1
\n(Note: This case study is based on many actual cases. All the names used are made up, and
\nany relation to actual people or events is purely accidental and coincidental.)
\nPSYCHOSOCIAL CASE STUDY
\nMarci has smoked cigarettes since age 16 and currently smokes one pack daily. Marci
\nstopped smoking cigarettes for six months one year ago, but she presently does not plan to cut
\ndown or quit.
\nShe has five prescription pills (Xanax) for depression and anxiety that were given to
\nher by a college classmate (for whom they were prescribed). Marci shared that she had been
\nstruggling with feelings of sadness and worrying too much about two months ago. She hasn\u2019t
\ntaken them yet but has considered trying them.
\nMarci first experimented with marijuana during her senior year of high school (age 17),
\nwith her use becoming more regular after she entered college. Marci was first introduced to
\nmarijuana by her high school boyfriend, who used it every day along with alcohol on the
\nweekends. Marci has never been in an in-patient nor an out-patient program. When her parents
\nfirst discovered her marijuana use, they insisted that she seek professional help for what they
\nperceived to be a drug problem. Although they even threatened to call her college academic
\ndean because of her dropping grades, Marci refused help and began to discuss quitting school.
\nWhile she started drinking wine with her family when she was 13, she started to
\n\u201cseriously\u201d drink starting around 18-years-old. She currently drinks four or more alcoholic
\nbeverages (usually wine or wine coolers; sometimes beer) three to four times a week and had
\nbeen smoking marijuana two to three times a week for one year. Her usual pattern was to go
\non weekend binges, starting to drink and smoke on Friday evenings until 2:00 a.m. She
\nwould then have a glass or two of wine around lunchtime on Saturday, smoking a joint or two
\n2
\nwith a couple of friends during Saturday afternoons prior to attending college sporting or
\nsocial events. She would then go to parties with friends on Saturday evenings, typically
\nconsuming six to seven cans\/bottles\/cups of beer and sharing several joints of marijuana with
\nothers. She had also started to consume energy drinks (Red Bull, Monster, etc.) when she
\ndrank beer at these parties to get an added \u201cboost\u201d to her high.
\nDuring the past two months, she has sometimes had one to two glasses of wine (she
\nalso used to smoke half a joint of marijuana with it) when alone on school nights. On the
\nmornings after she used alcohol, Marci tended to sleep in and cut class, but not every week.
\nHer recreational and social interests had increasingly involved the use of alcohol and
\nmarijuana, now since her arrest, it is mainly alcohol (although she still desires to smoke
\ncannabis). Recently, Marci has begun to express concern to her friends about \u201cfeeling
\ndepressed and anxious,\u201d but she reports no suicidal ideation or panic attacks. She is also
\nconcerned since she has missed her period.
\nMarci does not admit to any physical problems. She says she was not hurt in her
\naccidents other than a few bumps and bruises. She says she did not hit her head or lose
\nconsciousness from the accidents. She says she has been sexually active for the past two
\nyears with her \u201csemi-permanent\u201d boyfriend of two years. She thought she was pregnant about
\none year ago, but it turned out to be a \u201cfalse alarm.\u201d She says every now and then, especially
\nduring allergy season, she tends to get a \u201cdry, hacky cough.\u201d
\nMarci is the oldest of three children (one brother, Jacob, 17-years-old; and one sister,
\nSarah, 14-years-old) and continues to live at home while attending college. Her mother, Joan,
\nis a successful attorney, and her father, John, is a school administrator. Her family has always
\n3
\nattended weekly services at their church and have, on a couple of occasions, gone as a family on
\nchurch-sponsored humanitarian missions to Latin America. Marci and her siblings were always
\nvery active in the youth groups, and helping with various church ministries, such as the nursery
\nand pre-school child-care Sunday schools. From taking these trips, the family started
\nincorporating drinking wine with their evening dinners, similar to some of the local customs
\nobserved in these countries. This started when Marci was around 13-years-old. Marci\u2019s parents
\nfound out about her use of marijuana six months prior to her arrest. Marci\u2019s parents found out
\nabout her use of marijuana six months prior to her arrest. After her DUI, her parents sat her down
\nand expressed their concern about the amount she was drinking and want her to stop.
\nSince their confrontation and her arrest, she did cut down somewhat on her use of both alcohol
\nand marijuana, and (when pressed by her parents) she would abstain for several weeks at a time.
\nAs one consequence, her parents stopped giving her permission to drive a family car and were
\nconcerned about her influence on her younger siblings.
