Treatment Plan Assignment Case Study
Case Study
Camille is a 22-year-old self-identified single, cisgendered, biracial AfroCuban woman who is a college student. She is self-referred for counseling due to her concerns about her ongoing legal situation, times of feeling anxious and depressed, and her life after she graduates from college in two terms. Camille was recently charged with possession of a small amount of marijuana. Her license was suspended for one year, but she has driving privileges to get to school/work and back. Camille feels fearful each time she sees a police car when driving due to her disdain for the methods the police officers used to approach her vehicle, the harsh words that were spoken to her by one of the male officers, and her treatment at the jail when she was arrested five months ago for driving while impaired with a blood alcohol level of .13. She has already completed state-mandated psychoeducation and counseling for having her driving privileges restored once her year of revocation is over. She has smoked cigarettes since age 16 and currently smokes one pack daily. Camille stopped smoking cigarettes for six months one year ago, but she presently does not plan to decrease or quit. Camille first experimented with marijuana during her senior year of high school with her use of marijuana becoming more regular when she entered college. Camille was first introduced to marijuana by her friend at a regional cheering camp, who smoked and drank alcohol every Saturday with her high school friends. Initially Camille’s use was not that extensive, though. However, since beginning in high school, her recreational and social interests increasingly involved the use of alcohol and marijuana. She currently drinks four or more alcoholic beverages (usually Pino Grigio wine) three to four times a week with friends and was smoking marijuana two to three times during the week for one year prior to her arrest five months ago. Her pattern of use also included going on weekend binges, starting to drink and smoke on Friday evenings until 2:00 a.m. on Saturday. Camille described having a glass or two of wine around lunchtime on Saturday, smoking a joint or two with a couple of friends on Saturday afternoons prior to attending college sporting or social events. Later she would attend parties with friends on Saturday evenings, typically consuming four to five glasses of wine and sharing several joints or blunts of marijuana with others. Camille had been involved in two accidents, both occurred while she was intoxicated with alcohol and marijuana, but no other people or vehicles were involved. In one, she backed into a light pole in the mall parking lot. She slid to the side of road and her bumper was damaged when driving. Camille described the road conditions as slippery due to a severe rainstorm when she was driving. Neither accident required police involvement or a visit to the hospital.
Since her arrest, she occasionally has one or two glasses of wine when alone Monday through Thursday. When Camille was still smoking marijuana, on the mornings after she used, Camille tended to sleep in and skip class, but not every week. While she has not smoked marijuana in five months, she has continued her typical use of alcohol. Her alcohol use did decline by about half while attending the eight weeks of court-mandated psychoeducation and counseling. Although she has always been a good student (cumulative grade point average is 3.8), her grades have begun to decline and, by her own admission, she is concerned about not meeting her academic potential. Since her arrest, Camille has begun to express concern to her friends about “feeling depressed and anxious,” but there is no report of suicidal ideation or panic attacks.
Camille is the oldest of three children (one brother 17 years old, one sister 16 years old) and continues to live at home while attending college. Her mother is a successful attorney, and her father is the superintendent of schools in their community. Her family regularly attends Sunday church services, her mother teaching a mid-week bible study, and her father ministers twice a month at a men’s shelter. Twice the family has participated in a church-sponsored humanitarian missions to Europe. Neither parent has any history of substance-related, mood, or anxiety problems, with the exception of her mother’s recovery from tobacco-addiction, which began three years earlier. A maternal uncle has alcoholism, and both paternal grandparents struggled with depression and anxiety.
Camille’s parents detected her use of marijuana six months prior to her arrest and were becoming concerned with her consumption of alcohol. The family does serve alcohol several times a year when her parents host large family gatherings. When her parents first discovered her marijuana use, they insisted that she seek professional help for what they perceived to be a drug problem. Camille attended two sessions with a counselor at her college but did not continue because it was not helpful, and the counselor said she could not help her until she admitted she was an alcoholic. Camille refused additional formal help and began to discuss quitting school. Her parents stopped giving her permission to drive a family car except for work and school. She was also informed her use of the family car would be contingent upon her submitting to random drug screens per the request of her parents. However, they have not required her to have a screen yet. She did reduce her use of both alcohol and marijuana, when felt pressured by her parents due to their concerns about her wellbeing and the influence she would have on her siblings. After her parents persuading her to stop using drugs and alcohol, Camille had two periods where she abstained for two to three weeks at a time.
Camille admits that, once she began smoking marijuana, her previously good and trusting relationship with her parents has soured. She hides her use of marijuana and minimize her use of alcohol. She has felt increasingly negative about herself, as her grades have suffered and her general interests have narrowed, especially since her arrest. On one occasion, she tried cocaine and, on another, LSD, but she found both experiences unpleasant. It was not until her arrest that she decided her marijuana use was negatively impacting her relationship with her parents and could interfere with her desire to become an attorney. She has also become gradually aware that marijuana may be affecting her motivation, her schoolwork, and her spiritual life, but she has not expressed similar concerns about her use of alcohol. Camille achieved normal childhood milestones and performed well in high school. She wanted to live away from home during college, but her parents resisted the idea because of concern for Camille’s maturity and due to her parents overprotective parenting style.
Upon examination, Camille is a neatly dressed young woman with a compliant manner. She appears torn between embarrassment and anger at being forced to attend the previous court-ordered counseling. She states that, although she has not used marijuana since she was arrested,she still has doubts the severe harmfulness of marijuana use. Her use of alcohol has not changed. She disclosed she finds marijuana pleasurable, relaxing, and if she could find a way not to get caught, she would like to continue using it. She believes that both alcohol and marijuana have, at times, 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. Camille shows no evidence of a thought disorder. She reports feeling depressed and anxious at times throughout her adolescence and early adulthood, but these feelings have never been lasting. However, these feelings have been more frequent and intense since her arrest. She has no sleeping or eating problems, suicidal ideation, history of panic attacks or agoraphobia, cognitive deficits, or learning disability.
