Discussion—Motivational Interviewing and Stages of Change

Page 1 of 1 Substance Abuse Assessment

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Case Study—John

John is a longtime alcohol abuser who has managed to function in his job as a shipping foreperson for more than twenty years despite his problem. Last month John’s company instituted a new company policy that required all employees to submit to random urine screens. John tested positive the first time he submitted the random urine drop. His company referred him for an assessment that had to be conducted before he was allowed to return to work.

As the substance abuse evaluator, you are responsible for identifying whether or not a drinking problem exists and for recommending any necessary treatment. John presents in your office the next day with frustration related to his suspension from work. Although he understands the position of his company, indicating that many of “those guys there have drinking problems,” he is surprised that the company “is being this harsh on him.” He denied having a problem because he “does not drink everyday like some of those guys.”

You discuss with John his perception of his drinking as well as the company’s decision to refer him for an assessment and treatment. As the session proceeds, you agree that John probably is not dependent on alcohol. However, you introduce the possibility of abuse, given the history you were provided, and his admission to “getting hammered” most days he is drinking. You explain that his drinking behavior resulted in the presence of alcohol in his urine from drinking the previous night at home. You explore this with John in an effort to help him identify some of the consequences of his drinking, even though he is not alcohol dependent. This allows John to begin to focus on the potential consequences of his alcohol use pattern.