Decision tree on Comorbid Addiction

Decision tree on Comorbid Addiction
Comorbidity is the word for a situation in which a person has two or more illnesses at the same time. The National Institute of Health (NIH) says that when two or more diseases combine, it can make the outlook for both of them worse or make them harder to treat. The National Institute on Drug Abuse says that there is still not enough information about comorbidity, so it is still a study priority. On the other hand, drug abuse is not a new idea. It is a mental illness that causes people to want and use drugs uncontrollably and compulsively, to the point where they can’t function properly without the drug (NIH, 2018). Comorbidity can be used to talk about any two illnesses that happen at the same time, but it is often used to talk about drug abuse and addiction. This is because many people who abuse drugs or are addicted to them also have a mental health problem, such as attention deficit hyperactivity disorder (ADHD), depression, bipolar disorder, post-traumatic stress disorder (PTSD), and many others (NIH, 2018).

For this evaluation, we’re going to look at 19-year-old Miss Jane Doe (not her real name), who went to the emergency room with a man who turned out to be her brother. She said that she is anxious most of the time since their parents died a year ago. She feels worthless, guilty, hopeless, and powerless. She is often angry and antsy, and it’s hard for her to focus at school. This has made a big difference in her grades, which worried her teachers and family. Since the fight with her folks, she has gone from drinking two bottles a day to drinking six or more bottles a day. She says that drinking booze is the way she deals with her sadness. Miss Doe has both a depression disorder and an alcohol use problem, according to a test of her mental health. Before giving her medication, you should think about her comorbidities, how willing she is to get care, how much she weighs, and whether or not she has any allergies. The last thing to think about is whether or not she is ready to go to counseling sessions, which is the most important factor in deciding which medications to give her (NIH, 2018).

Choice No. 1

Options for choice number one:

Give her 250 mg of Antabuse (Disulfiram) by mouth once a day.
Give her 666 mg of Campral (Acamprosate) three times a day by mouth.
Give her 20mg of Celexa (Citalopram) once a day.

Decided: Give her 20 mg of Celexa (Citalopram) once a day.

Miss Doe just found out that she has two conditions that all need to be taken care of. But treating sadness should come first, since it often comes before drug abuse. Selective serotonin reuptake inhibitors (SSRIs), which is a type of drug that includes citalopram, are the first-choice treatment for depression right now (Guo et al., 2019).If you give Miss Doe citalopram as her first medicine, it gives her a choice that works well for her. The other two choices weren’t used for the first treatment because they aren’t main ways to treat alcohol abuse. Miss Doe’s depression problem may be treated in a way that makes her less likely to drink.

Miss Doe’s behavior is likely to get better once she starts taking her medicine. The biggest change that is expected is that her mood will get better and that she won’t feel sad as often as she has been. SSRIs work by stopping the release of serotonin, which makes it work more in the brain and makes the person feel better (Jakovljevic, 2015). It is also likely that she will drink a little less booze now that she has a better way to deal with her grief through counseling. After four weeks, Miss Doe should come back for a review.

Choice No. 2

Choices for choice #2:

Celexa (Citalopram) should be taken at a dose of 40 mg once a day.
Give her 666 mg of Campral (Acamprosate) three times a day by mouth.
She should take 20 mg of Celexa (Citalopram) once a day and 666 mg of Campral (Acamprosate) three times a day.

Celexa (Citalopram) should be taken at a dose of 40mg once a day.

When Miss Doe went back to be checked, she showed that she could handle citalopram well. Her sadness was also a little less bad, and she was happier than when she first came in, which shows how well the last dose worked. Because of this, her amount had to be raised from 20mg to 40mg. The other choice, acamprosate, is still a good one, but because citalopram was also helping her drink less, it was thrown out. Combining citalopram and acamprosate was an option, but Kupferberg et al. (2016) say that it shouldn’t be thought about until citalopram has hit its peak dose of 40mg.

