____________________________________ Substance Use Disorders: Assessment and Treatment, 2nd Edition
Client : Just about every night. Therapist : Are there things that cause you to remember the IED explosion or have panic, anxiety? Kind of set you off? Client : Yeah. Any kind of fire, even a match. Any kind of military vehicle. It doesn’t have to be right in front of me, just something on TV. Any news report on the war. Anything like that can set it off. Therapist : Do you find that you startle easily, like jump more than most people would when you hear any kind of loud noise? Client : Yes, any loud noise, like if I hear a door slam too hard. If I hear anything that sounds like a gunshot of any kind. I jump so badly that for 10 or so minutes my heart races. It feels like it’s going to come out of my chest, and I just can’t catch my breath. Therapist : Do the fear, the flashbacks, the nightmares, interfere with your sleep? Client : I don’t sleep much anymore. I lie in bed; it’s like I’m wait- ing for something awful to happen. Some nights, when I really feel exhausted, I’m scared to go to bed. I stay awake because I’m afraid the nightmares will just be there waiting for me. Therapist : Is there anything else about the explosion you think I should know? Client : Aside from everything else, I think it messed up something in my head. I mean it was so loud and we were just thrown around like dry leaves in a storm. Therapist : Can you help me understand what you mean when you say it messed up something in your head? Client : Since then I get headaches almost every day. Terrible head- aches, sometimes with ringing in my ears. And my memory is all messed up. I can’t read anything because by the end of a page I can’t remember what I read at the beginning. If I watch something, like a story on TV, I forget what happened and it doesn’t make any sense to me. Therapist : So, you have difficulty remembering things, even things you have just seen. Client : Yeah, it’s really bad. It drives my wife nuts. She can’t even send me to the store. I forget what to buy. And If I make a list, I can’t remember where I put it. It’s really bad. I never used to be like that before. I can’t even remember what day of the week it is without checking my watch. Therapist : Aside from feeling afraid and frustrated, have you noticed any change in your emotions and moods? Client : I feel irritable most of the time. I get irritated at little things. People look at me, or I walk into a room and forget why I’m there. I throw things and I yell. Nobody even wants to be around me, and I can’t blame them. Therapist : Any other unusual emotional problems besides the irri- tability?
Client : You know, it’s weird. Sometimes I laugh at nothing. It’s just someone says something, and I find it really funny. I’ll start laughing. It might not be funny at all, but for some reason I see it as hilarious and laugh and can’t stop. Other times I’ll just cry for no reason. Like my wife was telling me she planted flowers in our backyard last spring, but the frost killed them before they could get a hold. I just started cry- ing like I had lost my mother. I just couldn’t help myself. I just bawled like a child. She thought I was crazy, but I just couldn’t stop myself. Therapist : So, your wife is having difficulty with your emotions and moods? Client : Hell, I can’t deal with them. How can I expect her to do it? I’m just afraid I’ll lose her if things don’t get better. Therapist : Do you have any friends? Client : The only friends I had were in the military. I tried to get together with my old friends from school, but they’re so different. I feel bad being around them. We just don’t have anything in common, and I’m afraid I’ll do something or say something really stupid and crazy. It’s just too hard. Therapist : Do you drink alcohol? Client : Yes. We all drank a lot in Afghanistan, and now I drink even more. Sometimes it seems to help a little. Sometimes it doesn’t. I usually just drink enough to pass out. Therapist : What’s the most you drink in a night? Client : A dozen beers, maybe more. Sometimes it makes me feel good for a while. Sometimes it just makes me feel angry. When I black out there are no dreams then, so I guess it helps in a way. Therapist : Do you have anyone you can talk to about all this? How about your wife? Client : No. My wife and me, we just argue about how I act, about my drinking. I think she will probably leave me and go live with her parents. I really don’t want her to go, but I don’t seem to be able to talk to her without losing my temper and messing everything up. My life really sucks, and it just seems to be going from bad to worse. Sometimes I think it might have been better if I had just died back there in Afghanistan. Therapist : Do you ever think about killing yourself now? Client : Not really, but I’m afraid if I feel bad enough, I just might do something stupid. I’m not very religious or anything, but I think it’s wrong to kill yourself, no matter how bad things seem. I figure I must still be alive for some reason. It’s just that I can’t figure out what that might be. Therapist : I think it’s important that you hold on to that thought. You know, there are a lot of things going on with you that are not really your fault. Your flashbacks, bad dreams, and pretty negative moods are the result of the terrible trauma you experienced when that IED went off and you saw your friends die. Your shifting moods, uncontrollable response to things, and your problems with memory could all be the result of the concussion when that bomb went off.
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