Marci is a 22-year-old college student who was arrested five months ago for a DUI. She has a history of regular alcohol and marijuana use since high school. Her family has a history of substance use disorders and mental health issues. While Marci's grades have declined due to her substance use, she does not feel she has a problem with alcohol or marijuana. She is concerned about legal and academic consequences but does not want to change her substance use behaviors.

1. (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.)
Addictions Case Study: Narrative
Presenting Problem:
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.
Drug History and Current Patterns of Use:
She 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.

2. While she started drinking wine with her family when she was
13, she started to
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“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 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.
Family History:

3. 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
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

4. 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
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 cigar ettes
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

5. 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
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.
Substance Abuse Treatment History:
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.
General Medical History:
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

6. 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.”
Personal Status:
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.
Legal History:
She 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,

7. 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.
Education:
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.
Employment:
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.
Mental Status Exam and Observation:
Marci is a 22-year-old female, 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 (such as failing school, getting arrested), and low when

8. discussing subjects that were depressing to her (problems with
her parents trusting her). Her thought processes were logical,
and she
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.