Mandated DUI Referral With Denial and Collateral Discrepancy
Marcus, 34, was referred by his probation officer after a second DUI arrest three weeks ago (BAC 0.14). He attends intake because probation requires it. He says, 'I don't have a drinking problem; I just made a bad decision.' His AUDIT-C score is 9. He reports four to five beers on weekends and 'sometimes more' after arguments with his partner. He denies blackouts, withdrawal, and prior treatment. He works full-time as a warehouse supervisor and worries that treatment will jeopardize his job. His wife called the clinic and said he has been drinking nightly and missed two days of work last month. Marcus has not signed a release for her. He is polite but guarded and checks his phone repeatedly. You have 50 minutes and no collateral records beyond the probation referral.
1. What is your immediate approach to engaging Marcus while addressing the gap between his self-report and the collateral report?
Read the worked answer
Engagement comes before persuasion. I would use motivational interviewing: open questions, affirmations, reflections, and summaries, while avoiding argument or labels such as 'alcoholic.' I would reflect his stated concern about his job and ask what he makes of the AUDIT-C score of 9, offering it as neutral feedback rather than proof. I would not reveal that his wife called; without a signed release I cannot discuss her information, but I can ask whether he is willing to sign one and explore what his partner has noticed. I would ask permission before discussing drinking: 'Would it be okay if we looked at the parts of this that concern you?' I would assess his own reasons for change and the discrepancy between 'bad decision' and nightly drinking. If he becomes defensive, I would back off and revisit. The goal of the first session is alliance, honest information, and a return visit, not a confession.
2. Differentiate screening from assessment in this case and describe the next clinical steps and instruments you would use.
Read the worked answer
Screening is brief, standardized, and identifies probable risk; the AUDIT-C is a screen, and a score of 9 in a man suggests hazardous drinking but does not diagnose alcohol use disorder. Assessment is comprehensive and diagnostic: it establishes severity, course, withdrawal risk, co-occurring conditions, functional impairment, and level of care. Next steps include a clinical interview mapped to DSM-5 criteria, a biopsychosocial history, ASAM Criteria dimensions, mental health and suicide risk screening, and collateral contact with a signed release. I would use a structured tool such as the ASI or a comprehensive intake, plus a withdrawal scale if he reports recent heavy use. I would ask about morning drinking, tolerance, blackouts, driving after drinking, and family impact. I would also clarify probation requirements and obtain releases for probation and his wife. The screen is the doorway; the assessment determines diagnosis, safety, and treatment intensity.
3. The wife calls again and asks whether Marcus is 'getting help.' How do you respond, and what are the limits of reporting to probation?
Read the worked answer
Without a signed release, I cannot confirm or deny that Marcus is a client, whether he attended, or what he disclosed. I would listen to her concern, explain confidentiality in plain language, and ask whether she wants to give information that I may use only with Marcus's written permission. I would not say 'he is doing well.' I would offer to ask Marcus for a release. The probation referral does not itself waive confidentiality; I may report only what the consent or court order specifically authorizes, such as attendance or treatment compliance. I would clarify the probation officer's requirements in writing and review them with Marcus. If he refuses a release, I document the request and continue to encourage engagement. If there were imminent risk, I would follow duty-to-protect and emergency rules. Otherwise, the therapeutic alliance depends on Marcus trusting that I will not become an extension of probation.