Assessing and Treating Clients with Impulsivity

Answer

Assessing and Treating Clients with Impulsivity

During one of the care delivery days, I received a client who has had problems with alcohol since her late teens. She states that she has found it difficult to maintain her sobriety since a casino was opened near her home. The casino has introduced her to gambling and during the gambling she gets herself drinking alcohol for calmness during high-stakes matches. The client also reported that her cigarette smoking has increased over the past few years and she is greatly concerned about the adverse impacts of smoking on her health. She, therefore, faces difficulties in abstaining from smoking, drinking and gambling. I find that the client’s mood shows sadness with impulse control impaired. She represents no delusional or auditory hallucinations and denies homicidal or suicidal ideation. After the assessment, it was, therefore, important for me to take particular decisions for the treatment of the client.

Decision #1

First, the client would have to be administered with Naltrexone (Vivitrol) injection, 380mg intramuscularly in the gluteal area every 4 weeks.

Reasons for Choosing the Decision

Naltrexone (Vivitrol) injection, 380mg is one of the best prescriptions for the treatment of alcohol addiction or dependence in a patient who is capable of abstaining from alcoholism in an out-patient setting (Gordon et al., 2015). It also has no side effects such as fatigue and sedation associated with Antabuse (Disulfiram) 250 mg.

Anticipated Results

I was expecting the patient to report a significant reduction in the amount of alcohol she consumed at the end of the four weeks of the administration of Naltrexone (Vivitrol) injection, 380 mg. I also expected the client to desist from going to the casino for gambling.

Outcome of the Decision

The patient reported that she had completely abstained from drinking alcohol since receiving the injection. She also reported that she has reduced the frequency of going to the casino for gambling, but had resorted to gamble at her house. Besides, she had not experience any positive change in smoking cigarettes.

Difference between what I expected to achieve with Decision #1

I expected to achieve a reduction in alcohol consumption, but the patient had completely ceased from alcohol consumption. However, her gambling tendency had not reduced despite stopping going to the casino. Additionally, the patient complained of not noticing any change in regards to smoking.

Decision #2

            Secondly, I decided to introduce the patient to Varenicline (Chantix) and Valium (diazepam) 5 mg orally on a daily basis. I also introduced the patient to a counselor.

Reasons for Choosing the Decision

            I recommended Varenicline to the patient to help her stop smoking. It is important to note that Varenicline works by interfering with the nicotine receptors found in the brain (Liberman et al., 2013). In the same vein, the counselor would advise her on the negative effects of smoking while Valium (diazepam) 5 mg would help her recovery from anxiety.

Expected Results of the Decision

            I expected the patient to recover from anxiety and cease smoking and gambling.

 Results of the Decision

            After four weeks, the patient reported that she was no longer felt like smoking cigarettes. She was also not experiencing anxiety and stated that she had been advised by the counselor to attend a local meeting gamblers anonymous and found this very useful.

Difference between what I expected to achieve with Decision #2

I expected the patient to completely stop gambling, however, this did not occur as intended. The patient still practiced gambling but not often. I also expected her to be still drinking a little of alcohol but she had abstained from alcohol. Nonetheless, she talked of a metallic taste which I had never expected from the drugs.

Decision #3

Continue with the counseling and attending the local meeting gamblers anonymous. Similarly, the patient should continue with Varenicline and (Vivitrol) injection.

Reasons for Choosing the Decision

Varenicline and (Vivitrol) injection would help the patient to completely cease smoking and drinking alcohol (Liberman et al., 2013). Counseling and attending the meeting gamblers anonymous will help know the effects of the aforementioned on her health and wellbeing hence desist from such activities.

Expected Results of the Decision

I expected that the decision would perfectly reform the patient and stop smoking, drinking, and gambling.

Results of the Decision

The client reported after four weeks that the she was never taking part in smoking, alcoholism, and gambling. The client, however, showed sadness. She seemed not happy.

Difference between what I expected to achieve with Decision #3

I expected to achieve total reform of the patient, but her mood was still not alright. Therefore, she was to continue with the counseling and Valium (diazepam) 5 mg. I expected her to be happy after the positive steps but she never showed this.

Ethical Issues and Consideration

It is vital to review ethical issues and consideration when prescribing a patient with a drug. First, it is necessary to thoroughly assess the patient to evade the problem of erroneous diagnosis (Littlefield et al., 2015). The procedures to be used when treating the patient should also be reviewed. The patient should be handled with a lot of respect and her culture must also be taken into consideration.