Reference no: EM133470717

Irene was a 15-year-old girl referred to mandatory substance abuse counseling by the juvenile court after being arrested for marijuana possession. Approximately 1 month ago, Irene and her friends were caught drinking after a football game in a field a few miles away from her school. Although Irene was not intoxicated, she was questioned by police who discovered a small amount of cannabis in her purse. Whereas her friends were sent home to their parents, Irene was detained by police and ordered by a juvenile court judge to participate in 8 weeks of therapy.

"This is total crap," Irene said as she began her first therapy session with Rebecca, her substance use counselor. "Everyone else got to go home, but they arrested me, probably because I was the only Latina. Everyone drinks and uses a little, you know, just to have some fun. God knows we don't go to the games to watch football!"

Rebecca began, cautiously, "Sometimes, adults overreact or do things that are not fair."

Irene replied, "Yeah. There were seven of us and a few boys. All of us drove out there to party and relax. I was the only one who got in trouble."

Rebecca commented, "They singled you out."

"Right. Just me." Irene continued, "And now I'm stuck going to this place. I can think of a dozen kids who drink a lot more than me. Kids who are addicted. Kids who I know sell drugs. But they don't get into trouble. Well if I have to be here, fine. But the judge can't make me talk." Irene crossed her arms in defiance.

Rebecca took a deep breath. She looked away from Irene, out the window, and said, "Your dad tells me you're a good swimmer."

"What?" Irene asked.

Rebecca said, "When I talked to your dad on the telephone before you came here, he mentioned that you swim on the varsity team. He said that you're pretty good and that he's really proud of you."

Puzzled, Irene looked up and replied, "What's that got to do with anything?"

Rebecca explained, "I was wondering... Are you still eligible to swim if you get in trouble with the police?"

Irene replied with a sarcastic tone, "The school swim season doesn't start for 2 months."

"Oh, right," Rebecca said. "But if you get in trouble again, you probably couldn't swim."

Irene paused, digesting Rebecca's words, then responded, "No, probably not."

Rebecca added, "I wonder how your dad would feel if you couldn't swim."

"He'd probably be more hurt by it than I would," Irene replied. "He comes to every meet. He was a college swimmer and really wants me to swim in college too."

Rebecca added, "And you probably like swimming yourself, at least a little? And being on the team?"

Irene answered, "Of course."

Rebecca said, "So even if the police, or the school administrators, or the judge is unfair, or overreacting, or singling you out for whatever reason, it's still in your best interests to NOT get into trouble with alcohol or drugs-at least until swim season is over."

Irene replied, "I guess not."

Discussion Questions

1. What are the six steps in the stages of change model? Which step best describes Irene at the beginning of the session?

2. What are the four overlapping processes of motivational interviewing? Which process did Rebecca emphasize with Irene?

3. What is harm reduction? In what way did Rebecca use a harm reduction approach with Irene?

4. Imagine that you were Irene's therapist. You want to use decision balance to weigh the costs and benefits of continuing her current alcohol and marijuana use versus (2) reducing her substance use. What might be the costs and benefits of each behavior?

5. Irene asserted that most kids her age use alcohol and marijuana regularly. Based on data from the Monitoring the Future studies, is Irene's assertion true? How might Rebecca use individualized feedback to increase Irene's motivation to change?