Comorbid Addiction (ETOH and Gambling)

Posted: January 5th, 2023

Comorbid Addiction (ETOH and Gambling)

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Comorbid Addiction (ETOH and Gambling)

The client is a 53-year-old female who accepts to have engaged in long-term substance abuse. Maria Perez reports that she become a regular user of alcohol immediately after her father’s death when she was a teenager. She has tried to seek help from Alcoholics Anonymous (AA) for more than two decades but accepts that her drinking behavior is worsening for the past two years. The establishment of a new social joint near her home has aggravated her drinking behavior making it difficult for her to maintain her sobriety. She spends a lot of time gambling with friends at the new Rising Sun facility and gets a strong urge to consume more alcohol when betting to relax her during high-stakes bets. She acknowledges she engages in reckless gambling behaviors when she is high on ETOH (alcohol), and also reports increased smoking in the past couple of years, a practice she thinks may affect her health. She has tried to quit smoking but regular gambling does not allow her to remain sober. She is gaining weight from her habitual drinking, and she is already into debts related to overindulgence in gambling. The patient is conscious and oriented to her environment. Her speech is normal and dresses like any other normal person. Nevertheless, she displays poor communication styles in the way she avoids eye contact, and in the way she remains gloomy throughout the interaction. A diagnosis of Maria’s case reveals that she suffers from comorbid addiction, which comprises ETOH and gambling, specifically gambling disorder, alcohol use disorder. Consequently, the client requires both pharmacologic and therapeutic intervention to treat her comorbidity because she shows the effects of ETOH and gambling in the way she presents her case. 

Decision One

A suitable immediate action, in this case, is to prescribe Antabuse (disulfiram) 250 mg that the patient should take orally every morning. Basu and Joseph (2019) regard Antabuse as being effective because the FD acknowledges it as being appropriate for addressing uncontrollable alcohol use. Even though Antabuse could cause possible side effects such as mild headache, garlic or metallic taste in the mouth, and feeling of tiredness, the medication is suitable because it suppresses aldehyde dehydrogenase by dominating over NAD (nicotinamide adenine dinucleotide). Basu and Joseph (2019) argue that aldehyde dehydrogenase play critical functions in converting alcohol to acetaldehyde. Administering disulfiram is a much better option than offering Vivitrol (naltrexone) injection, 380 mg intramuscularly in the gluteal area after every four weeks. Pedersen et al. (2018) discourage offering naltrexone injection in comparison to Antabuse arguing that the option is not only painful but also comes with much severe side effects such as a persistent feeling of nausea and intensified increased blood pressure. Administering Antabuse is also a better option than asking the patient to take Campral (acamprosate) 666 mg orally three times each day because besides subjecting the user to regular headaches, the drug makes one feel high. The primary goal for administering Antabuse is to offer medication that is legitimate and approved by FDA. The consideration is likely to impact the treatment approach and communication with the client because quick recovery with less severe side effects would instill courage in her to proceed with the drug. 

Decision Two

The most effective decision on the second phase of the intervention is to continue with the present dose of Antabuse and refer the client to a qualified counselor who can help her quit undesirable drinking and gambling behaviors. More fundamentally, Kelly and Renner (2016) think that it is a good idea to involve a patient in talks about the need to quit smoking and inform them that substance abuse cause severe health complications. Both the counselor and the medical practitioner should borrow teachings from Maqbool, Dar, Rasool, and Gani (2019) who argue that persistent intake of alcohol can interfere with the liver that plays vital functions in disintegrating poisonous components in the body. Both interveners should inform Maria that increased damage to the liver puts her at risk of getting hepatitis and other complications such as cirrhosis and jaundice, which is associated with yellowing of the skin due to a high level of bilirubin in the body. The option of maintaining Antabuse while maintaining therapeutic intervention from a counselor is appropriate compared to introducing Maria to Campral (acamprosate) 666 mg orally BID at the same time offering Antabuse or giving Wellbutrin (bupropion) XL 150 mg orally daily while continuing with the present dose of Antabuse. The combination of drugs could result in possible adverse drug reactions that could cause inappropriate health outcomes. Maintaining the present dose of Antabuse and referring the patient to counseling for current gambling concerns increase the chances of realizing better result because Rizeanu (2018) identifies therapeutic counseling to be an essential step in addressing various conditions, including alcohol use disorder and gambling disorder. A qualified counselor can give guidance and support through the transformative process to a freer and healthier lifestyle. Overall, the adopted option is effective in the way it suggests a comprehensive intervention plan in addressing the patient’s problem.