\nNeither her brother nor her sister currently drink or use substances. Her brother Jacob
\nadmits to \u201cdrinking a beer with his friends\u201d when he was 16-years-old, but did not like it. He
\nalso admitted to trying his mother\u2019s (Joan) cigarettes several times (about 10 of them) when he
\n15-years-old, but since he wanted to play sports, he stopped. Her sister Sarah says she has never
\nused and does not want to try any of it because she \u201chates the smell of all of it, and sees from
\nMarci\u2019s example how much trouble it causes.\u201d
\nHer father (45-years-old) drank alcohol to the point of inebriation many times when he
\nwas younger (being arrested once for Public Intoxication when he was 19), but stopped when he
\nmet and married Joan 25 years ago when they were both 20-years-old. He has not drank alcohol
\nregularly since then (other than the glass of wine at dinner). He has not had any particular
\n4
\nproblem with mood disorders, although he says he \u201cworries from time-to-time about problems at
\nwork and providing for his family.\u201d He says both his parents struggled with depression and
\nanxiety, but never (to his knowledge) used any prescription or illegal drugs. He says his dad
\ndrank occasionally, and John got his first taste of liquor from the stash his dad kept in the
\nworkshop when he was around 12-years-old. John\u2019s mother never drank, but she told John her
\nfather (John\u2019s grandfather) was an alcoholic most of John\u2019s life until his death 42 years ago.
\nJohn is an only child.
\nMarci\u2019s mother (45-years-old) says she used marijuana growing up (\u201clike everyone my
\nage at the time\u201d) and has struggled off-and-on with depression and anxiety since she was quite
\nyoung. She never drank when she was younger but has enjoyed the practice of drinking a glass
\nof wine with dinner. She says she occasionally will have another glass or two \u201cto help her
\nsleep.\u201d Joan says she was addicted to tobacco, and smoked cigarettes for over 30 years before
\nbeginning to quit about three years ago using nicotine gum and patches. She has now cut the
\ngum and patch use down considerably and has not had a cigarette for two weeks. Joan says her
\nfather drank excessively all her life and was quite violent when he was drunk. She says that her
\nfather would beat up her mother frequently, and put her in the hospital at least once that she
\nremembers for two days. Her father could also be verbally abusive to her two brothers and two
\nsisters (Joan is the youngest). Joan\u2019s father died from a car accident 10 years ago, and alcohol is
\nthought to have been a factor. Joan\u2019s mother also drank, but not to the excess of her father, and
\ncould get \u201cacid-tongued\u201d to the father and all the children. Joan reports that she and the two
\nsisters do not have a good relationship with their mother, but the two brothers seem to have an
\nokay relationship. At this time, Joan\u2019s oldest brother drinks excessively, and seems to be
\nfollowing in her father\u2019s footsteps. The other brother has never touched alcohol as far as Joan
\n5
\nknows. (Interestingly, both brothers blame the use and non-use of alcohol on the example of
\ntheir father.) Joan says she is very close to the younger brother, but she has a \u201clove-hate\u201d
\nrelationship with the older brother, since he reminds her so much of her dad and his abuse. Both
\nof Joan\u2019s sisters drank and smoked a little when they were younger but stopped once they
\nmarried and had children (though the oldest sister\u2019s first-born son displays some symptoms of
\nFetal Alcohol Syndrome). She does not know anything about her grandparents since they died
\n(on both sides) before she was born, although there were \u201cfamily rumors\u201d that there was a lot of
\ndrinking that took place on both maternal and paternal sides.
\nMarci is currently unemployed. In the past she has worked as a waitress, and when she
\nturned 21, as a part-time bartender for the extra money. Her longest place of employment was
\nwaitressing for six months. Over the past four years, she has been fired or left three other places
\nof employment due to excessive absenteeism and once for destruction of property.
\nMarci was arrested five months ago for Driving While Impaired (DWI) with a blood
\nalcohol level of 0.13. She was also charged with possession of 1 gram of marijuana. Her license
\nwas suspended, but she has driving privileges to get to school\/work and back. Over the past
\nthree years she has had two accidents that occurred while she was intoxicated with alcohol and
\nmarijuana, but no other people or vehicles were involved, and no charges were filed against her.
\nIn the first one (30 months ago), she backed into a light pole in the mall parking lot. In the other
\n(13 months ago), she slid into a ditch when making a moderate curve on a road under normal
\nroad conditions, suffering some cuts to her face and bruises to her chest, sides, and knees, and
\nneeding to call a friend to pull her car out of the ditch. She also had one \u201cdestruction of
\nproperty\u201d count two years ago, where she was placed on six months of probation and ordered to
\npay reparations to the owner, which she did.
