Vignette Analysis

Jack is a 32 year old Latino-American man who is referred to you by his primary care physician for severe anxiety and mood dysphoria. Jack’s physician has put him on anti-anxiety medication, “to help me with these attacks”. Jack is the oldest of 4 boys. He was raised in what he describes as, “a gang infested Los Angeles neighborhood where I saw my best friend shot to death in front of me”. Jack describes his father, as a hard working man who would drink daily after work. “We would never know how our dad would be when he came home. One day he was a good guy and the next day my brothers and I would run for cover to avoid being hit by whatever dad had in his hand”. He describes his mother as a sweet, passive traditional woman who attended church daily. Jack is married and has 2 small children. He tells you that, “sometimes I hear my father’s voice coming out of my mouth. I don’t ever want my kids to go through what I did.” Jack does admit to drinking several times a week, “it helps quiet my mind and lower my anxiety.” He denies being abusive to his family, but does say that, “sometimes when I drink I don’t remember what I did, but the next day my children are afraid to come near me. I only mean to drink a couple of beers, but I guess I overshoot the mark”

What are you diagnostic thoughts for Jack?

Diagnostically, I would consider an Alcohol Use Disorder, and a Trauma Related Disorder. Jack appears to have at least 2 symptoms of an alcohol use disorder (305.00): drinking in larger amounts over a longer period of time than intended; knowledge of persistent problems at home caused by alcohol (APA, 2013). Jack comes from an alcoholic home and has experienced violence in his childhood. “Substance abuse is relatively common among those exposed to traumatic events, perhaps especially those who have experienced interpersonal violence”