Week 8: Therapy for Clients With Impulsivity, Compulsivity, and Addiction Impulsivity and compulsivity have a wide range of clinical presentations and often overlap with many other psychiatric disorders. Some individuals act without forethought and have difficulty saying “no” to certain things such as using illicit drugs or spending money, whereas other individuals engage in compulsive behaviors with undesirable consequences. In some cases, these impulsive and compulsive behaviors also fuel issues with addiction. To effectively assess and treat clients, you must understand how these disorders differ, as well as how their symptoms impact clients and their families. This week, as you examine therapies for individuals with impulsivity, compulsivity, and addiction, you explore the assessment and treatment of clients with these disorders. You also consider ethical and legal implications of these therapies. Photo Credit: [Apolinar B. Fonseca]/[Moment]/Getty Images Assignment: Assessing and Treating Clients With Impulsivity, Compulsivity, and Addiction Impulsivity, compulsivity, and addiction are challenging disorders for clients across the lifespan. These disorders often manifest as negative behaviors, resulting in adverse outcomes for clients. In your role as the psychiatric mental health nurse practitioner, you have the opportunity to help clients address underlying causes of the disorders and overcome these behaviors. For this Assignment, as you examine the client case study in this week’s Learning Resources, consider how you might assess and treat clients presenting with impulsivity, compulsivity, and addiction. Learning Objectives Students will: · Assess client factors and history to develop personalized therapy plans for clients with impulsivity, compulsivity, and addiction · Analyze factors that influence pharmacokinetic and pharmacodynamic processes in clients requiring therapy for impulsivity, compulsivity, and addiction · Evaluate efficacy of treatment plans · Analyze ethical and legal implications related to prescribing therapy for clients with impulsivity, compulsivity, and addiction Learning Resources Note: To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus. Required Readings Note: All Stahl resources can be accessed through the Walden Library using this link. This link will take you to a log-in page for the Walden Library. Once you log into the library, the Stahl website will appear. Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge University Press. To access the following chapters, click on the Essential Psychopharmacology, 4th ed tab on the Stahl Online website and select the appropriate chapter. Be sure to read all sections on the left navigation bar for each chapter. · Chapter 14, “Impulsivity, Compulsivity, and Addiction” Stahl.

1. Week 8: Therapy for Clients With Impulsivity, Compulsivity,
and Addiction
Impulsivity and compulsivity have a wide range of clinical
presentations and often overlap with many other psychiatric
disorders. Some individuals act without forethought and have
difficulty saying “no” to certain things such as using illicit
drugs or spending money, whereas other individuals engage in
compulsive behaviors with undesirable consequences. In some
cases, these impulsive and compulsive behaviors also fuel
issues with addiction. To effectively assess and treat clients,
you must understand how these disorders differ, as well as how
their symptoms impact clients and their families.
This week, as you examine therapies for individuals with
impulsivity, compulsivity, and addiction, you explore the
assessment and treatment of clients with these disorders. You
also consider ethical and legal implications of these therapies.
Photo Credit: [Apolinar B. Fonseca]/[Moment]/Getty Images
Assignment: Assessing and Treating Clients With Impulsivity,
Compulsivity, and Addiction
Impulsivity, compulsivity, and addiction are challenging
disorders for clients across the lifespan. These disorders often
manifest as negative behaviors, resulting in adverse outcomes
for clients. In your role as the psychiatric mental health nurse
practitioner, you have the opportunity to help clients address
underlying causes of the disorders and overcome these
behaviors. For this Assignment, as you examine the client case
study in this week’s Learning Resources, consider how you
might assess and treat clients presenting with impulsivity,
compulsivity, and addiction.
Learning Objectives
Students will:
· Assess client factors and history to develop personalized
therapy plans for clients with impulsivity, compulsivity, and

