Ellis first consumed alcohol on weekends when he was age 14. He now had a high tolerance and would drink a pint of liquor to "get drunk" every 2-3 days or sometimes more often. He has had occasional morning tremors that were resolved by drinking an "eye-opener" (i.e., drinking first thing in the morning to "steady one's nerves" or to get rid of a hangover). He denied other withdrawal symptoms, but the morning drinking reminded him of his father, who ultimately died of liver cirrhosis due to alcohol use at age 56. Since the onset of frequent cocaine use, he has begun to use alcohol to "come down" from the cocaine high. Beginning in high school, Ellis smoked cannabis socially, never smoking more often than twice per month. During the year prior to the evaluation, he found that marijuana helped with insomnia, and he began to crave it every evening. His husband objected, especially as they live in an area of the country where cannabis is not legal. He continued to use the marijuana, despite the nightly arguments, because cannabis led to the greatest likelihood that he would sleep without nightmares. Ellis identified cocaine as his overall drug of choice. He had first used cocaine a few years after he left the military. He used primarily by intranasal snorting, although he did experiment with smoking crack cocaine. He denied ever using intravenous drugs. Over the prior year, his cocaine costs had increased to $200 per week, and he found himself pawning items to maintain his habit. He also found himself missing class because the frequent use made him edgy and unable to sit still. Although his husband did not know about the cocaine, Ellis noted it was "just a matter of time before he finds out" as he has been making little progress toward his college degree and had lost multiple part-time jobs because of cocaine-related absenteeism. Ellis also consumed other substances when he found them easily available, generally at parties. These included ecstasy (estimated 10 lifetime uses), benzodiazepines (estimated 20 lifetime uses), PCP (estimated 3 lifetime uses), and prescription opiates (estimated 5 lifetime uses). He had also smoked 3-5 cigarettes per day since age 16. His efforts to quit smoking failed because of persistent craving and withdrawal symptoms.