Use of Alcohol

Abstinence from alcohol should be determined on a client-by-client basis. The counselor might point out that some individuals find that overcoming marijuana dependence is more likely if they abstain from drinking alcohol. The client who is concerned about being tempted to substitute alcohol for marijuana should stop all use of alcohol. If a counselor determines that a client has begun to abuse other drugs or alcohol during this treatment approach, the client should be treated appropriately.

Clients With Special Needs

It is important to be sensitive to the special needs of clients. For example, clients with children may need flexible schedules or assistance with child care. Some clients may be cognitively impaired or function at a generally low cognitive level and need adaptations in the treatment approach or techniques that increase the likelihood of their absorbing the material. Strategies may include additional practice with new behavioral skills and repetition of key concepts. The counselor may minimize the use of long and complex sentences or condense the information from cognitive behavioral session handouts (forms in sessions 3–9) onto index cards for some clients. The clientcentered aspects of MET allow the counselor to adapt the sessions to the client’s needs.

Arranging for Additional or Followup Treatment

The counselor and client should address the need for additional care. For example, some clients with a substance use disorder have co-occurring mental disorders, most commonly depression. The counselor is encouraged to assess the presence and severity of other problems that might require attention. The counselor can explain that the client can continue to make progress after treatment ends because the client now has the skills and the ability to continue to improve and progress as these skills are used in new situations. If after a careful discussion of these issues, the client asks for a referral or information about further substance abuse treatment, the counselor can provide this information readily.


The counselor has a complex task that involves relationship building, teaching, supporting, encouraging, monitoring progress and setbacks, and recognizing signs that the client may be withdrawing from treatment or losing his or her motivation to change. The counselor views these common clinical problems as part of the treatment process that can lead to client growth and the strengthening of the therapeutic alliance.