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(Note: This case study is based on many actual cases. All the names used are made up, and

any relation to actual people or events is purely accidental and coincidental.)

PSYCHOSOCIAL CASE STUDY

Marci has smoked cigarettes since age 16 and currently smokes one pack daily. Marci

stopped smoking cigarettes for six months one year ago, but she presently does not plan to cut

down or quit.

She has five prescription pills (Xanax) for depression and anxiety that were given to

her by a college classmate (for whom they were prescribed). Marci shared that she had been

struggling with feelings of sadness and worrying too much about two months ago. She hasn’t

taken them yet but has considered trying them.

Marci first experimented with marijuana during her senior year of high school (age 17),

with her use becoming more regular after she entered college. Marci was first introduced to

marijuana by her high school boyfriend, who used it every day along with alcohol on the

weekends. Marci has never been in an in-patient nor an out-patient program. When her parents

first discovered her marijuana use, they insisted that she seek professional help for what they

perceived to be a drug problem. Although they even threatened to call her college academic

dean because of her dropping grades, Marci refused help and began to discuss quitting school.

While she started drinking wine with her family when she was 13, she started to

“seriously” drink starting around 18-years-old. She currently drinks four or more alcoholic

beverages (usually wine or wine coolers; sometimes beer) three to four times a week and had

been smoking marijuana two to three times a week for one year. Her usual pattern was to go

on weekend binges, starting to drink and smoke on Friday evenings until 2:00 a.m. She

would then have a glass or two of wine around lunchtime on Saturday, smoking a joint or two

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with a couple of friends during Saturday afternoons prior to attending college sporting or

social events. She would then go to parties with friends on Saturday evenings, typically

consuming six to seven cans/bottles/cups of beer and sharing several joints of marijuana with

others. She had also started to consume energy drinks (Red Bull, Monster, etc.) when she

drank beer at these parties to get an added “boost” to her high.

During the past two months, she has sometimes had one to two glasses of wine (she

also used to smoke half a joint of marijuana with it) when alone on school nights. On the

mornings after she used alcohol, Marci tended to sleep in and cut class, but not every week.

Her recreational and social interests had increasingly involved the use of alcohol and

marijuana, now since her arrest, it is mainly alcohol (although she still desires to smoke

cannabis). Recently, Marci has begun to express concern to her friends about “feeling

depressed and anxious,” but she reports no suicidal ideation or panic attacks. She is also

concerned since she has missed her period.

Marci does not admit to any physical problems. She says she was not hurt in her

accidents other than a few bumps and bruises. She says she did not hit her head or lose

consciousness from the accidents. She says she has been sexually active for the past two

years with her “semi-permanent” boyfriend of two years. She thought she was pregnant about

one year ago, but it turned out to be a “false alarm.” She says every now and then, especially

during allergy season, she tends to get a “dry, hacky cough.”

Marci is the oldest of three children (one brother, Jacob, 17-years-old; and one sister,

Sarah, 14-years-old) and continues to live at home while attending college. Her mother, Joan,

is a successful attorney, and her father, John, is a school administrator. Her family has always

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attended weekly services at their church and have, on a couple of occasions, gone as a family on

church-sponsored humanitarian missions to Latin America. Marci and her siblings were always

very active in the youth groups, and helping with various church ministries, such as the nursery

and pre-school child-care Sunday schools. From taking these trips, the family started

incorporating drinking wine with their evening dinners, similar to some of the local customs

observed in these countries. This started when Marci was around 13-years-old. Marci’s parents

found out about her use of marijuana six months prior to her arrest. Marci’s parents found out

about her use of marijuana six months prior to her arrest. After her DUI, her parents sat her down

and expressed their concern about the amount she was drinking and want her to stop.

Since their confrontation and her arrest, she did cut down somewhat on her use of both alcohol

and marijuana, and (when pressed by her parents) she would abstain for several weeks at a time.

As one consequence, her parents stopped giving her permission to drive a family car and were

concerned about her influence on her younger siblings.

Neither her brother nor her sister currently drink or use substances. Her brother Jacob

admits to “drinking a beer with his friends” when he was 16-years-old, but did not like it. He

also admitted to trying his mother’s (Joan) cigarettes several times (about 10 of them) when he

15-years-old, but since he wanted to play sports, he stopped. Her sister Sarah says she has never

used and does not want to try any of it because she “hates the smell of all of it, and sees from

Marci’s example how much trouble it causes.”

Her father (45-years-old) drank alcohol to the point of inebriation many times when he

was younger (being arrested once for Public Intoxication when he was 19), but stopped when he

met and married Joan 25 years ago when they were both 20-years-old. He has not drank alcohol

regularly since then (other than the glass of wine at dinner). He has not had any particular

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problem with mood disorders, although he says he “worries from time-to-time about problems at

work and providing for his family.” He says both his parents struggled with depression and

anxiety, but never (to his knowledge) used any prescription or illegal drugs. He says his dad

drank occasionally, and John got his first taste of liquor from the stash his dad kept in the

workshop when he was around 12-years-old. John’s mother never drank, but she told John her

father (John’s grandfather) was an alcoholic most of John’s life until his death 42 years ago.

John is an only child.