2. addiction
· Analyze factors that influence pharmacokinetic and
pharmacodynamic processes in clients requiring therapy for
impulsivity, compulsivity, and addiction
· Evaluate efficacy of treatment plans
· Analyze ethical and legal implications related to prescribing
therapy for clients with impulsivity, compulsivity, and addiction
Learning Resources
Note: To access this week’s required library resources, please
click on the link to the Course Readings List, found in
the Course Materials section of your Syllabus.
Required Readings
Note: All Stahl resources can be accessed through the Walden
Library using this link. This link will take you to a log-in page
for the Walden Library. Once you log into the library, the Stahl
website will appear.
Stahl, S. M. (2013). Stahl’s essential psychopharmacology:
Neuroscientific basis and practical applications (4th ed.). New
York, NY: Cambridge University Press.
To access the following chapters, click on the Essential
Psychopharmacology, 4th ed tab on the Stahl Online website
and select the appropriate chapter. Be sure to read all sections
on the left navigation bar for each chapter.
· Chapter 14, “Impulsivity, Compulsivity, and Addiction”
Stahl, S. M., & Grady, M. (2012). Stahl’s illustrated substance
use and impulsive disorder New York, NY: Cambridge
University Press.
To access the following chapter, click on the Illustrated Guides
tab and then the Substance Use and Impulsive Disorders tab.
· Chapter 10, “Disorders of Impulsivity and Compulsivity”
Stahl, S. M. (2014b). The prescriber’s guide (5th ed.). New
York, NY: Cambridge University Press.

3. To access information on the following medications, click on
The Prescriber’s Guide, 5th ed tab on the Stahl Online website
and select the appropriate medication.
Review the following medications:
For insomnia
For obsessive-compulsive disorder
· Citalopram
· clomipramine
· escitalopram
· fluoxetine
· fluvoxamine
· paroxetine
· sertraline
· venlafaxine
· vilazodone
For alcohol withdrawal
· chlordiazepoxide
· clonidine
· clorazepate
· diazepam
· lorazepam
· oxazepam
For bulimia nervosa and binge eating
· fluoxetine
· topiramate
· zonisamide
For alcohol abstinence
· acamprosate
· disulfiram
For alcohol dependence
· nalmefene

4. · naltrexone
For opioid dependence
· buprenorphine
· naltrexone
For nicotine addiction
· bupropion
· varenicline
Book Excerpt: Substance Abuse and Mental Health Services
Administration. (1999). Treatment of adolescents with
substance use disorders. Treatment Improvement Protocol
Series, No. 32. Retrieved from
http://www.ncbi.nlm.nih.gov/books/NBK64350/
· Chapter 1, “Substance Use Among Adolescents”
· Chapter 2, “Tailoring Treatment to the Adolescent’s Problem”
· Chapter 7, “Youths with Distinctive Treatment Needs”
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
Note: Retrieved from Walden Library databases.
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
Note: Retrieved from Walden Library databases.
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
Note: Retrieved from Walden Library databases.
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,

5. 8(1), 74–84. doi:10.1080/15504263.2012.648439
Note: Retrieved from Walden Library databases.
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
Note: Retrieved from Walden Library databases.
Required Media
Laureate Education (2016c). Case study: A Puerto Rican woman
with comorbid addiction [Interactive media file]. Baltimore,
MD: Author
Note: This case study will serve as the foundation for this
week’s Assignment.
To prepare for this Assignment:
· Review this week’s Learning Resources. Consider how to
assess and treat adolescent clients requiring therapy for
impulsivity, compulsivity, and addiction.
The Assignment
Examine Case Study: A Puerto Rican Woman With Comorbid
Addiction. You will be asked to make three decisions
concerning the medication to prescribe to this client. Be sure to
consider factors that might impact the client’s pharmacokinetic
and pharmacodynamic processes.
At each decision point stop to complete the following:
· Decision #1
· Which decision did you select?
· Why did you select this decision? Support your response with
evidence and references to the Learning Resources.
· What were you hoping to achieve by making this decision?
Support your response with evidence and references to the
Learning Resources.
· Explain any difference between what you expected to achieve

6. with Decision #1 and the results of the decision. Why were they
different?
· Decision #2
· Why did you select this decision? Support your response with
evidence and references to the Learning Resources.
· What were you hoping to achieve by making this decision?
Support your response with evidence and references to the
Learning Resources.
· Explain any difference between what you expected to achieve
with Decision #2 and the results of the decision. Why were they
different?
· Decision #3
· Why did you select this decision? Support your response with
evidence and references to the Learning Resources.
· What were you hoping to achieve by making this decision?
Support your response with evidence and references to the
Learning Resources.
· Explain any difference between what you expected to achieve
with Decision #3 and the results of the decision. Why were they
different?
Note: Support your rationale with a minimum of three academic
resources. While you may use the course text to support your
rationale, it will not count toward the resource requirement.
Co-morbid Addiction (ETOH and Gambling)
53-year-old Puerto Rican Female
BACKGROUND
Mrs. Maria Perez is a 53 year old Puerto Rican female who
presents to your office today due to a rather “embarrassing
problem.”

