Patient’s History

PA is a 48 years old African American female client veteran who presented to the clinic with concern on her drinking habit and substance abuse use. The client is alert and oriented to all spheres but pleasantly confused. She reported that she has an addiction to ETOH: drinks daily (1-3 25 oz. beer), last use yesterday; she has been drinking continuously for a year now. Also crack cocaine: daily use, unknown amount, previous use yesterday, for three years. THC: daily use, unknown amount, last use yesterday, since she was 14 years old. Reported that she has a diagnosis of PTSD due to sexual abuse during the Afghanistan war and throughout her life; also, she is on no medication to treat her PTSD. Her medical HX includes Hep C, HTN, Asthma, and six herniated discs in her back. The client reported that she takes Neurontin, Meloxicam, but she is non-compliant. The client indicated that she would like to join a detox program. Reported being homeless and had nowhere to go. Client denies Suicidal/homicidal Ideations or psychosis (Substance Abuse and Mental Health Services Administration, 2014).

The DSM-5 Diagnosis

309.81(F43.10) Posttraumatic Stress Disorder

303.90(F0.20) Alcohol Use Disorder; Moderate

304.30 (F12.20) Cannabis Use Disorder; Moderate

304.20 (F14.20) Stimulant Use Disorder; Cocaine, Moderate (American Psychiatric Association, 2013).

This client diagnosis was based on DSM-5 criteria, individual interaction with the patient, coupled with counselor assessment (American Psychiatric Association, 2013). It was then concluded that the client could be associated with the above-stated diagnosis. Prescribed medications seemed to be working well if the client remained compliant and seemed to lend a clue to diagnosis as well (Hayes, Strosahl, & Wilson, 2011).

Therapeutic Approaches

The use of Exposure therapy (ET) has been recommended as a first-line treatment for PTSD symptoms in treatment guidelines from several organizations including the National Institute for Clinical Excellence and the International Society for Traumatic Stress Studies (Bruce, & Jongsma, 2010b). Exposure therapy involves helping patients learn to tolerate their arousal long enough to extinguish the emotional trauma associated stimuli (Sharpless & Barber, 2011). If extinction to trauma-related stimuli gets achieved, patients will evidence little or no anxiety in response to traumatic memories or objectively safe trauma cues (Varcarolis, 2016). Thus, by addressing the patient’s avoidance strategies, the normal process of healing gets fostered (Wilson, 2012). The clinical procedures for exposure therapy used in this case remain similar to the evidence-based prolonged exposure protocol for PTSD (Varcarolis, 2016).

Ethical or Legal Implications

The legal or moral issue in this type of therapy will be to carefully assess whether if the treatment provided will be harmful or beneficial to the client (Corey, Corey, & Corey, 2013).