Question:

1. Do you think that Mr. B has a clinically significant problem with marijuana/cannabis? In other words, does he have a psychological disorder? Describe why or why not?

2. If you were Mr. B's therapist, what would be your goals for his therapy?

Case of Mr. B.

Mr. B is a 20-year-old male college student who was recently arrested for possession of marijuana, which was detected when he was stopped for unsafe driving. He was charged with driving while intoxicated with cannabis, and his license was suspended. Mr. B is the oldest of three children and continues to live at home while attending college. His mother is a successful attorney and his father is a school administrator. He has smoked cigarettes since age 16 and currently smokes one pack a day. He drinks five drinks on occasion and has been smoking marijuana several times a week for 1 year. His usual pattern of use is to go on weekend binges, starting to smoke on Friday evenings and then again early in the day on Saturday continuing into the evening. He has had two car accidents that occurred while he was intoxicated with marijuana. During recent months, he has sometimes smoked marijuana on school nights. On the mornings after he uses marijuana, Mr. B tends to sleep in and cut class. Although he has always been a good student, his grades have begun to go down and he is not meeting his academic potential; his recreational and social interests are also limited.

Mr. B's parents detected his use of marijuana 6 months earlier, and since that time Mr. B has been in a constant struggle with his parents about his perceived "right" to smoke marijuana. When his parents first discovered his marijuana use, they insisted that he seek professional help for what they perceived to be a drug problem. Although they even threatened to call his college Dean, Mr. B refused help and began to discuss quitting school. He did cut down on his use somewhat, however, and when pressed by his parents, would abstain for several weeks at a time. His parents also stopped giving him permission to drive a family car and were concerned about his influence on his younger siblings. Neither parent has any history of substance-related problems, with the exception of his mother's recovery from tobacco addiction, which began 3 years earlier. A maternal uncle was an alcoholic.

Mr. B admits that since he began smoking marijuana, his previously good and trusting relationship with his parents has soured. He has taken to hiding his use, has lied to them, and has felt increasingly negative about himself, especially as his grades have suffered and his general interest have narrowed. On one occasion, he tried cocaine and, on another, LSD, but found both experiences unpleasant. It was not until his arrest for possession that he decided that drug use was ruining his relationship with his parents and could interfere with his desire to become an attorney. He has also become gradually aware that marijuana may be affecting his motivation and schoolwork.

Mr. B was first introduced to marijuana by his girlfriend, who uses it every day and whose mother also uses marijuana. Mr. B smokes both alone and with friends; however, he would sometimes not use marijuana for weeks at a time during summer holidays and when pressed by his parents. He introduced his 17 year old brother to marijuana, but his brother felt paranoid on that occasion and has not tried it since.

Mr. B achieved normal milestones and performed well in high school. He wanted to live away from home during college, but his parents resisted the idea because of financial pressures and a tendency to be overprotective. Upon examination, Mr. B is a neatly dressed young man with a sarcastic manner. He appears torn between embarrassment and anger at being forced to seek help. He states that, although he has not used marijuana since he was caught, he still has doubts about its harmfulness. He says that he finds marijuana pleasurable and relaxing and that, if he could find a way not to get caught, he would like to continue using it. He believes that marijuana has helped him feel better about not achieving the high goals he had set for himself and not fulfilling the expectations his parents have for him. Mr. B shows no evidence of thought disorder. He reports that he has been unhappy at times but that this feeling has never been lasting. He has no sleeping or eating problems, suicidal ideation, history of panic attacks or agoraphobia, cognitive deficits or learning disability.