The comorbidity of post-traumatic stress disorder and alcohol use disorder is becoming attracting attention in the United States. These disorders are common amongst United States veterans. The co-occurrence of post-traumatic stress disorder and alcohol use disorder has contributed to greater health risks amongst individuals and posed greater challenges to veterans in readjusting to civilian life. As such, research has been conducted to understand why post-traumatic stress and alcohol disorders co-occur, and how best to treat those who present with these dual diagnoses. This paper is a case study of a veteran who presented with the mentioned dual diagnoses in a Veteran Affairs Medical Center and how best I would have provided treatment to the individual.
A 60-year old, divorced, male veteran was transferred to a Veteran Affairs (VA) Medical Center for post-traumatic stress disorder (PSTD) and alcohol use disorder treatment. The veteran was transferred to the VA medical center, following an alcohol-related arrest. The veteran was presented for treatment at the medical center, after showing long-standing anxiety symptoms and being involved in excessive use of alcohol. The veteran began engaging in excessive use of alcohol after being laid from his job. Upon admission, the veteran was screened to determine his alcohol consumption level and scored 10 out of 12 points from the Alcohol Use Disorders Identification Test (AUDIT). The score showed that the individual had been engaged in excessive use of alcohol harmful to his health. The veteran was also screened for post-traumatic stress disorder and he scored 50 on the PSTD checklist for military populations. The scores showed that the veteran needed an immediate evaluation of these dual diagnoses.
During the initial assessment process, it was recognized that the veteran consumed more alcohol than he intended, spent a great deal of time excessively drinking alcohol, and gave up on important activities because of his frequent use of alcohol. The veteran also claimed that he had been experiencing hyperarousal symptoms for the past 40 years. Furthermore, the veteran reported that PSTD and alcohol use disorder symptoms had adversely affected him, thus contributing to distress in family relationships (family members not able to cope with the veteran’s behaviors), occupational functioning (veteran not able to get along with his colleagues at work), and social relationships (the veteran was unable to maintain better relationships with close friends and romantic relationships). The veteran was unable to communicate with others effectively (poor verbal skills), thus this is one of the factors that led to him developing poor relationships with others.
Concerning alcohol use, the veteran stated that he began drinking alcohol when he was 19 since returning to the U.S from Vietnam. He stated that he had been taking at least 6 alcoholic drinks a day. He further said that the present increase in the use of alcohol was due to him getting laid from his job. The veteran reported that he had a desire to quit alcohol drinking due to the recommendations from his previous doctors. The veteran further stated that 7 days before the initial assessment, he had not been involved in any alcohol consumption activity. The veteran also denied showing any history of alcohol withdrawal symptoms but admitted that he often had strong cravings for alcohol.
Regarding post-traumatic stress disorder, the veteran reported that he had experienced numerous symptoms. The veteran stated that he frequently experienced nightmares, flashbacks, intrusive memories, and hyperarousal symptoms that stemmed from him witnessing traumatic events such as the death of his close friend in Vietnam. The veteran claimed that the symptoms of psychological and physiological distress that he experienced triggered memories of trauma, feelings of detachment, and severe sleep disturbances (could only sleep for about 2 to 3 hours every night).
The veteran also revealed his social history during the assessment process. The individual stated that he had married in his early ’20s, and had only one child. However, due to his excessive alcohol consumption, the wife filed for a divorce. The veteran further reported that despite being near his family members including parents, and siblings, he rarely visited them because of the poor relationship he had with them. The veteran stated that since his divorce, he avoided becoming close with other women despite being involved in romantic relationships with them.
Course of Treatment
As a therapist, I would recommend an integrated treatment for the veteran’s PSTD and alcohol use disorder. Considering the symptoms of both disorders that resulted in the veteran experiencing trauma, I would engage the patient in trauma therapy. For a therapist to engage a patient in trauma therapy, he or she has to first gain a patient’s trust to allow the individual to disclose the traumatic events the client experienced before (Falimirski, 2009). During the therapeutic process, I would engage the veteran in individual psychotherapy. Individual psychotherapy would focus on relapse prevention of alcohol use, and coming up with cognitive-behavioral strategies that would help improve the individual’s health status. During the individual psychotherapy, engaging the client in new coping skills for anxiety such as walking, reading, and maintaining social activities would help improve the client’s health status (Ellis, 2017). I would also engage the client in group therapy. Some of the topics that I would include in the group psychotherapy would include anger management, stress reduction, and understanding of post-traumatic stress disorder. Group psychotherapy can be of significant importance as it can help a client to develop better relationships if at all he or she had been having problems in previous relationships (Fehr, 2018). In this situation, group psychotherapy would have helped the veteran to form better friendships with other combat veterans.
Engaging the veteran in family therapy would also be beneficial in addressing both disorders. The aim of engaging the patient in family therapy would be to ensure that the client builds a better relationship with close family members (Wampler & Patterson, 2020). The goal of the therapy would also be to educate the veteran’s family members on how to cope up with the client’s behaviors in case he engaged in excessive use of alcohol again (Dragisic-Labas & Djokic, 2010). Family therapy largely would help the veteran to reconnect with his close family members.
During the therapeutic process, I would monitor the veteran’s PSTD symptoms and alcohol use disorder symptoms. I would ensure that the veteran does not experience PSTD symptoms such as physiological reactivity to triggers, nightmares, and irritability by the end of the therapeutic sessions. I would also ensure that the veteran can maintain a long period of abstinence from alcohol. I would also monitor how the veteran gets along with others in the society after the therapeutic process, and develop relationships with close family members.
Incidences of post-traumatic stress disorder and alcohol use disorder have been on the rise across the United States, particularly amongst veterans. Considering the case study of the 60 years, divorced, veteran, PSTD, and alcohol use disorder contribute to psychological consequences and affect social relationships as well. Therefore, in treating an individual with these dual diagnoses, a therapist ought to ensure he or she engages a patient in both individual therapy and group therapy to ensure that the patient develops skills to cope with anxiety, and build better relationships with others in the society.
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Ellis, D. J. (2017). Rational Emotive Behavior Therapy and Individual Psychology. The Journal of Individual Psychology, 73(4), 272-282. https://doi.org/10.1353/jip.2017.0023
Falimirski, M. (2009). Trauma: Contemporary Principles and Therapy. Annals of Surgery, 249(1), 179. https://doi.org/10.1097/sla.0b013e3181929495
Fehr, S. S. (2018). Why Group Therapy? Introduction to Group Therapy, 25-36. https://doi.org/10.4324/9781351007481-3
Wampler, K. S., & Patterson, J. E. (2020). The Importance of Family and the Role of Systemic Family Therapy. The Handbook of Systemic Family Therapy, 1-32. https://doi.org/10.1002/9781119438519.ch1