Jack is a 51 year-old former serviceman with symptoms of severe anxiety, depression, and an inability to cope with everyday life stressors that are leading him to drink excessively and have aggressive outbursts when he perceives someone as threatening him. His problems with anxiety relate to his experiences in the Persian Gulf. Jack becomes anxious whenever he experiences situations that remind him of his war experiences, and avoids such triggers. These problems include panic attacks, nightmares, flashbacks, and oversensitivity to stressful events. Jack describes symptoms of depression, poor sleep, reduced appetite, and low energy. These problems have been persistent for many years. Overall his mood is low, worse at night. He has no libido, which is causing added problems in his relationship. At times he becomes very angry, striking out at any one nearby. He is worried that he may hit his current wife, as he has a history of domestic violence in his first marriage. Jack also drinks up to eight bottles of beer daily. He relates to his father, who was a violent man and a drinker, which led eventually to Jack’s mother leaving. He has experienced a number of physical problems in the past, including pneumonia, back pain, and headaches, none of which have been sustained. He does not smoke cigarettes but in the past was a heavy smoker. He smokes up to three joints of marijuana daily and has tried cocaine, amphetamine, and hallucinogenic mushrooms. His caffeine intake is very high, up to 11 cups of coffee daily.
• What would you consider Jack’s diagnosis to be?
• Develop a treatment plan to help Jack start to resolve his problems.