16.9 Case Study

James, a 23-year-old Black man, seeks counseling to address his use of methamphetamine and co-occurring anxiety symptoms. He reports using methamphetamine several times a week to manage social anxiety and cope with job-related stress. While James recognizes some negative impacts of his substance use, such as disrupted sleep and strained relationships, he does not feel ready to stop using entirely, describing the drug as “the only thing that helps me keep up with my life.”

James has been referred to counseling by his family, who have expressed concern about his well-being. However, James explores harm reduction strategies rather than abstinence.

During a counseling session, James disclosed that he often uses methamphetamine while driving, particularly during long commutes to client meetings as a freelance graphic designer. He admits this behavior, stating, “I have never been in an accident,” and minimizes the risks associated with driving under the influence.

Discussion Questions

1. How should the counselor address James’s driving under the influence without undermining his autonomy?
2. What harm reduction strategies could be implemented to prioritize safety while respecting James’s reluctance to stop using methamphetamine?
3. Under what circumstances, if any, should confidentiality be breached in this case?
4. How could the counselor address the potential consequences of reporting James’s behavior, given systemic biases in law enforcement and the disproportionate risks faced by Black individuals?
5. How can the counselor maintain a nonjudgmental and collaborative relationship while addressing behaviors that pose safety risks?