7. SUBJECTIVE
Mrs. Perez admits that she has had “problems” with alcohol
since her father died in her late teens. She reports that she has
struggled with alcohol since her 20’s and has been involved
with Alcoholics Anonymous “on and off” for the past 25 years.
She states that for the past two years, she has been having more
and more difficulty maintaining her sobriety since they opened
the new “Rising Sun” casino near her home. Mrs. Perez states
that she and a friend went to visit the new casino during their
grand opening at which point she was “hooked.” She states that
she gets “such a high” when she is gambling. While gambling,
she “enjoys a drink or two” to help calm her during high-stakes
games. She states that this often gives way to more drinking and
more reckless gambling. She also reports that her cigarette
smoking has increased over the past two years and she is
concerned about the negative effects of the cigarette smoking on
her health.
She states that she attempts to abstain from drinking but that
she gets such a “high” from the act of gambling that she needs a
few drinks to “even out.” She also notices that when she drinks,
she doesn’t smoke “as much” but enjoys smoking when she is
playing at the slot machines. She also reports that she has
gained weight from drinking so much- she currently weights
122 lbs., which represents a 7 lb. weight gain from her usual
115 lb. weight.
Mrs. Perez is quite concerned today because she has borrowed
over $50,000 from her retirement account to pay off her
gambling debts. She is very concerned because her husband
does not know that she has spent this much money.
MENTAL STATUS EXAM
The client is a 53 year old Puerto Rican female who is alert,
oriented to person, place, time, and event. She is dressed
appropriately for the weather and time of year. Her speech is
clear, coherent, and goal directed. Her eye contact is somewhat
avoidant during the clinical interview. As you make eye contact

8. with her, she looks away or looks down. She demonstrates no
noteworthy mannerisms, gestures, or tics. Her self-reported
mood is “sad.” Affect is appropriate to content of conversation
& self-reported mood. She visual or auditory hallucinations, no
delusional or paranoid thought processes are readily
appreciated. Insight and judgment are grossly intact, however,
impulse control is impaired. She is currently denying suicidal or
homicidal ideation.
Diagnosis: Gambling disorder, alcohol use disorder
Decision Point One
Select what the PMHNP should do:
Naltrexone (Vivitrol) injection, 380 mg intramuscularly in the
gluteal region every 4 weeks
Antabuse (Disulfiram) 250 mg orally daily
Campral (Acamprosate) 666 mg orally three times/day
Co-morbid Addiction (ETOH and Gambling)
53-year-old Puerto Rican Female
Decision Point One
Naltrexone (Vivitrol) injection, 380 mg intramuscularly in the
gluteal region every 4 weeks
RESULTS OF DECISION POINT ONE
· Client returns to clinic in four weeks
· Mrs. Perez said that she felt “wonderful” as she has not
“touched a drop” to drink since receiving the injection
· Client reports that she has not been going to the casino, as
frequently, but when she does go she “drops a bundle”
(meaning, spends a lot of money gambling)
· Client She is also still smoking, which has her concerned. She
is also reporting some problems with anxiety, which also have

9. her concerned
Decision Point Two
Refer to a counselor to address gambling issues
RESULTS OF DECISION POINT TWO
· Client returns to clinic in four weeks
· Client reports that the anxiety that she had been experiencing
is gone
· Client reports that she has met with the counselor, but did not
really like her. She did start going to a local meeting gamblers
anonymous. She stated that last week, for the first time, she
spoke during the meeting. She reports feeling supported in this
group
Decision Point Three
Explore the issue that Mrs. Perez is having with her counselor,
and encourage her to continue attending the Gamblers
Anonymous meetings
Guidance to Student
Although controversy exists in the literature regarding how long
to maintain a client on Vivitrol, four weeks is probably too soon
to consider discontinuation. The psychiatric mental health nurse
practitioner should explore the issues that Mrs. Perez is having
with her counselor. As you will learn in future courses, ruptures
and the therapeutic alliance can result in clients stopping
therapy. Clearly, if the client does not continue with therapy,
the likelihood of the gambling problem spontaneously remitting
is lower (than had the client continued to receive therapy).
Recall that there are no FDA approved treatments for gambling
addiction, and the mainstay of treatment for this disorder is
counseling. Since Mrs. Perez reports good perceived support
from the gamblers anonymous meetings, she should be
encouraged to continue her participation with this group.
The PMHNP needs to discuss smoking cessation options with
Mrs. Perez in order to address the totality of addictions, and to

