Multicultural Considerations in the Assessment Process
Rob is a 23-year-old African American male. He is currently engaged and has one child
with his fiancée. He lives in a suburban community and was referred to a counselor, via
his employer, for what was described as "on the job intoxication." The client says that
his employer is concerned about his drug use because he failed a drug test after an
accident at work. Rob was suspended for one month, pending the outcome of his
referral to counseling. Rob tells you that he smokes marijuana, only a few times a week.
Additionally, he asserts that he is using cannabis for medicinal reasons, specifically to
help with insomnia. Rob reports he does not go to work intoxicated and only smokes
marijuana at night to help him sleep. Rob is worried about explaining why he may lose
his job to his family. He does not see a problem with his use of marijuana and also
states he likes his job, but feels like his boss is just trying to control him. Rob believes
that he should be able to use marijuana since it " . . . has never hurt anyone" and is a
medicine. Rob says he is willing to participate in counseling ". . . if he has to and it helps
him keep his job." The employer has given the client four weeks to start (p. 76).
● What are some of your observations about the case of Rob?
● Are their cultural considerations to attend to?
● How might Rob feel about counseling?
● What steps could you take to get a clearer picture of Rob’s case?
Sample Solution
Observations about Rob's case:
- Rob is engaged with a child and lives in a suburban community, suggesting he has some level of stability and responsibility in his life.
- Rob's employer's concern about his drug use stems from a failed drug test after an accident at work, indicating that his use may be affecting his job performance and safety.
- Rob minimizes his marijuana use, claiming he only smokes a few times a week and solely for medicinal purposes to treat insomnia. However, the drug test suggests his use may be more frequent or have a greater impact than he admits.
Full Answer Section
- Rob expresses resentment towards his employer's intervention, viewing it as an attempt to control him. He also holds a strong belief in the harmlessness of marijuana and its medicinal benefits.
- Rob is willing to participate in counseling but only if it helps him keep his job, indicating a lack of intrinsic motivation for addressing his marijuana use.
- African Americans are disproportionately affected by marijuana-related arrests and convictions, which can lead to significant social and economic disadvantages. This context may influence Rob's perception of his employer's actions and his own legal risks.
- Cultural attitudes towards marijuana use vary, and some communities may view it more favorably than others. Rob's cultural background may shape his beliefs about the acceptability and safety of marijuana use.
- Rob may feel resentful of being mandated into counseling, perceiving it as an invasion of privacy and an overreaction to his drug use.
- He may be skeptical of the benefits of counseling, questioning its ability to change his behavior or attitudes towards marijuana.
- Rob may fear that counseling could lead to negative consequences, such as job loss or legal repercussions.
- Conduct a thorough intake assessment: Gather more detailed information about Rob's marijuana use, including frequency, quantity, methods, and reasons for use. Explore his social history, mental health, and any potential co-occurring disorders.
- Evaluate the severity of Rob's marijuana use: Assess whether Rob's use meets the criteria for a marijuana use disorder based on the DSM-5 diagnostic criteria. Consider the impact of his use on his daily functioning, relationships, and overall well-being.
- Explore Rob's motivations for using marijuana: Understand the underlying reasons why Rob uses marijuana, whether it's for self-medication, social reasons, or stress relief. Identify any triggers or factors that contribute to his use.
- Educate Rob about the potential risks and harms of marijuana use: Provide accurate information about the short-term and long-term effects of marijuana use, including its impact on cognitive function, mental health, and physical health.
- Address Rob's concerns about employment and legal consequences: Clarify the employer's policies regarding marijuana use and explain the potential legal risks of continued use. Discuss strategies for maintaining employment while addressing his marijuana use concerns.
- Help Rob develop a personalized treatment plan: Collaborate with Rob to develop a plan that addresses his marijuana use and any underlying issues. This may include individual therapy, group therapy, cognitive-behavioral therapy, or motivational enhancement therapy.
- Involve Rob's fiancée and family members: With Rob's consent, involve his fiancée and family members in the counseling process. They can provide support, encourage Rob's adherence to treatment, and help address any family concerns related to his drug use.
- Monitor Rob's progress and make adjustments as needed: Regularly assess Rob's progress in reducing or eliminating his marijuana use. Provide ongoing support and counseling as needed, and adjust the treatment plan based on his evolving needs and circumstances.