Mr. and Mrs. Williams had been married for 20 years and had two children: Steven, 16 years

old, and Sally, 13 years old. The Williams’ initially sought treatment for Steven, who had been

exhibiting symptoms of anger and being withdrawn around the house for about six months after

he was nearly expelled from school. His parents expressed concern that Steven, once mocked

for being a “mama's boy”, no longer wants to be at the house, does not talk to either parent

about his life, and has not been observing his curfew. There have been multiple instances of

Steven not following family rules. Upon assessment by a family therapist, he was referred to you

for a drug and alcohol evaluation due to the discovery of his regular substance use.

During the initial session with you, Steven reported that he is using alcohol (3 to 4 nights per

week; at least “6 beers” at a time for the past 9 months), cannabis (mostly on weekends and he

is vague about his report), and has tried “molly” (a synthetic form of ecstasy; a few times in the

last 12 months). He admits to exhibiting angry behaviors at home and at school when asked. He

shared recently got into a fist fight at school that led to a referral to an alternative learning center

located at a separate school campus, which is used in lieu of expulsion for serious infractions of

school rules. He would have preferred expulsion and home school.

Steven stated he is concerned that his alcohol and drug use were interfering with his

functioning. He cited a couple of recent blackouts, episodes of fighting, and problems

concentrating on his schoolwork. Steven reported that he is not sure if limiting or stopping

alcohol use will be possible, since his peer group spends most of its time drinking. He says

that's what “everyone does”. He is also worried about the damage being done to his body

because his parents made his a doctor’s appointment. His biggest concern is that his parents

are not going to let him get his driver’s license if he doesn’t get things “under control”. The

motivation to have more freedom and independence appears to be motivating Steven’s

cooperation in the intake assessment.

After the initial session with you, Steven met with his medical doctor to undergo medical testing

related to the impairment of his liver, cardiovascular system, and nervous system. Steven was

medically cleared and no known physical complications (outside of substance use) were

discovered.

Case Study is adapted from McNeece, C. A. & DiNitto, D. M. (2011). Chemical Dependency: A

systems approach. Englewood Cliffs, NJ: Prentice-Hall.