The counselor welcomes the client and provides an overview of the session. In this session the counselor uses problemsolving and motivational strategies to teach the client how to use the social service system independently. The counselor helps the client identify problem areas and develop plans to address them. The client builds self-efficacy in recognizing problems and using the social service agencies. The case management model is based on the general model of problemsolving described by D’Zurilla and Goldfried (1971). CSAT’s TIP 27, Comprehensive Case Management for Substance Abuse Treatment (CSAT 1998), provides more information on the case management process.
Determine Whether and When To Use Psychosocial Problemsolving
Clients who present for marijuana-dependence treatment often experience problems in other areas. They may be depressed or anxious. They may have lost their jobs or feel they are not doing work they enjoy. They may have health or relationship worries. These difficulties may be related to their long-term marijuana use or may be co-occurring mental disorders.
Although most clients indicate concerns about other life areas, not all want to focus on these problems during treatment. The counselor asks generally about the client’s life problems. The counselor and the client decide whether and how much to focus on these other problems, depending on their severity and the degree to which the client wants help with them. If no further attention is warranted, the counselor proceeds to another skill topic. However, the client who indicates significant concerns or who wants help with a non–substance-related problem may benefit from one or more problemsolving sessions.
Use the Problem Checklist To Identify and Prioritize Psychosocial Problems Other Than Substance Use
Problems unrelated to marijuana use that may be a hindrance to the client’s abstinence efforts include
• Lack of housing or financial support
• Unemployment
• Chronic or acute medical conditions
• Legal problems
• Family or parental pressures
• Social isolation
• Need for transportation and child care.
By reviewing the client’s intake or initial session assessments, including the measures of motivation and marijuana-related problems identified on the Personal Feedback Report (PFR) (form AS8), the counselor develops a sense of the type and severity of the client’s psychosocial problems. Careful assessment requires extensive input from and collaboration with the client. The counselor and client use the Problem Checklist (form 3A) to prioritize problems. The counselor asks the client about each category, encouraging the client to identify each problem as specifically as possible (I need a job paying at least $9 an hour rather than I have no money), the effect of the problem on the client’s abstinence from marijuana, and a realistic and concrete goal for the problem (I’ll be attending a trade course at the community college by the end of March rather than I’ll get a job next week):
Counselor (C): You’ve said that although you’re not happy living at your brother’s, you recognize that it’s a stable place for you for now. However, you’d like to start saving some money for your own place. You mentioned that getting a job is a priority for you; it would keep you occupied and help you get your own apartment. That sounds like a good idea because you think you might use if you have nothing to do all day. How do you see it?
Bob (B): That sounds right, but I don’t think I can get a job without a car or driver’s license.
C: Transportation is another issue, and we should add it to our list. How have you been getting to our meetings?
B: I get a ride from my sister-in-law on her way to work and take the bus home.
C: That’s pretty resourceful; how did you set that up?
B: I knew the bus lines because I used to work near here.
C: It sounds as if you’re good at figuring out how to do what you need to do. As we begin to think through how you can reach your goal of getting a job, we’ll need to consider how you’ll get there. A lot of jobs and training programs are on bus lines, so it may not be difficult. What other difficulties can you foresee that might make it hard for you to reach your goals? You’ve told me you don’t have any medical or legal problems; are there any problems associated with your former marriage or your kids?
B: No; I’d like to see the kids more, but that’s okay. I guess that’s all I can think of, for now.
C: Do you think your relationship with your kids is connected with your marijuana use?
B: I think I’d be a better dad and see them more often if I wasn’t smoking.
C: So it sounds as if that’s an important goal for you and another reason for stopping. You may become aware of other problems as we go on; we can talk about them and how they may be associated with your marijuana use as they come up.
or
C: During your initial assessment, you noted housing, transportation, and a family medical concern as problems.
Shirley (S): I’m concerned about my older sister. She has bipolar disorder and whenever she goes off her medication, my husband and I spend a couple of hundred dollars to get her back to a psychiatrist and on medication. We have only one car, so we argue about who will use it. Now that I’ve started student teaching, I need the car every day. It was difficult for me to get here today because my husband was late.
C: As you think about these three areas, how would you prioritize them? Which seems more pressing for you?
S: Right now transportation is a top priority, then my sister, and then a new house. We’re going to see whether I get a teaching job this fall before we start looking for a house.
C: Let’s start with transportation. What would you like to happen and when?
S: We don’t have the money for a second car right now.