Please take about 15-20 minutes to read the following case study and to answer the questions at the end.

Case Study

Lance is a 23 y.o. white male who has been in treatment with you for about three months, originally seeking help for problems with anxiety and depression. He reports that he was raised in an alcoholic family, where his parents divorced when he was about 6 years old, and was in the custody of his mother who suffered from depression.

In the course of your assessment with him, he has revealed to you that he has been heavily involved in the "party scene" since he was about 19. This has included the use of alcohol, as well as marijuana, ecstasy, ketamine, and methamphetamines. Your work has included dealing with family of origin issues, but has also gently served to raise his awareness of the risks and effects of his substance usage. He has acknowledged that he needs to "stop partying", as it is affecting his life in negative ways. He feels that his memory and thinking are being impaired by the substance use, and he is not functioning well at work, often calling in sick after a night of substance use. Because of his family background, it is very important to Lance to have a successful career, and the deterioration of his work performance is a cause for distress.

Lance has made several initial attempts to limit his use of illicit substances, but is unwilling to remain abstinent from alcohol, even though he acknowledges that alcohol is often a trigger for the use of the other substances. He says that almost everyone he knows his age is engaged in the party scene, and he is not ready to engage in a life in total abstinence, since that would isolate him from almost everyone who has been in his circle of friends. He says that he will probably consider this in a few years, when he will be more ready to settle down into the next stage of his adult life.

In the course of raising with Lance the idea of developing "new playgrounds and new playmates" in order to build the foundation for a more sober lifestyle, you have met with considerable resistance. Your attempts to gently push him in this direction have seemed to create a fair measure of friction in the therapeutic relationship, to the point where Lance has inferred that he may discontinue therapy if pushed too hard in this direction.

Questions for this case scenario:

1. Based upon the information given, which stage do you think Lance is in?
2. What do you think would be the advantages and disadvantages of utilizing a harm reduction approach to working with Lance at this point in time? Do you see any possible dangers of utilizing this approach?
3. If you were to script out a motivational interview approach for your next meetings with Lance, what elements would you need to include in your attempts to help him move to the next stage of his treatment? What dangers and pitfalls do you think you would need to take particular caution in avoiding?
4. If Lance were ready to engage in the development of a Change Plan Worksheet, what might be the focus in each of the six parts of the worksheet, based upon the information given, and how would you utilize motivational interviewing approaches to facilitate the completion of this worksheet.

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