Janie Douglas is a 14-year-old Caucasian female brought for an initial evaluation by her father, Alexander Douglas, age 38. Mr. Douglas found a roach clip and a bong in Kylie’s room. When confronted, Janie admitted she has been smoking cannabis every day for a year. She also has been smoking half a pack of cigarettes per day since age 12. Janie states that she has tried beer and vodka but she “doesn’t drink much.” She also admitted to taking ecstasy once at a party.
Mr. Douglas wants Janie admitted to the hospital immediately. He states Janie is failing in school, has been breaking her curfew, and has been constantly fighting with her mother, who was too upset to come to the appointment today. Janie is irritable, sleeps 10–12 hours per day, and has a decreased appetite. She is well-groomed and polite to you during the interview.

1. How you would approach this interview and situation with Kylie and her father?
2. Based on the DSM-5, identify a possible diagnosis and a differential diagnosis for Kylie. Provide a rationale for your answer.
3. What level of care would you recommend to Kylie and why?
4. What pharmacological and/or nonpharmacologic interventions would suggest for Kylie and her family?
5. What challenges you would anticipate in working with Kylie and her family?

Sample Solution