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exhibiting symptoms of anger and being withdrawn around the house for about six months after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
Case Study is adapted from McNeece, C. A. & DiNitto, D. M. (2011). Chemical Dependency: A
systems approach. Englewood Cliffs, NJ: Prentice-Hall.
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