Marci’s mother (45-years-old) says she used marijuana growing up (“like everyone my

age at the time”) and has struggled off-and-on with depression and anxiety since she was quite

young. She never drank when she was younger but has enjoyed the practice of drinking a glass

of wine with dinner. She says she occasionally will have another glass or two “to help her

sleep.” Joan says she was addicted to tobacco, and smoked cigarettes for over 30 years before

beginning to quit about three years ago using nicotine gum and patches. She has now cut the

gum and patch use down considerably and has not had a cigarette for two weeks. Joan says her

father drank excessively all her life and was quite violent when he was drunk. She says that her

father would beat up her mother frequently, and put her in the hospital at least once that she

remembers for two days. Her father could also be verbally abusive to her two brothers and two

sisters (Joan is the youngest). Joan’s father died from a car accident 10 years ago, and alcohol is

thought to have been a factor. Joan’s mother also drank, but not to the excess of her father, and

could get “acid-tongued” to the father and all the children. Joan reports that she and the two

sisters do not have a good relationship with their mother, but the two brothers seem to have an

okay relationship. At this time, Joan’s oldest brother drinks excessively, and seems to be

following in her father’s footsteps. The other brother has never touched alcohol as far as Joan

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knows. (Interestingly, both brothers blame the use and non-use of alcohol on the example of

their father.) Joan says she is very close to the younger brother, but she has a “love-hate”

relationship with the older brother, since he reminds her so much of her dad and his abuse. Both

of Joan’s sisters drank and smoked a little when they were younger but stopped once they

married and had children (though the oldest sister’s first-born son displays some symptoms of

Fetal Alcohol Syndrome). She does not know anything about her grandparents since they died

(on both sides) before she was born, although there were “family rumors” that there was a lot of

drinking that took place on both maternal and paternal sides.

Marci is currently unemployed. In the past she has worked as a waitress, and when she

turned 21, as a part-time bartender for the extra money. Her longest place of employment was

waitressing for six months. Over the past four years, she has been fired or left three other places

of employment due to excessive absenteeism and once for destruction of property.

Marci was arrested five months ago for Driving While Impaired (DWI) with a blood

alcohol level of 0.13. She was also charged with possession of 1 gram of marijuana. Her license

was suspended, but she has driving privileges to get to school/work and back. Over the past

three years she has had two accidents that occurred while she was intoxicated with alcohol and

marijuana, but no other people or vehicles were involved, and no charges were filed against her.

In the first one (30 months ago), she backed into a light pole in the mall parking lot. In the other

(13 months ago), she slid into a ditch when making a moderate curve on a road under normal

road conditions, suffering some cuts to her face and bruises to her chest, sides, and knees, and

needing to call a friend to pull her car out of the ditch. She also had one “destruction of

property” count two years ago, where she was placed on six months of probation and ordered to

pay reparations to the owner, which she did.

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Marci is a 22-year-old female college student who was arrested five months ago for

driving while impaired with a blood alcohol level of 0.13. She was also charged with possession

of a small amount (about 1 gram) of marijuana. Her license was suspended, but she has driving

privileges to get to school/work and back.

Marci admits that, since she began smoking marijuana, her previously good and trusting

relationship with her parents has soured. She had begun to hide and lied to them about using, and

had felt increasingly negative about herself, especially as her grades have suffered and her general

interests have narrowed. On several occasions she tried cocaine, and on another, LSD, but she

found the experiences unpleasant. It was not until her arrest that she began to feel some guilt and

remorse over the fact that her drinking and especially her marijuana use was negatively impacting

her relationship with her parents, and interfering with her desire to be an attorney. She had also

become gradually aware that marijuana had been affecting her motivation, her schoolwork, and her

spiritual life, but she has not expressed concerns about her use of alcohol.

Marci achieved normal milestones and performed well in high school, generally

achieving A’s and B’s. She is in her junior year of college. She wanted to live away from home

during college, but her parents resisted the idea because of financial pressures and their tendency

to be overprotective. Although she has always been a good student, her grades have begun to go

down and she is not meeting her academic potential.

Marci is neatly dressed, and displays a compliant manner. Her grooming was

appropriate. She was cooperative in the interview answering all questions politely. Her mood

seemed somewhat anxious and depressed.

Her affect was appropriate, and she was not overly emotional but appears torn between

embarrassment and anger at being forced to attend counseling. Her rate of speech was somewhat

rapid when addressing her substance using history and seemed pressured at times, but otherwise

appeared normal. Her tone modulated from high when discussing subjects that made her anxious

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(such as failing school, getting arrested), and low when discussing subjects that were depressing

to her (problems with her parents trusting her). Her thought processes were logical, and she

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demonstrated proper insight to her own actions, how they contributed to her situation, and her

continued lack of feeling the need to stop marijuana and alcohol consumption. She was oriented

x 4 (to person, place, time, reason why she is being assessed). She had no problem answering

the mental status questions or doing “serial sevens.”

She states that, although she has not used marijuana since she was arrested, she still has

doubts about its harmfulness. Her use of alcohol has not changed. She says that she finds

marijuana pleasurable and relaxing and that, if she could find a way to not get caught, she would

like to continue using it. She believes that both alcohol and marijuana have helped her feel better

about not achieving the high goals she had set for herself and not fulfilling the expectations her

parents have for her.

Marci shows no evidence of a thought disorder, and her content of thought appeared

normal. She did not demonstrate any psychotic symptoms, and denied any past or current

hallucinations or delusions. She admitted to feeling paranoid at times when she was using

marijuana. She denied any obsessions or compulsions. She reports that she has been depressed

and anxious at times but that these feelings have never been lasting (although they have been

more frequent over the past month). Her memory did not seem impaired, and her intelligence

appeared above average. She has only a few problems regarding sleeping (trouble sleeping

soundly, getting up too late), but no eating problems, history of panic attacks or agoraphobia,

cognitive deficits, or learning disability. She denies any suicidal and homicidal ideations.

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