Several assessment points about the client's mental state can be gained through the clinical interview. First and foremost, the client is addicted to alcohol as a result of stress or sadness. The client's stress or despair stems from the incident of losing her father at a young age (University of Michigan Health System, 2016). After her father died, the client turned to alcohol as a coping method to help her cope with her sorrow. Second, based on the quantity of money she spends at the casino, the client suffers from impulsivity. Once she begins gambling, it is her impulsiveness that keeps her going such that she has ended up spending and losing huge amounts of money to the vice. This is worrying because it is now leading to poor financial decisions that she makes so that she can cover for losses brought about by unplanned gambling limits.
Third, the patient also shows signs of compulsiveness or compulsive behavior. This can be seen through her use of cigarettes as a distraction as she gambles. Also, drinking alcohol to "cancel out" on the high caused by gambling is also a sign of the client's compulsiveness. Since there are no known medical solutions for gambling addiction, counseling and attending the gamblers anonymous meetings are the best therapy that the client can use to overcome her gambling addiction (Grant, Odlaug, & Schreiber, 2014). Solving her gambling addiction could be beneficial since it will lead to solving her alcohol and cigarette addiction. This is because she engages in smoking and drinking during her gambling escapades.
Analyze factors that influence pharmacokinetic and pharmacodynamic processes in clients requiring therapy for impulsivity, compulsivity, and addiction
Drug interactions is an important factor to consider when looking at the factors that influence the pharmacodynamics as well as pharmacokinetic processes in clients requiring therapy for impulsivity, compulsivity, and addiction. This is because the drugs prescribed to the clients require that the patients do not use the substances whose addiction they are being treated for. Therefore, continued use and abuse of the addictive substance or substances is a major influence (Salmon, & Forester, 2012). Secondly, since patients with impulsivity, compulsivity and addiction have psychological or mental related problems, counseling as a form of therapy is an important influence of pharmacokinetic as well as pharmacodynamics processes.
This is because the counseling therapy as well as attending support group meetings help the client in gaining the mental strength of overcoming her problems with addiction, impulsivity, and compulsivity (Stahl, 2013). In the event that a client discontinues counseling therapy, then she is likely to return into her previous addictions thereby affecting the effect of the medication administered to solve other notable addictions (Loreck, Brandt, & DiPaula, 2016). Other factors include the client genetics in relation to the drugs, as well as variations in drug absorption and distribution.
Evaluate efficacy of treatment plans
The treatment plans for the client include medication as well as therapy. The medication that the client has been put on is effective since it has helped in reducing her alcohol addiction. However, the patient should not be discontinued on the Vivitrol medication (Stahl, 2014b). Discontinuation of Vivitrol for the patient at four weeks is premature and could lead to a relapse back into alcoholism. The medication for nicotine addiction as well as opioid dependence is, however, taking slow effect. Perhaps the medication can be changed with one that is more effective. This is because even after four weeks of medication, the client is still worried about her smoking patterns (Stahl, & Grady, 2012). She is worried that she cannot control her smoking patterns and that it might lead to worse problems. On the issue of the therapy, the gamblers anonymous meetings are effective and beneficial. They are helping the patient gain mental stability regarding her gambling addiction. However, for the counseling sessions, the counselor should strive and create a therapeutic alliance with the client so as to avoid discouraging the client from coming for therapy. Changing a counselor is quite unnecessary since it will negate all the progress and efforts that have been made so far with the patient regarding confidentiality and trust. To make the counseling therapy more effective, the counselor should create a good connection with the client to motivate her.
Analyze ethical and legal implications related to prescribing therapy for clients with impulsivity, compulsivity, and addiction
Various clients have different representations of impulsivity, compulsivity, and addiction. Also, various clients have different pharmacodynamics and pharmacokinetics regarding response to medication. As such, it is important to carefully assess the unique qualities of a patient before prescribing therapy so as to avoid experiencing more risks than benefits (Stahl, 2014b). Ethically, looking at the client’s medical history is important as it enables a personalized prescription. Regarding counseling therapy, issues such as client rights like confidentiality should be considered when assigning a counselor who will take up the patient’s case. Analysis of the factors that influence pharmacokinetic as well as pharmacodynamics processes in clients is also important.
References
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
Salmon, J. M., & Forester, B. (2012). Substance abuse and co-occurring psychiatric disorders in older adults: A clinical case and review of the relevant literature. Journal of Dual Diagnosis, 8(1), 74–84. doi:10.1080/15504263.2012.648439
Sanches, M., Scott-Gurnell, K., Patel, A., Caetano, S. C., Zunta-Soares, G. B., Hatch, J. P., & ... Soares, J. C. (2014). Impulsivity in children and adolescents with mood disorders and unaffected offspring of bipolar parents. Comprehensive Psychiatry, 55(6), 1337–1341. doi:10.1016/j.comppsych.2014.04.018
Stahl, S. M. (2014b). The prescriber’s guide (5th ed.). New York, NY: Cambridge University Press.
Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge University Press.
Stahl, S. M., & Grady, M. (2012). Stahl’s illustrated substance use and impulsive disorder New York, NY: Cambridge University Press.
University of Michigan Health System. (2016). Childhood trauma linked to worse impulse control in adulthood, study finds. Retrieved from https://www.sciencedaily.com/releases/2016/01/160120201324.htm
