Introduction
The 1988 movie Clean and Sober, directed by Glenn Gordon Caron with Michael Keaton and M. Emmet Walsh as the main actors, gives a realistic view of the physical and, most importantly, moral consequences of addiction and the process of recovery. The film revolves around Daryl Poynter, a realtor cited by Michael Keaton, who falls into a difficult period after a cocaine overdose results in a near-death condition. Trying to rob the pharmacy and all the drug stores in town, Daryl Poynter ends up in a drug rehabilitation center after he is caught by the police and sent to jail. Relied on the example of Daryl’s case, the research will deal with the cause, assessment, diagnosis, and treatment method of addiction, hence applying all sorts of theories of addiction, such as biological/genetic, psychological, familial, cultural/social, and environmental ones. Through observing the path of Daryl, it is possible to learn a lot about addiction as well as co-occurring disorders diagnosis, expectations, assessment methods, diagnosis, and clinical treatment. This study focuses on the communication of addiction and the effort of individuals to overcome addiction through their journey through theory proposes. Therefore, the film and the contemporary addiction theories ideas will be utilized in this research.
Aetiology/Conceptualization
Clean and Sober published this movie that could be explored to examine the causes of addiction from the experiences of Daryl Poynter. Daryl’s battle with drug abuse challenges all explanations through the biological, psychological, familially, cultural, and environmentally based perspectives (2020).
First, Daryl has a particular set of vital and innate factors that are hard-wired in his brain that influence his addiction vulnerability (Dubovsky et al., 2021). Research seems to provide evidence that there is an underlying genetic foundation to addiction since it is seen more often among individuals with a family history of poor addiction (2020). Psychologically, Daryl is frustrated because substance abuse may be the option he has used to cope with stress, trauma, low self-esteem, or whatever he is facing. In this category, the attraction to drugs could work as an escape from his problems, and he might have had a first or second step in an addictive journey as a self-medication method (Dubovsky et al., 2021).
However, the family system also likely became a crucial source of Daryl’s addition. The story suggests a family dysfunction that might have led to the character’s feelings of inadequacy and an invalid of support, intercepting his desperate attempt to escape from the world into drug abuse. Also, the cultural and social background the movie has moreover portrayed extensively influences Daryl’s addiction. In the realty domain, which is very dynamic and exciting, substance abuse can start to be perceived as a strategy for managing stress and just keeping up good performance (2020).
On the other hand, many environmental factors around Daryl, such as the company of drugs, alcohol, and friends, play a significant role in his drug addiction. The movie symbolizes him in the company of people who are nothing but fellow addicts, thus making the whole situation more supportive of his daily dose of an addict’s substance. Not only that, but also Daryl possibly having a dual diagnosis is a prevalent condition that often frustrates treatment, but very few medical specialists are knowledgeable about the disease (DSM-IV-TR_-to_DSM-5).
Assessment Methods for Daryl Poynter/Rationale and Application
In the context of biological/genetic factors, we should see genetic weaknesses as part of the most critical aspect. Genetic disposition to addiction can be established either through the use of family history or genetic screening methods, genetic markers that indicate addiction bias (DSM-IV-TR_-to_DSM-5). This identification, particularly of Daryl’s genetic risk factors, is beneficial for designing a targeted intervention and prevention program. To share, economists need to go beyond simply pointing out inequalities and urge policymakers to take critical actions to address those inequalities (Dubovsky et al., 2021).
A psychological assessment has to be conducted to have a detailed psyche profile of Dual. Using the standard psychological examinations helps us to get to know his style of life, traumas, and ways out of them, and also to provide him with treatment that he might need (2020). This entails such as measures of PTSD, stress, and self-esteem. Unlike the Former, the local Family assessment will gain more weight, including Family therapy sessions and genograms (2020). These tools assist in understanding family processes, including relationships, history, and the same issues that the patient is currently facing (Dubovsky et al., 2021). Identify the pathology of the family system and insufficient support within the family, and examine how addiction has existed in the family history. Daryl Will help to address how the family influences his addiction.
Moreover, cultural competence evaluation and network analysis of social should be done to continue the success of this mission. Knowing Daryl’s background is valuable since it helps to learn about his socio-cultural environment. This includes work stressors affecting job behavior and psychosocial well-being (2020, April 16). Clean and sober – “You an addict?” Distinguishing what is culture-specific in stress sources and support allows for creating easily applicable models (2020).
In addition, assessment will be geared towards the media and presentation of information. It refers to the assessment of indicators such as the online friend’s social network, peer influence, and the living environment of this particular person. Using localization of environmental causes, social networks, and living conditions that have already proven effective, we should facilitate the creation of a supportive environment and plan the implementation of the necessary actions to prevent relapse (2020).
On the one hand, the Dual Diagnosis Assessment would be critical in Daryl’s life. This is because it will then be possible to determine if there are co-existing mental health concerns or if they all came together, and usually, they play a role in the course of treatment and preventing decline (2020). The outcome of this phenomenon is seeking the possibility of treatment of co-existing issues, for example, in Daryl’s treatment plan (2020, April 16) Clean and sober – “You an addict?” A comprehensive scoring that will consider both Environment and Dual Diagnosis factors will indicate the effect of these things on Daryl’s recovery chances, which is essential for his treatment to be better and long-lasting (2020).