10. enhance her overall health.
BIBL 104
Biblical Worldview Essay Instructions
Rationale for the Biblical Worldview Essay
In preparation for the Biblical Worldview Essay and by
completing your textbook readings you will be equipped to
demonstrate your understanding of the authority of scripture,
translate how the Bible represents a theistic worldview, and
compare and contrast your religious perspective (Syllabus
MLOs: A, B, C, F, G, H, I and Module/Week 7 LOs 1, 3, 4).
Every person has a worldview whether he or she realizes it or
not. What is a worldview? James W. Sire defines a worldview
as:
[A] commitment, a fundamental orientation of the heart, that
can be expressed as a story or in a set of presuppositions
(assumptions which may be true, partially true or entirely false)
that we hold (consciously or subconsciously, consistently or
inconsistently) about the basic constitution of reality, and that
provides the foundation on which we live and move and have
our being.[footnoteRef:2] [2: James W. Sire, The Universe
Next Door, 5th ed. (Downers Grove: IVP Academic, 2009), 20.]
Stated more succinctly, “…[A] worldview is simply the total set
of beliefs that a person has about the biggest questions in life.”
F. Leroy Forlines describes such questions as the “inescapable
questions of life.” Life’s inescapable questions include the
following: “Is there a God? If so, what is He like? How can I
know Him? Who am I? Where am I? How can I tell right from
wrong? Is there life after death? What should I and what can I

11. do about guilt? How can I deal with my inner pain?” Life’s
biggest, inescapable questions relate to whether there is a God,
human origins, identity, purpose, and the hereafter, just to
mention a few.
Satisfying answers to the “inescapable questions of life” are
provided by the Holy Scriptures. The Holy Scriptures,
consisting of the Old and New Testaments, form the starting
point and foundation for the biblical worldview. More
specifically related to our purposes, the apostle Paul reflects
several components of the biblical worldview in his letter to the
Romans.
The apostle Paul authored Romans toward the end of his third
missionary journey, about 57 A.D. He addressed this letter
specifically to the Christians in Rome. At the time the church in
Rome consisted of Jewish and Gentile believers, with Gentile
Christians in the majority. Paul wrote to the Christians in Rome
in order to address specific concerns and challenges they were
facing. While Romans was an occasional letter (not a systematic
theology), Paul presents the Gospel of Jesus Christ in a very
systematic fashion. The Gospel is actually the overarching
theme of Romans as Paul spells this out in his programmatic
statement in 1:16–17. As the systematic presentation of the
Gospel of Jesus Christ, Romans is foundational to the
biblical/Christian worldview.
Recognizing that Romans is not a systematic theology and does
not contain all the essential truths that are relevant to a
worldview per se, the apostle Paul articulates truths that are
foundational to the biblical worldview. In Romans 1–8, Paul
addresses certain components of a worldview that relate to the
natural world, human identity, human relationships, and culture.
In a 750–1,000-word essay, describe what Romans 1–8 teaches
regarding (1) the natural world, (2) human identity, (3) human
relationships, and (4) culture. Furthermore, (5) explain how the

12. teaching on these topics affects your worldview. Make sure that
you address each of these topics in your essay.
· As an essay, it must be written with excellent grammar,
spelling, and style.
· Begin your essay with an interesting introduction that contains
a precisely-stated thesis. End your essay with a strong
conclusion that summarizes your main points succinctly.
Structure of assignment paragraphs:
· Introduction/Thesis (approximately 75 words)
· The Natural World (approximately 150–200 words)
· Human Identity (approximately 150–200 words)
· Human Relationships (approximately 150–200 words)
· Culture (approximately 150–200 words)
· Conclusion (approximately 75 words)
· Use each of the categories above as headers for each
paragraph in your essay.
· The body of your essay must address the specified components
of the assignment in excellent grammatical style.
· Your essay must be typed in a Microsoft Word document using
Times New Roman, 12-point font.
· It must be single spaced and must contain 750–1,000 words.
· All sources must be cited and a bibliography must be included.
· Do not footnote Scripture references; cite them parenthetically
within the essay body following the quotation or allusion to the
biblical text.
Review the Biblical Worldview Essay Grading Rubric to see the
specific grading criteria by which you will be evaluated before
submitting your essay.
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