Case Scenario

Peter is a twenty-year-old Caucasian college student referred for counseling by the dean of academic affairs. Peter has been suspended from school for drinking and fighting on two occasions over the past six weeks. He has a history of recurrent detentions and classroom dismissals for similar, though less severe, behavior since high school. Peter was suspended for having a pint of vodka and a small quantity of marijuana in his locker.

Peter has recently started experiencing mood swings and is feeling depressed and agitated. Earlier, having felt that the stress of home life was the root cause of his depression, Peter thought that leaving home and living on-campus would resolve his mood swings. He has been practicing self-medication with marijuana and alcohol. He disclosed that he had been prescribed medication for depression when he was in high school but has since then stopped all medication and follow-up on mental health counseling. Presently, he has no desire to enter or seek treatment voluntarily. He has come in for therapy only to avoid being expelled from the college. He denies having any problem with either alcohol or drugs and feels marijuana should be legalized. In addition, he compares his alcohol and drug use to others’ and does not think his intake of substances is a problem. He feels that everyone is just picking on him; he works hard and should be allowed to do. He takes alcohol or marijuana because he just wants to relax after a tough day’s work.

Based on your understanding of the above scenario and drawing upon all relevant course material, address the following questions:

Does Peter have a co-occurring mental disorder? Describe what that disorder may be based on the symptoms mentioned in the case scenario.Analyze and justify the co-occurring disorders in the case.
At what stage of change does Peter appear to be in? Why? Explain.
What model of treatment could possibly work with Peter? Would he do well with a psycho-educational model, CBT, behavioral approach? Why? Share your clinical recommendations based on research.
What are the relapse concerns? Are there any noted defense mechanisms intact?

Sample Solution