Case Study 2 Steve is a fourteen-year-old high school student whose year-long use of alcohol and marijuana is beginning to take a toll. Steve’s grades are plummeting, and he’s noticed that he’s no longer excited about playing in his band. Steve’s parents have been on his back about his grades, but they are consumed by their own daily concerns and haven’t had the time to figure out if something else is contributing to Steve’s poor school performance. Steve does not want his parents to know about his alcohol and drug use. His father grew up in an abusive home with a father who was alcohol dependent and is intolerant of any person who uses alcohol or drugs. Steve has begun to talk to a school-based counselor about his drug problem, and he now attends an individual session at his school and a group session at a local treatment program.
The counselors from his school and treatment program think it’s important to have Steve’s parents participate in family counseling, but Steve refuses to consent to the disclosure of his drug use for fear of a serious disruption in his family life. Federal confidentiality laws prohibit the counselors from contacting Steve’s parents without his consent. Questions: Should the program heed Steve’s refusal to release information to his parents? Should different considerations (and legal standards) prevail if Steve begins to show up for his sessions very intoxicated, in greater distress or with greater impairment, and less able to make rational decisions during his counseling sessions? How could the counselor try to involve the parents in a way that would preserve his therapeutic alliance with Steve? If Steve had been struggling with depression rather than drug use, the counselor at his outpatient program would not have been required to obtain Steve’s consent to inform his parents of his condition. Is there a principled difference for the legal standards for obtaining consent to contact parents/guardians for these two conditions, both of which impair a person’s decision-making capacity?