When Miss Doe goes back for her check-up in four weeks, her mood should be better and her sadness should be gone, according to the plan. Her early feelings of anxiety, worthlessness, guilt, hopelessness, and helplessness will have gone away, if they haven’t gone away completely. Her drinking will have doubled down to a level that would be considered normal for a social drinker.

Choice No. 3

Possible answers for #3:

Give her 250 mg of Antabuse (Disulfiram) by mouth once a day.
Give her 30 mg of Remeron (Mirtazapine) by mouth once a day.
She should take 40 mg of Celexa (Citalopram) once a day and 666 mg of Campral (Acamprosate) three times a day.

Decision: Give her 250 mg of Antabuse (Disulfirum) by mouth once a day.

When Miss Doe came back for her review, she had made a lot of work toward getting better. When she was checked out, she was in a good mood, and all of her other early signs had gone away. She went to all of her counseling meetings, which, along with the medication (citalopram) she was taking, helped her get better. But she was still drinking too much, so we gave her disulfiram. She was no longer depressed, so giving her mirtazapine wouldn’t have helped. The third choice, which was to take both citalopram and acamprosate, was a good one, but the client turned it down because she would have to take a lot of pills.

When she comes back for a review in four weeks, it is expected that Miss Doe will no longer drink booze at all. This is because disulfirum stops the enzyme aldehyde dehydrogenase from working, which causes acetaldehyde to build up in dangerous amounts (Guo et al., 2019). This buildup makes it unpleasant to drink booze, which makes people less likely to do so. The goal of therapy is to stop drinking.

Ethical Things to Think About

When doing their regular jobs, health care workers have to make sure they act in a proper way. To do this, you have to follow the ethical ideals of autonomy, justice, doing good, and not doing harm. Mental health professionals often break some of these rules, especially the one about liberty. They do this by saying that their clients might not be mentally stable enough to make some decisions about their health (Haddad and Geiger, 2020). That shouldn’t be the case. Clients have the right to choose what medicine to take and whether or not to take it. However, health care workers must give them all the information they need to make an informed choice. In this case, Miss Jane Doe turned down the combo of citalopram and acamprosate after she was given all the information she needed. This gave her the freedom to make her own decisions.


Comorbid addiction is when a person has two illnesses, often mental health problems, at the same time. It is marked by drug and alcohol abuse that goes along with a mental disorder like depression, attention deficit hyperactivity disorder (ADHD), bipolar disorder, post-traumatic stress disorder (PTSD), and many others (NIH, 2018). In some cases, treating the mental problem may be enough to stop the drug abuse without any other help. Psychotherapy (counseling) and medication are two types of treatments. Selective serotonin reuptake inhibitors (SSRIs) are the first line of treatment for depression. When used with counseling, they are very successful. Mental health professionals also have to be careful to follow the ethical concepts of justice, beneficence, non-maleficence, and, most importantly, autonomy.


Guo, S., Chen, L., Cheng, S. & Xu, H. (2019). Comparative cardiovascular safety of selective serotonin reuptake inhibitors (SSRIs) among Chinese senile depression patients: A network meta-analysis of randomized controlled trials. Medicine. Retrieved from https://doi:10.1097/MD/0000000000015786

Haddad, L. M., & Geiger, R. A. (2020). Nursing Ethical Considerations. Treasure Island (FL): StatPearls Publishing.

Jakovljevic M. (2015). Person-centered psychopharmacotherapy: what is it? Each patient is a unique, responsive and responsible subject. Psychiatria Danubina; 27(1), S28–S33.

Kupferberg, A., Bicks, L., & Hasler, G. (2016). Social functioning in major depressive disorder. Neuroscience & Biobehavioral Reviews, 69, 313-332.

National Institute of Health (2018). Comorbidity: Substance Use Disorders and Other Mental Illnesses Drug-Facts. National Institute on Drug Abuse. Retrieved from

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