Angel Case Study (Anxiety, PTSD, Substance Use Disorder) Case Study Details 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 withPTSD: 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 withMixed 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

Continue in your role as an intern with the substance abuse facility.

Assume you have been asked to assist in the preparation of a report for the treatment team at your facility on the benefits of adopting the Motivational Interviewing program for clients like Angel who struggle with substance abuse.

• How might Motivational Interviewing be used for a client like Angel?
• How could Motivational Interviewing help clients like Angel gain control over their addictions?
• Identify the core elements of Motivational Interviewing and how staff would be taught to look for them when working with clients like Angel.