Substance use is a severe problem in the United States and worldwide, often diagnosed with other comorbid psychiatric illnesses. Indeed, substance-induced mood disorders are relatively common. At the same time, the converse can be true since anxiety and depression may trigger individuals to use various mind-altering substances (Tolliver & Anton, 2022). For example, the research found that more than 40% of patients with major depressive disorder (MDD) also had alcohol dependence, and 21% had a history of alcohol abuse (Tolliver & Anton, 2022). Furthermore, it was found that people with bipolar disorder also have an increased risk of developing substance use disorder (Tolliver & Anton, 2022). In Angel’s case, his binge drinking and cocaine use problems stem from other mental health issues that developed when he was first deployed to Iraq. The gradual development of various psychiatric diseases combined with substance abuse worsened his relationships with his children and separation from his wife. The treatment plan should be aimed at curing Angel’s substance dependence and improving his mental health using a therapeutic approach, motivational interviewing, cognitive behavioral therapy, and group treatment.
Effect on Angel’s Life
This patient’s addiction problem had a tremendous negative effect on his life and family. Specifically, it caused Angel to become excessively violent toward his wife, who decided to separate from him. It appears that after multiple incidents of aggression from her husband, the woman may develop post-traumatic stress disorder (PTSD) or MDD. Furthermore, Angel is not in a good relationship with his adult children, who already have their own families. Seeing multiple episodes of their father’s substance abuse may have left emotional trauma on Angel’s children. According to Stringer and Baker (2018), “children growing up in homes where one or more parents engage in substance use may be exposed to domestic violence,” affecting individuals even in adulthood (p. 2). Furthermore, research shows that children who grew up with at least one parent with alcohol addiction were more likely to develop it too later in life (Stringer & Baker, 2018). Moreover, Angel’s substance addiction damages his emotional health since his anxiety worsens during withdrawal. Lastly, the patient’s legal status was affected because he was accused of domestic violence and was on probation for two years.
Substance Abuse Treatment
Although the SMART program became popular worldwide, Alcoholics Anonymous (AA) may be more appropriate in Angel’s case since self-recovery may be unattainable in his situation; hence, he requires group support. AA is a 12-step program worldwide community of people who want to attain sobriety (National Institute on Drug Abuse, 2018). The first six steps are admitting powerlessness over alcohol, accepting a higher power, turning life to a greater power, moral inventory, admitting wrongdoings, and realizing that higher power removes defects (Wagener, 2022). The next six steps believe shortcomings will be eliminated, listing people you hurt, apologizing, personal inventory, prayer or meditation, and delivering an AA message to others (Wagener, 2022). There is no actual end date for this program, but research shows that AA is 60% more effective in maintaining sobriety than other methodologies (Erickson, 2020). It can be useful for Angel because he will have peer support and possibly spiritual awakening, which are effective in helping individuals quit an addiction.
Benefits of Group Therapy
Angel may benefit from group therapy because the support and understanding from other people with the similar background may be beneficial. Furthermore, seeing other AA members’ success may inspire him to abstain longer, mainly because Angel himself has several factors that motivate him. Specifically, the patient wants to restore good relationships with his children since he will become a grandfather soon. Angel is recommended to attend this program for at least six months, but the effectiveness will be higher if he stays in AA for one year. In fact, research shows that those who were involved in AA, in addition to formal treatment, had a higher chance to remain sober than those who only chose the latter (Wagener, 2022). Since Angel offended his wife, he should accept his guilt and seek ways to mend his relationship with her. It is essential to show this patient that all people make mistakes, but admitting them is one powerful way to return control of one’s own life.
Benefits of Individual Therapy
As practical as it may seem, group therapy should always be combined with an individual approach in cases of substance abuse disorders diagnosed in combination with other psychiatric issues. Specifically, Angel was diagnosed with PTSD and anxiety, requiring Eye Movement Desensitization and Reprocessing (EMDR), trauma-focused cognitive-behavioral therapy (CBT), and mindfulness-based CBT (MBCBT). Research demonstrated that introducing short 2-week intense sessions of the selected treatment options is more effective than lengthy treatment (Watkins et al., 2018). Furthermore, MBCBT was shown to have higher success rates than psycho-education (Giommi et al., 2021). Overall, Angel’s PTSD treatment will last for two weeks, while the mindfulness approach can be used for a lifetime. Notably, the patient’s offender status should be discussed during the sessions, and Angel should be reassured that he can seek forgiveness from people he hurt.
Summary
Angel, a 44-year-old man, was diagnosed with substance dependence as well as anxiety and PTSD. The treatment plan for PTSD includes two weeks of EMDR and trauma-based CBT; for anxiety, MBCBT is needed. The patient’s primary problem, alcohol addiction, should be treated using an individualized approach and group therapy, namely the AA program. There is no requirement for the minimum time Angel must attend AA meetings, but staying with the program for at least six months is recommended to attain positive results.
References
Erickson, M. (2020). Alcoholics Anonymous most effective path to alcohol abstinence. Stanford Medicine. Web.
Giommi, F., Castagner, V., Zaccaro, A., Gemignani, A., Serretti, A., Mandelli, L., Conversano, C., Vincenzi, S., & Chiesa, A. (2021). Mindfulness-based cognitive therapy vs. psycho-education for patients with anxiety disorders who did not achieve remission following adequate pharmacological treatment. Mindfulness, 12(8), 2059-2075. Web.
National Institute on Drug Abuse. (2018). Principles of drug addiction treatment: A research-based guide. Web.
Stringer, K. L., & Baker, E. H. (2018). Stigma as a barrier to substance abuse treatment among those with unmet need: An analysis of parenthood and marital status. Journal of Family Issues, 39(1), 3-27. Web.
Tolliver, B. K., & Anton, R. F. (2022). Assessment and treatment of mood disorders in the context of substance abuse. Dialogues in Clinical Neuroscience, 17(2), 181-190. Web.
Wagener, D. (2022). Alcoholics Anonymous: The 12 steps of AA & success rates. American Addiction Centers. Web.
Watkins, L. E., Sprang, K. R., & Rothbaum, B. O. (2018). Treating PTSD: A review of evidence-based psychotherapy interventions. Frontiers in Behavioral Neuroscience, 12, 1–9. Web.