PTSD

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Posttraumatic Stress Disorder
 Posttraumatic Stress Disorder (PTSD) is very common amongst military veterans and it is a debilitating and disabling condition that impacts and individual’s life in its entirety. While many veterans are able to function normally after a completion of their service, there are some that are plagued by PTSD and substance abuse which is a common co-occurring symptom. Indeed, in contrast to average prevalence of 15–30% in the general population, as many as 63% of veterans with a documented alcohol use disorder also meet criteria for PTSD (Mahoney, 2020). The William Thompson case study is about an Iraq war veteran who after serving is now suffering from PTSD and substance abuse disorder. The client is denying or refusing to acknowledge that he has PTSD. While many civilians do not seek help, or wait years to do so, concerns about stigma may be amplified among veterans because military culture places a high value on emotional strength and mental toughness (Meshberg-Cohen, 2017). The client is showing classic symptoms of PTSD including having issues keeping a job, substance abuse, refusal to get help and minimizing.  In community and veteran samples, PTSD is associated with poor social and family relationships, absenteeism from work, lower income, and lower educational and occupational success (American Psychiatric Association, 2013).
        There are varying therapeutic approaches that can be utilized to treat this client, finding the best one depends on the individual being treated as well as the evidence for treatment. Practice guidelines for PTSD include CBT and EMDR as effective first-line treatment modalities (Wheeler, 2014). Depending on the severity of the illness along with the substance abuse or use disorder, medication can be utilized as well. Based on the client and his presentation, I would utilize EMDR therapy because there is evidence that it is effective at treating PTSD since it is trauma based. Three decades of research have resulted in 30 randomized controlled trials (RCT) attesting to the efficacy of EMDR therapy in the treatment of PTSD (Hurley, 2018). The Practice Guidelines of the World Health Organization [WHO] (2013) describe the EMDR therapy approach, “Like CBT with a trauma focus, EMDR aims to reduce subjective distress and strengthen adaptive beliefs related to the traumatic event (Hurley, 2018). Unlike CBT with a trauma focus, EMDR does not involve (a) detailed descriptions of the event, (b) direct challenging of beliefs, (c) extended exposure, or (d) homework” (p. 1) (Hurley, 2018). Along with EMDR, I would recommend an adrenergic agent. To date, a number of adrenergic agents have been tested for their efficacy in treating PTSD. These include the alpha-2 adrenergic agonists clonidine and guanfacine, the nonselective beta-adrenergic agent propranolol, and most promising prazosin, which is an alpha-1 adrenergic receptor antagonist that blocks the actions of NE on alpha-1 receptors (Petrakis, 2016). Several randomized controlled trials have found that the alpha-1 blocker prazosin is effective in reducing symptoms of posttraumatic stress disorder (PTSD) among active-duty soldiers (Roundup, 2017). SSRI’s are the medication of choice or first line for PTSD and alcohol dependence and have been proven effective in studies. The expected outcome for this client is that he will be able to manage his PTSD and substance abuse through the combination of EMDR therapy as well as medication and this will allow him to more effectively function and cope. 
References
American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental disorders. Washinton, DC: Author: American Psyhciatric Association.
Hurley, E. C. (2018). Effective treatment of veterans with PTSD: Comparison between intensive daily and weekly EMDR approaches. Frontiers in Psychology, 9, https://doi-org.ezp.waldenulibrary.org/10.3389/fpsyg.2018.01458.
Mahoney, C. T. (2020). Parallel process modeling of posttraumatic stress disorder symptoms and alcohol use severity in returning veterans. Psychology of Addictive Behaviors, https://doi-org.ezp.waldenulibrary.org/10.1037/adb0000569.
Meshberg-Cohen, S. K. (2017). Relationship between substance use and attitudes towards seeking professional psychological help among veterans filing PTSD claims. Addictive Behaviors, 74, 9–12. https://doi-org.ezp.waldenulibrary.org/10.1016/j.addbeh.2017.05.024.
Petrakis, I. L. (2016). Prazosin for veterans with posttraumatic stress disorder and comorbid alcohol dependence: A clinical trial. Alcoholism: Clinical and Experimental Research, 40(1), 178–186. https://doi-org.ezp.waldenulibrary.org/10.1111/acer.12926.
Roundup, R. (2017). Research Roundup. Brown University Psychopharmacology Update, 8(4), 7–8. https://doi-org.ezp.waldenulibrary.org/10.1002/pu.30223.
Wheeler, K. (. (2014). Psychotherapy for the advanced practice psychiatric nurse: A how-to guide for evidence-based practice (2nd ed.). New York, NY: Springer Publishing Company.

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