Gambling Disorder and Alcohol use Disorder

A 50-year old Puerto Rican woman diagnosed with gambling disorder and alcohol use disorder was started on Antabuse (Disulfiram) 250mg orally daily. Why would you choose this medication? (Client returns to the clinic in 4 weeks and complained of sedation, and a metallic taste in her mouth. She also reports of face flushing and her heart pounding heavily. She indicated her spending has decreased whenever she gambles but her cigarette smoking increased).
Decision 2: Continue patient on current dose of Antabuse and refer client to counselling for gambling issues. What would be your rationale for choosing this decision to maintain current dose of Antabuse and refer client for counselling? (Client returns to the clinic and states to you that she does not like the counselor, and has started going to a gamblers meeting anonymous. Meeting was successful and effective. She participates and spoke for the first time).
Decision 3: Explore the issue client is having with the counselor, and encourage her to continue attending the Gambler Anonymous meeting. Discuss smoking cessation options. What were you hoping to achieve by making this decision? State why your decision to start patient on Antabuse is superior to Naltrexone (Vivitrol) 380mg injection intramuscular every 4 weeks and Campral (acamprosate) 666mg orally three times daily. (This is an important theme in decision making).What is the Ethical concern in giving the patient Antabuse?