The following scenario is taken from " Seven Case Studies of People...

The following scenario is taken from "Seven Case Studies of People with Substance Abuse ProblemsLinks to an external site.". (Some language and ideas may be offensive to some students but are included in an effort to depict clinical reality. Direct statements by the client are noted in italics.)

• Read this Case Study as a description of a client presenting to you for substance abuse assessment:

Laura is a very successful businesswoman in the high-stress, high-powered world of corporate finance. She has been referred to you by the company's employment assistance program.  Laura presents herself as a no nonsense business professional. She is frank and honest about the events that have brought her to your office. Laura tells you that although she tells herself that she will only have one or two glasses of wine with dinner, she usually finishes the whole bottle.

Each morning she drinks at least 3 to 4 cups of coffee, even on the weekends. She noticed that her sleeping problems developed around the same time her Dad died. He was only in his early 50's and they were very close. His death hit her hard and she says she wanted to give in to a big depression. However, she fought it and lost herself in her work. She makes it a point to work out at least three times a week in the morning before going to work. In addition to the above medications, Laura is also prescribed Xanax as needed for panic attacks and diet pills (amphetamine) to control her weight, a problem she had since she was a child. Over the last year she has become more reclusive. She can barely make it to business dinners and after-work functions. 

"....more often than not I finish off the bottle before going to bed. I just can't seem to stop. A lot of times I will come home and tell myself that I'll only have one glass and no more but by the time I go to bed, the bottle is empty and I'm deciding whether I should open another or not. I never used to drink to excess or take anti-anxiety medication before. Now I can't seem to stop drinking or taking these 'downers' at social events. I can't seem to control when I take them and things are happening that I'm not too happy about. Of course the alcohol adds to my weight problem which then causes me to take more of my Redux. Then I have to increase my Xanax to calm my nerves and also take my Valium to make sure I get a full nights sleep. It has become a very vicious circle. All this has been going on for about a year but last week put the "cherry on the pie."

Laura tells you that last week she was to meet the firm's top client at a business luncheon. She could not get out of bed that morning. It took all her willpower to get up and get dressed. As it was, she was still 20 minutes late, "which is inexcusable."  She was so nervous and sick she had to excuse herself in the middle of her presentation.  In the bathroom she took another Xanax to calm her nerves. Then at the luncheon she could not stop herself from ordering several glasses of wine and had to be assisted to her car after the meeting was over.

"My client spoke to my boss and staff and then canceled his account with me. The next day I met with my boss and he recommended (ordered) I make an appointment with our EAP program (or be terminated.) I'm really scared. Work is all I have. I can't afford to blow it. Do you mind if I smoke?"

1. Determine which (1) of the 6 Stages of Motivation (See Chapter 4) this client is most likely experiencing at present.  Define and describe that stage.
2. Provide rationale for your determination of the Stage.
3. Include Reference citation in-text, and include Title and References pages in APA format.