Angel Case Study

Angel is a 44-year-old separated man who says that his substance dependence and his anxiety disorder both emerged in his early 20’s after joining the army.  He says that he started to drink to “feel better” at the NCO club on base when his episodes of anxiety made it hard for him to interact with his peers.  He states that his anxiety became extreme after his first deployment to Iraq. He worked as a military police officer and was often exposed to hostile fire as his group supported operations. He also states that alcohol and now cocaine were a part of his dishonorable discharge. 

His wife called police after an argument regarding his drinking. He shoved her and police arrested him and charged him with domestic violence (DV). He was required to attend DV classes as well as substance abuse treatment as part of the plea. He further has community service hours (48) and 2 years of probation. You are conducting the intake assessment into your treatment agency.

Angel notes that coming off the cocaine and binge drinking contribute to low mood and increased anxiety, but he has not responded well to referrals to adjunct support services, and past inpatient stays have led to only temporary abstinence. He does not have VA connected benefits and his job as a cook offers no insurance coverage.  Yet, Angel is now trying to forge a closer relationship to his adult children, and he says he is especially motivated to get a better handle on both his PTSD and his substance use because he will be a grandfather in January. Angel states he and his wife are currently separated but talk on a daily basis.

Symptoms 

· Alcohol Use 

· Depression 

· Anxiety 

· PTSD 

· Substance Abuse 

Diagnoses and Related Treatments 

PTSD

The following treatments have empirical support for individuals with PTSD: 

· Cognitive Processing Therapy (CPT)  

· Trauma-focused Cognitive Behavioral Therapy (cf-CBT)  

· Eye Movement Desensitization and Reprocessing (EMDR)

Mixed Substance Abuse/Dependence 

The following treatments have empirical support for individuals with Mixed Substance Abuse/Dependence: 

· Motivational Interviewing plus CBT for Mixed Substance Abuse/Dependence 

· Seeking Safety for Mixed Substance Abuse/Dependence 

· Motivational Enhancement Therapy (MET) for Substance Abuse Treatment 

Generalized Anxiety Disorder 

The following treatments have empirical support for individuals with Mixed Substance Abuse/Dependence: 

· CBT for Generalized Anxiety Disorder 

· Psychoeducation 

· Mindfulness  

Adjunct support services 

· AA, NA or other 12-Step program  

· SMART recovery  

· Peer Recovery Coaching 

· Mindfulness Recovery