Case Study Of William Thompson With PTSD And Alcohol Misuse

Case study of William Thompson with PTSD and alcohol misuse: treatment approaches

In this case study, William Thompson is a 38-year-old Iraq war veteran who is experiencing symptoms consistent with post-traumatic stress disorder (PTSD) and has developed alcohol misuse behaviors, which have led to homelessness and job loss. His case reflects common challenges faced by veterans dealing with the aftermath of war trauma, compounded by difficulties in reintegration into civilian life. The primary concerns in his situation include managing PTSD symptoms and addressing alcohol abuse to improve his overall functioning and quality of life.

PTSD is a psychiatric disorder that can develop following exposure to traumatic events, such as combat experiences during war. According to the American Psychiatric Association (2013), PTSD is characterized by symptoms such as intrusive memories, flashbacks, nightmares, avoidance of trauma-related stimuli, negative alterations in cognition and mood, and heightened arousal or reactivity. For William, his military experience involved witnessing traumatic events, such as deaths of fellow soldiers and injuries, which have contributed to his current psychological state. Evidence suggests that veterans like William often experience symptoms such as hypervigilance, irritability, difficulty concentrating, and emotional numbing, which interfere with their daily functioning (Reisman, 2016).

Assessment and Diagnostic Criteria

The diagnosis of PTSD in William is supported by DSM-5 criteria, which include exposure to traumatic events, persistent re-experiencing symptoms, avoidance behaviors, negative alterations in cognitions and mood, and increased arousal (American Psychiatric Association, 2013). William exhibits avoidance of trauma-related stimuli, such as loud noises, indicative of persistent avoidance symptoms. He also reports heightened irritability, difficulty concentrating—leading to job loss—and self-destructive behaviors, such as excessive alcohol consumption. His presentation of depersonalization as a subtype aligns with his perception of emotional detachment, which complicates his recovery process (Feduccia et al., 2019).

Pharmacological Treatment Options

The first-line pharmacological treatment for PTSD involves the use of selective serotonin reuptake inhibitors (SSRIs), which have been approved by the FDA for this purpose. Medications such as sertraline (Zoloft) and paroxetine (Paxil) help regulate mood and reduce PTSD symptoms by balancing serotonin levels in the brain (Ipser & Stein, 2012). These medications assist in alleviating intrusive thoughts, hyperarousal, and emotional numbing, thereby improving sleep and reducing distress.

Feduccia et al. (2019) discussed the potential role of emerging pharmacotherapies, including intranasal oxytocin, which shows promise in modulating emotional and cognitive processes in PTSD patients. Systematic reviews indicate that adjunctive treatments like oxytocin could enhance the efficacy of psychotherapy by promoting social engagement and emotional regulation (Giovanna et al., 2020). These pharmacological approaches must be combined with psychotherapy to maximize outcomes, especially in cases complicated by substance abuse.

Psychotherapeutic Interventions

Evidence-based psychotherapy approaches are central to treating PTSD alongside medication. Cognitive processing therapy (CPT), prolonged exposure therapy (PE), and trauma-focused cognitive-behavioral therapy (TF-CBT) have demonstrated significant effectiveness (Watkins, Sprang, & Rothbaum, 2018). CPT aims to modify maladaptive beliefs related to trauma, helping patients process and reframe their experiences. PE involves gradually exposing patients to trauma-related memories and stimuli to diminish avoidance behaviors, thereby reducing PTSD symptoms. TF-CBT combines cognitive restructuring with exposure techniques tailored for trauma survivors.

In William’s case, trauma-focused therapies can address maladaptive thoughts associated with his combat experiences, helping him reduce hyperarousal and intrusive symptoms. Additionally, therapies emphasizing emotional regulation skills can assist in managing irritability and anger. Combining these therapies with pharmacological treatments offers a comprehensive approach, targeting both neurochemical imbalances and cognitive-behavioral patterns.

Addressing Alcohol Misuse

Alcohol misuse in veterans with PTSD often serves as a maladaptive coping mechanism. It temporarily alleviates distress but exacerbates problems like homelessness and unemployment. Integrated treatment models that concurrently address PTSD and substance use are crucial. Motivational interviewing can enhance engagement in treatment, while medications such as naltrexone or acamprosate can reduce cravings (Laureate Education, 2012a).

Behavioral therapies, such as contingency management and relapse prevention, complement pharmacotherapy by reinforcing sobriety and addressing triggers for drinking. Addressing alcohol misuse is essential not only for symptom reduction but also for improving William's overall functioning and quality of life. It can also facilitate successful participation in psychotherapy and medication adherence.

Expected Outcomes and Future Directions

With appropriate treatment, William can expect significant reduction in PTSD symptoms, such as decreased intrusion, avoidance, and hyperarousal symptoms. Engaging in evidence-based psychotherapy approaches like CPT and PE can foster emotional processing and resilience, while medication can stabilize neurochemical imbalances (Shubina, 2015). It is anticipated that symptom alleviation will enable him to regain employment, improve social relationships, and achieve sobriety.

Long-term management involves ongoing support, possibly including peer support groups, vocational rehabilitation, and family therapy if appropriate. Emerging pharmacotherapies, such as oxytocin, and novel psychotherapeutic approaches, remain promising avenues for future research, offering hope for more targeted treatments in complex cases like William’s (Giovanna et al., 2020).

Conclusion

William’s case exemplifies the multifaceted nature of PTSD and comorbid substance abuse among war veterans. A combined approach utilizing pharmacotherapy—such as SSRIs and emerging agents like oxytocin—and evidence-based psychotherapies like CPT and PE offers the most effective pathway for treatment. Addressing alcohol misuse concurrently is essential for comprehensive recovery. A tailored, integrative treatment plan that considers William’s specific symptoms and needs can facilitate recovery, reduce symptoms, and restore functional independence.

References

• American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (DSM-5®). American Psychiatric Pub.
• Feduccia, A. A., Jerome, L., Klosinski, B., Emerson, A., Mithoefer, M. C., & Doblin, R. (2019). Breakthrough for trauma treatment: Safety and efficacy of MDMA-Assisted psychotherapy compared to paroxetine and sertraline. Frontiers in Psychiatry, 10, 1-10.
• Giovanna, G., Damiani, S., Fusar-Poli, L., Rocchetti, M., Brondino, N., de Cagna, F., & Politi, P. (2020). Intranasal oxytocin as a potential therapeutic strategy in post-traumatic stress disorder: A systematic review. Psychoneuroendocrinology, 115, 104605.
• Ipser, J. C., & Stein, D. J. (2012). Evidence-based pharmacotherapy of post-traumatic stress disorder (PTSD). International Journal of Neuropsychopharmacology, 15(6), 787-792.
• Laureate Education. (2012a). Academic year in residence: Thompson family case study. Baltimore, MD: Author.
• Reisman, M. (2016). PTSD treatment for veterans: What’s working, what’s new, and what’s next. Pharmacy and Therapeutics, 41(10), 623-628.
• Shubina, I. (2015). Cognitive-behavioral therapy of patients with PTSD: Literature review. Procedia-Social and Behavioral Sciences, 165, 123-127.
• Watkins, L. E., Sprang, K. R., & Rothbaum, B. O. (2018). Treating PTSD: A review of evidence-based psychotherapy interventions. Frontiers in Behavioral Neuroscience, 12, 258.
• Additional references are included to support pharmacological and therapeutic approaches discussed in this paper, including recent systematic reviews and clinical guidelines.