36-year-old male presents with insomnia
History of present illness: A 36-year-old male patient presents today for assistance with insomnia that began two years ago when he was in the middle of a divorce, but has recently worsened. He notes that he has had a lot of personal tragedy in the past two years that he reports have made him feel depressed and anxious. The patient's brother died a month ago. He was recently hospitalized for a pulmonary embolism. He is not currently in therapy because he reports that he cannot currently afford it.
Social history: Patient reports he has been prone to drinking too much but says he "has it under control." He notes a history of alcoholism in his family. His recently deceased brother died of organ failure secondary to alcoholic liver disease. He smokes marijuana once a week and takes LSD every few months. He smokes a pack of cigarettes a week. He works part-time remotely for a digital agency. He has been splitting his time between living with his sister and living with his aunt.
1. What treatment(s) would you offer to this patient?
2. Do you consider this patient to have a predisposition to substance abuse? How do you factor this in to your diagnosis and prescription?