Maria Perez addiction decision tree case study guide
A Walden-style decision-tree case: a 53-year-old with gambling disorder and alcohol use disorder, three medication decision points, and a write-up defending each choice against its actual results.
Editorial process
Last reviewed · August 12, 2026
What is each decision point actually testing?
The decision-tree format grades a specific and transferable skill: defending a pharmacologic choice with cited evidence before the outcome is known, then explaining honestly why the result that came back differed from the expectation you committed to. For each of the three decision points the template asks the same four things — which option you selected, why, what you hoped to achieve, and the difference between expectation and result — and the third question is where the marks concentrate and hide, because the case engine is deliberately built to produce complications you did not order. The write-up that scores is the one treating each surprise as pharmacology to be explained rather than bad luck: what the chosen drug can and cannot do for a patient whose disorders interlock, and what her four-week returns reveal about exactly that gap.
The first decision is an alcohol-pharmacotherapy choice with a comorbidity trap. Mrs. Perez has intertwined alcohol use, gambling disorder, and heavy smoking; disulfiram punishes drinking but does nothing for cravings or the gambling high, while the opioid antagonist route — naltrexone — carries evidence for reducing alcohol craving and has the theoretically attractive property of blunting the reward circuitry gambling also rides on, and the long-acting injection sidesteps the adherence problem her impulse-control picture predicts. Acamprosate is the abstinence-maintenance alternative with a dosing caveat the case's own guidance flags: at her weight, under 60 kilograms, the standard dose runs high. Whichever option you defend, the results block will hand you new problems — her suicidal ideation and out-of-control anxiety at the four-week return are the case testing whether you notice that anti-craving medication does not treat emerging mood pathology.
The second and third decisions are safety examinations dressed as choices. The benzodiazepine option — adding diazepam for her anxiety — is the planted error: a scheduled controlled substance with its own addiction liability, in a patient with two active addictive disorders, whose follow-up duly shows early-refill behavior and a chilling indifference to her own suicidal ideation. The defensible line reasons toward non-addictive management of anxiety and mood — and the third decision's bupropion option demands the same double-reading, since it serves depression and smoking cessation together but requires care in this clinical picture. Close by naming the ethical threads: informed consent around medication risks, the $50,000 secret as a confidentiality boundary you respect, and culturally attuned care. Support every why with the learning resources, as the template demands. A cleaning note: the record circulated with a completed student paper appended after the assignment; it is excluded from the brief above.
Likely learning objectives
Inferred from the brief — check these against your own rubric.
- 01Defend an alcohol-pharmacotherapy choice for a patient whose alcohol, gambling, and nicotine disorders interlock.
- 02Read the case's own guidance signals — the weight-based acamprosate caveat, the adherence problem long-acting injection solves.
- 03Catch the planted benzodiazepine error: a controlled substance offered to a patient with two active addictions.
- 04Explain each expectation-versus-result gap as pharmacology, including the emerging suicidality the anti-craving choice cannot touch.
- 05Carry the ethical threads — consent, the concealed debt, culturally attuned care — through the write-ups.
Read the full question
Review every instruction before using the planning guidance that follows.
Turn the brief into deliverables
- 01A completed write-up for each of the three decision points: selection, rationale, intended outcome, and expectation-versus-result analysis.
- 02Evidence and Learning Resource references supporting every rationale and intended outcome.
- 03The ethical considerations the case carries, addressed within the write-ups.
How should the expectation-versus-result write-ups run?
Decision one: the anti-craving choice
Weigh disulfiram, naltrexone, and acamprosate for a patient with interlocking alcohol and gambling disorders — adherence, craving mechanism, the reward-circuit rationale, and the weight-based dosing caveat.
The four-week surprise
Explain why suicidal ideation and severe anxiety emerging at follow-up are outside what the anti-craving agent treats — the expectation-versus-result analysis the template requires.
Decision two: the planted error
Reason past the diazepam option — controlled substance, two active addictions, the early-refill and indifference signals — toward non-addictive anxiety and mood management with the suicidality addressed.
Decision three and the ethical close
Read the bupropion option's double duty for mood and smoking against this clinical picture, then close with consent, the concealed $50,000, and culturally attuned care.
Where are the addiction pharmacotherapies documented?
Recommended databases
- NIAAA
- American Psychiatric Association
- MedlinePlus
Search sequence
- 1.Review the alcohol-use-disorder material for the three medication options' mechanisms and evidence.
- 2.Read the gambling-disorder overview for the comorbidity the first decision must engage.
- 3.Confirm the benzodiazepine risk framing before writing decision two.
- 4.Draft each decision's four template answers with citations, then thread the ethics through.
Reference shortlist
These are authoritative starting points, not a ready-made bibliography. A qualified reviewer must confirm that each source fits the assignment and supports the claim beside which it is cited.
Nothing here is cleared for citation until you have read it.
- 01
Understanding Alcohol Use Disorder
National Institute on Alcohol Abuse and Alcoholism · 2024
The authoritative AUD frame, including the three approved medications the first decision chooses among and what each does to craving and drinking.
- 02
What is Gambling Disorder?
American Psychiatric Association · 2024
The gambling-disorder side of the comorbidity — diagnosis, course, and the reward-mechanism reasoning the naltrexone argument draws on.
- 03
Alcohol Use Disorder (AUD)
MedlinePlus, U.S. National Library of Medicine · 2024
The plain-language treatment overview supporting the counseling, education, and consent threads of the write-ups.
Review before submission
Common mistakes
- Choosing the benzodiazepine for her anxiety — the follow-up's early refills and 'who cares' remark are the case grading that error.
- Defending a decision without engaging the comorbidity: what serves the alcohol disorder must be read against the gambling and smoking.
- Writing the results as bad luck instead of explaining pharmacologically why expectation and outcome diverged.
- Missing the weight-based dosing caveat the case's own guidance supplies.
- Treating her suicidal ideation as background noise rather than the emerging problem the second decision must address.
- Skipping the evidence citations the template demands at every why.
Submission checklist
- All three decisions selected and defended with cited evidence.
- Intended outcomes stated per decision, supported by Learning Resources.
- Each expectation-versus-result difference explained mechanistically.
- The benzodiazepine trap reasoned through, not stumbled into.
- Ethical threads — consent, confidentiality of the debt, cultural attunement — visible.
- Template structure followed for every decision point.
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Written by
Aaron Bishop
MA, Education
assignment interpretation and research-methods coaching across disciplines
Aaron leads the EssayCrackers editorial desk. He works on how assignment briefs are read — what a rubric is actually asking for, and where students most often answer a different question than the one set.
Reviewed by
Dr. Nathan Cole
PhD, Rhetoric & Composition
Argumentation and thesis development
Nathan teaches first-year composition and directs a university writing center. He reviews EssayCrackers guides for argumentative soundness and citation accuracy.