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Marci is a 22-year-old single Caucasian female college student who is self-referred for counseling due to her concerns about her ongoing legal situation, times of feeling anxious and depressed, and her life after college. She was arrested five months ago for driving while impaired with a blood alcohol level of .13. Marci was also charged with possession of a small amount of marijuana. Her license was suspended for 1 year, but she has driving privileges to get to school/work and back. Marci 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. Marci stopped smoking cigarettes for six months one year ago, but she presently does not plan to cut down or quit. Marci first experimented with marijuana during her senior year of high school with her use of pot becoming more regular when she entered college. Marci was first introduced to marijuana by her high school boyfriend, who used it every day and alcohol on the weekends. Marci’s use was not that extensive, though. She currently drinks four or more alcoholic beverages (usually 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 5 months ago. Her usual pattern of use also included going on weekend binges, starting to drink and smoke on Friday evenings until 2:00 a.m. She would 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 four to five glasses of wine and sharing several joints of marijuana with others. She has had two accidents that 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. In the other, she slid into a ditch when making a moderate curve on a road under normal road conditions. During recent months since her arrest, she has sometimes had one to two glasses of wine when alone on school nights. When Marci was still smoking marijuana, on the mornings after she used, Marci tended to sleep in and cut class, but not every week. While she has not smoked marijuana in 5 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, her grades have begun to decline and, by her own admission, she is concerned about not meeting her academic potential. Beginning in high school, her recreational and social interests increasingly involved the use of alcohol and marijuana. Since her arrest, Marci has begun to express concern to her friends about “feeling depressed and anxious,” but there is no report of suicidal ideation or panic attacks.<
Marci is the oldest of three children (one brother 17 years old, one sister 14 years old) and continues to live at home while attending college. Her mother is a successful attorney, and her father 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’s parents detected her use of marijuana six months prior to her arrest but had incorporated drinking wine with meals since Marci was 13 years old. When her parents first discovered her marijuana use, they insisted that she seek professional help for what they perceived to be a drug problem. Marci went to two sessions with a counselor at her college, but did not continue because it wasn’t helpful and the counselor said she couldn’t help her until she admitted she was an alcoholic. Although her parents even threatened to call her college academic dean because of her dropping grades, Marci refused additional formal help and began to discuss quitting school. She did cut down somewhat on her use of both alcohol and marijuana, and, when pressed by her parents, she had two periods where she abstained for two to three weeks at a time. Her parents also stopped giving her permission to drive a family car except for work and school and were concerned about her influence on her younger siblings. They also told her that in order to continue to use the family car at all, she would have to submit to a random drug screen anytime they told her to. However, they have not required her to actually have a screen yet. 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.<
Marci admits that, once she began smoking marijuana, her previously good and trusting relationship with her parents has soured. She had begun to hide 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 that 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. Marci achieved normal milestones and performed well in high school. She wanted to live away from home during college, but her parents resisted the idea because of financial pressures and a tendency to be overprotective.<
Upon examination, Marci 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 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 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. Marci shows no evidence of a thought disorder. She reports that she has been depressed and anxious at times throughout her adolescence and early adulthood, but that these feelings have never been lasting. However, these times 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.<