\n6
\nMarci is a 22-year-old female college student who was arrested five months ago for
\ndriving while impaired with a blood alcohol level of 0.13. She was also charged with possession
\nof a small amount (about 1 gram) of marijuana. Her license was suspended, but she has driving
\nprivileges to get to school\/work and back.
\nMarci admits that, since she began smoking marijuana, her previously good and trusting
\nrelationship with her parents has soured. She had begun to hide and lied to them about using, and
\nhad felt increasingly negative about herself, especially as her grades have suffered and her general
\ninterests have narrowed. On several occasions she tried cocaine, and on another, LSD, but she
\nfound the experiences unpleasant. It was not until her arrest that she began to feel some guilt and
\nremorse over the fact that her drinking and especially her marijuana use was negatively impacting
\nher relationship with her parents, and interfering with her desire to be an attorney. She had also
\nbecome gradually aware that marijuana had been affecting her motivation, her schoolwork, and her
\nspiritual life, but she has not expressed concerns about her use of alcohol.
\nMarci achieved normal milestones and performed well in high school, generally
\nachieving A\u2019s and B\u2019s. She is in her junior year of college. She wanted to live away from home
\nduring college, but her parents resisted the idea because of financial pressures and their tendency
\nto be overprotective. Although she has always been a good student, her grades have begun to go
\ndown and she is not meeting her academic potential.
\nMarci is neatly dressed, and displays a compliant manner. Her grooming was
\nappropriate. She was cooperative in the interview answering all questions politely. Her mood
\nseemed somewhat anxious and depressed.
\nHer affect was appropriate, and she was not overly emotional but appears torn between
\nembarrassment and anger at being forced to attend counseling. Her rate of speech was somewhat
\nrapid when addressing her substance using history and seemed pressured at times, but otherwise
\nappeared normal. Her tone modulated from high when discussing subjects that made her anxious
\n7
\n(such as failing school, getting arrested), and low when discussing subjects that were depressing
\nto her (problems with her parents trusting her). Her thought processes were logical, and she
\nPage 8 of 9
\ndemonstrated proper insight to her own actions, how they contributed to her situation, and her
\ncontinued lack of feeling the need to stop marijuana and alcohol consumption. She was oriented
\nx 4 (to person, place, time, reason why she is being assessed). She had no problem answering
\nthe mental status questions or doing \u201cserial sevens.\u201d
\nShe states that, although she has not used marijuana since she was arrested, she still has
\ndoubts about its harmfulness. Her use of alcohol has not changed. She says that she finds
\nmarijuana pleasurable and relaxing and that, if she could find a way to not get caught, she would
\nlike to continue using it. She believes that both alcohol and marijuana have helped her feel better
\nabout not achieving the high goals she had set for herself and not fulfilling the expectations her
\nparents have for her.
\nMarci shows no evidence of a thought disorder, and her content of thought appeared
\nnormal. She did not demonstrate any psychotic symptoms, and denied any past or current
\nhallucinations or delusions. She admitted to feeling paranoid at times when she was using
\nmarijuana. She denied any obsessions or compulsions. She reports that she has been depressed
\nand anxious at times but that these feelings have never been lasting (although they have been
\nmore frequent over the past month). Her memory did not seem impaired, and her intelligence
\nappeared above average. She has only a few problems regarding sleeping (trouble sleeping
\nsoundly, getting up too late), but no eating problems, history of panic attacks or agoraphobia,
\ncognitive deficits, or learning disability. She denies any suicidal and homicidal ideations.
\nPage 9 of 9<\/p>\n
——<\/p>\n
1 (Note: This case study is based on a number of real-life examples.) All of the characters’ names are made up, and<\/p>\n
Any resemblance to real people or events is completely coincidental.)<\/p>\n
STUDY OF A PSYCHOSOCIAL CASE<\/p>\n
Marci has been smoking cigarettes since she was 16 years old and currently consumes one pack per day. Marci<\/p>\n
She gave up cigarettes for six months a year ago, but she has no plans to do so now.<\/p>\n
down or give up.<\/p>\n
She was given five prescription pills (Xanax) for depression and anxiety.<\/p>\n
a college classmate of hers (for whom they were prescribed). Marci revealed that she had been through a difficult time.<\/p>\n
Two months ago, I was struggling with sadness and overthinking things. She hasn’t done so.<\/p>\n
He hasn’t tried them yet, but he is considering it.<\/p>\n
Marci began by experimenting with<\/p>\n","protected":false},"excerpt":{"rendered":"
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