Decision Three

The most effective option at the third stage of intervention is to meet Maria’s counselor to find out the issues she raises about the therapeutic process and the intervener, and to encourage her to be an active participant in her AA group. It is wise to find out from the therapist why the client does not feel comfortable attending the therapeutic sessions, and possibly come up with an effective work plan that would elevate how Maria attends to sessions and relates with the therapist. Encouraging Maria to attend the Gamblers Anonymous meetings and discussing smoking cessation strategies presents a suitable opportunity for the client to build her confidence and become more intrigued to quit. Menchon et al. (2018) encourage those undergoing counseling to be confident because confidence inspires one to be optimistic that they will overcome their tribulations. It may not be useful to encourage the client to maintain her therapies with the counselor without finding out why she is feeling more needs to happen to make the process more engaging and fruitful. The patient may also not record quick recovery if she stops using Antabuse even if she proceeds with counseling and engages in talks on how to quit smoking. Maintaining Antabuse throughout the entire process is a vital requirement in helping the client overcome alcoholism and build a steady life. 

Ethical Considerations

The intervention approaches are ethical because they do not seek to cause any harm to the client but instead aim to improve her well-being. Choosing Antabuse over other medications, for example, is an ethical choice because the FDA approves it as effective in reducing alcoholism. The option is also honest because Antabuse is not likely to cause severe side effects as would be experienced with other available medications. Referring the client to a counselor is also an ethical option because this provides an opportunity for the client to share ideas with the therapist that would help avoid any adverse effects or give valuable tips on how to remain safe. Meeting Maria’s counselor and discussing ways to improve the therapy is also ethical because it implies that the medical practitioner supports the client to regain good health.  

Conclusion

Maria requires a combination of interventions that would help her overcome the substance use issues and the gambling problem that consumes a lot of her money and time. The patient at the time of presenting herself at the hospital displays signs and symptoms, which shows that she suffers from both gambling disorder and alcohol use disorder. Besides these two complications, the client looks fine in the way she interacts with people, dress, or react to environmental stimuli. Nonetheless, a critical analysis of her condition reveals that she requires appropriate assistance that would help her overcome her tribulations. The paper considers providing Antabuse (disulfiram) 250 mg that the patient takes orally each morning to be the most effective intervention. The mechanism of the drug in the body is appropriate and is the reason why FDA recommended it as the first medication for alcohol use disorder. The patient is also likely to improve in her condition if she gets the help of a competent counselor who can help her overcome the undesirable gambling behavior that consumes much money and drives her to inappropriate substance use. Prescribing Antabuse is preferable to offering Campral (acamprosate) 666 mg, and also suitable than providing Vivitrol (naltrexone) injection, 380 mg because both medications are likely to cause adverse reactions. The paper further recommends that Maria continues with Antabuse and counseling until she experiences significant improvement in her health. The option is ethical because it seeks to achieve the patient’s wellbeing, and aims at helping her quit undesirable conduct and embrace those that can help to become sober, healthy, and wise in the way she makes decisions. Both practitioners and those who suffer from gambling disorder and alcohol use disorder can acquire valuable information from the research that they can apply in their practice and lives to achieve a satisfying outcome. 

References

Basu, D., & Joseph, J. (2019). Adverse Drug reactions to disulfiram treatment with or without alcohol challenge in the Indian setting: Systematic review. Journal of Postgraduate Medicine Education and Research 53 (1), 21-30. doi:10.5005/jp-journals-10028-1307

Kelly, J. E., & Renner, J. A. (2016). Alcohol-related disorders. In T. A. Stern, M. Favo, T. Wilens, & J. F. Rosenbaum. (Eds.), Massachusetts General Hospital psychopharmacology and neurotherapeutics (pp. 163–182). Elsevier.

Maqbool, M., Dar, M., Rasool, S., & Gani, I. (2019). Substance use disorder and availability of treatment options: An overview. Journal of Research in Health Science 1 (3), 4-10. doi 10.26739/2523-1243

Menchon, J., et al. (2018). An overview of gambling disorder: from treatment approaches to risk factors. F1000 Research 7, doi: 10.12688/f1000research.12784.1

Pedersen, B., et al. (2018). Disulfiram for alcohol use disorder. Cochrane Database SystematicReviews 9, doi: 10.1002/14651858.CD010487.pub2

Rizeanu, S. (2018). Cognitive-behavioral therapy for gambling addiction. doi: 10.5772/intechopen.72671