropion) XL to aid in smoking cessation, reduce cravings, and treat depression if there is any. Wellbutrin is exhibited as a successful anti-addiction medication for nicotine (AAC.org, 2018). I also selected to add Wellbutrin because of the effect studies have shown it has on gambling (Black et al., 2007).

I did not select the other two decisions because for one Antabuse is working so there is no needing in adding another alcohol dependence treatment medication like Campral. Also, we are getting some positive result regarding her gambling and is too early to refer her for counseling; we will refer her for counseling if all options fail to correct her gambling habit.

The reason for this is because I was hoping for a decrease in cigarette smoking, alcohol abstinence, and a reduction in gambling. The outcome of my decision is that the client returned to the clinic in four weeks, a report she is feeling much better and all reported side effects gone. The client also reports a decrease in cigarette smoking, and the client smokes only a couple of cigarettes a day. The client continues to visit the casino, but spending continues to decrease. This was my expectation since I wanted a decrease in cigarette smoking, alcohol abstinence, and decrease spending. All of these was achieved as evidenced by the client statement. It will be right to assume that since the client did not report a symptom, it means she is sober. Proceed to decision point three.

Decision Point 3

For number three, I selected to maintain current doses of each medication and refer to counseling for her gambling. I selected to maintain current medications because the client is responding to treatment as evidenced by a decrease in cigarette smoking and gambling coupled with alcohol abstinence; hence no change is recommended. Overall, there has been tremendous improve toward cigarette smoking and alcohol consumption, and we need counseling to address and attain gambling abstinence. One of the recommended gambling therapies includes cognitive behavioral therapy (CBT) ("Compulsive gambling," 2016). CBT focuses on challenging the client regarding her gambling behavior and has evidenced-based data proving success with gambling issues ("Compulsive gambling," 2016). I did not select the other two decisions because, there is no need in increasing Wellbutrin XL because the current dose is working just fine, and increase dose may lead to risk for side effects. The client is responding to Antabuse so; therefore, there is no need to discontinue it. Moreover, I was hoping for total abstinence from alcohol, gambling and smoking cessation. Am pleased to say therapy was successful.

Ethical Considerations

It is the role of any healthcare provider to ensure they have observed all ethical issues surrounding any treatment method in addition to disorders. In the present case, the first ethical case is about informed consent where the client must ware of any medication, treatment or intervention that need to be taken (Loreck et al., 2016). The client, in this case, should be informed about the best treatment method and its side effects. For instance, the client should be informed about Antabuse, how it works, what she should make it work well and the expected side effects. Moreover, client opinions such as the form of counseling they prefer should also be respected.

Conclusion

In conclusion, this paper has disused three treatment methods that are naltrexone, Antabuse, and Campral and analyzed which is the most effective in treating alcohol dependency disorder by considering the case of Ms. Perez. Among the three, Antabuse is the most effective in Ms. Perez case since it has been successful in treating alcohol abuse because of the intense side effect individuals get if they consume alcohol while taking it. Nevertheless, medical professionals must pay attention to various ethical conditions when treating patients with addiction disorders.

References

Black, D. W., Arndt, S., Coryell, W. H., Argo, T., Forbush, K. T., Shaw, M. C., ... & Allen, J. (2007). Bupropion in the treatment of pathological gambling: a randomized, double-blind, placebo-controlled, flexible-dose study. Journal of Clinical Psychopharmacology, 27(2), 143-150.

Bupropion (Wellbutrin/Zyban) as an Anti-Addiction Medication. (2018). Retrieved from https://americanaddictioncenters.org/addiction-medications/bupropion

Compulsive gambling. (2016, October 22). Retrieved from https://www.mayoclinic.org/diseases-conditions/compulsive-gambling/diagnosis-treatment/drc-20355184

Garegnani, J., & Kanniyappan, V. (2016). U.S. Patent Application No. 14/611,270. Retrieved from https://patents.google.com/patent/US20160263102A1/en

Grant, J. E., Odlaug, B. L., & Schreiber, L. N. (2014). Pharmacological treatments in pathological gambling. British Journal of Clinical Pharmacology, 77(2), 375-381. doi:10.1111/j.1365-2125.2012.04457.x

Loreck, D., Brandt, N. J., & DiPaula, B. (2016). Managing opioid abuse in older adults: Clinical considerations and challenges. Journal of Gerontological Nursing, 42(4), 10-15. doi:10.3928/00989134-20160314-04

McCracken, L. M., McCracken, M. L., & Harris, R. A. (2016). Mechanisms of action of different drugs of abuse. The Oxford Handbook of Substance Use and Substance Use Disorders: Two-Volume Set, 135.

Mohammad, A., Irizarry, K. J., Shub, R. N., & Sarkar, A. (2017). Addiction Treatment Aftercare Outcome Study. Retrieved from https://ncphp.org/wp-content/uploads/2017/04/Addiction-Treatment-Aftercare-Study.pdf

Skinner, M. D., Lahmek, P., Pham, H., & Aubin, H. J. (2014). Disulfiram efficacy in the treatment of alcohol dependence: a meta-analysis. PloS one, 9(2), e87366.

Stahl, S. M. (2013). Stahl's essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge University Press.

Stahl, S. M. (2018). The prescriber's guide (6th ed.). New York, NY: Cambridge University Press.