Diagnostic Impressions and Rationale
As depicted in the movie “Clean and Sober”, I diagnose Daryl Poynter with the condition known as addiction to the substance while following the pattern of Substance Use Disorder according to the DSM-5 criteria (2020). It becomes apparent that Daryl has established a behavior portraying a destructive habit of using illegal substances, eventually leading to a state of mental or emotional disturbance, as shown by his addiction problem of cocaine (Dubovsky et al., 2021).
Substance Use Disorder (Cocaine Type), DSM-5 Criteria Met
- Impaired Control
Daryl is shown to have a dominant insistence that he stop or cut down his use if any, and has shown this through his withdrawal of cocaine at his overdose and then taking him to a drug rehabilitation center. Even so, it seems impossible to stay sober in the face of this addiction, making it evident that he no longer has a grip on his drug use (Dubovsky et al., 2021).
- Social Impairment
Daryl’s drug use is disregarded because of the emerging problems in his life, and relationships are cracking one after another. The relationships suffer to an extent, and he has difficulty maintaining their job and keeping his social network.
- Risky Use
Daryl’s cocaine use persists despite knowing that it is causing a weakening in his mental and physical conditions. Such examples include being very near death from overdose and a plan to rob a pharmacy to gain the drug. Such conduct indicates a lack of respect for his well-being and security (2020)
- Pharmacological Indicators
The tolerance effect is also pronounced with Daryl, as seen in the strengthening of the cocaine preparation doses necessary to provide the relief that he seeks. Meanwhile, he comes to know he has chief complaints of withdrawal symptoms when he tries to quit using cocaine (2020).
- Duration and Significance
Although he was aware of the damage his problem-causing substance abuse was bringing, he carried on using it for an extended period and in a severe way (2020, April 16). Clean and sober – “You an addict?”
Differential Diagnosis
The differential diagnosis that is not an SUD or addictive disorder is Major depressive disorder (MDD). Interestingly, the root cause of Daryl’s symptoms cannot solely be attributed to drug use. However, the existence of a mental illness accompanying MDD, which is a chronic illness, cannot be excluded either due to the considerable psychological suffering the movie portrays (Dubovsky et al., 2021).
Major Depressive Disorder (MDD) Differential Diagnosis Rationale
Daryl’s behavior and emotional state throughout the movie suggest a possibility of Major Depressive Disorder
- Persistent Depressed Mood
Over the film’s journey, Daryl exhibited himself to be constantly speechless by the various feelings that make up depression, grief, and hopelessness, especially after his accident and during the period of his recovery (DSM-IV-TR_-to_DSM-5).
- Hobbies that once brought me joy now leave me feeling bored and uninterested.
Daryl hates and attempts to escape from anything except sniffing his tracks of cocaine. So, he is on the suffering end of the socialization process.
- Very dramatic Weight Loss or Gain
Consequently, other than the loss or gain in body weight reflected on the scale, signs of depression like missing to eat or eating more than usual, resulting in lower or higher body mass respectively, will be evident (DSM-IV-TR_-to_DSM-5).
- Fatigue and lack of aggression
To obtain a conclusion is relatively simple because Darryl fails all the aspects expected from a young man regarding his behavior, activity, and appearance. These features can be explained, for example, in the way that he consumed cocaine or he is suffering from depression probably (2020).
- Recurrent Thoughts of Death
Daryl admits having lost his hopes and sake, in one scene, expressing suicidal ideas; these ideas indicate constant and repetitive thoughts of death, which is the core manifestation of Major Depressive Disorder (2020, April 16). Clean and sober – “You an addict?”
Recommended Treatment Plan for Daryl
The extreme nature of Daryl Poynter’s addiction, together with his mental health instability, necessitates that he undergo intervention from the inpatient rehabilitation program initially and an emphasis on detoxification and stabilization (2020). The first step in Daryl’s treatment should involve purification to ensure his physical and mental well-being by eliminating the remaining cocaine from his body and dealing with the symptoms of cocaine withdrawal. There should be a systematic procedure under the care of medical professionals to ensure your safety and keep discomfort at a minimum (2020, April 16). Clean and sober – “You an addict?” Cognitive Behavioral Therapy (CBT), the foundation of Daryl’s treatment plan, is also deeply significant. It will make him appreciate and alter himself, which is the root of his addiction and depression. Through CBT, Daryl will identify and master new coping strategies to handle stress and triggers in a better way (Dubovsky et al., 2021).
It is crucial that, given the probability of comorbid Diagnostic and Statistical Manual of Mental Disorders-5 (DSM-5) major depressive disorder (MDD), the treatment of primary drugs and second psychiatric disorders is taken into account while considering the possibility of this serious mental condition. Through a holistic approach, simultaneous treatment for mental health and substance abuse disorders will be provided. The medical approach should involve the use of medication in the treatment plan so that successfully both the addictive and depressive symptoms will be managed. Antidepressants can be considered as one of the initial treatments for MDD whose symptoms the medication can effectively reduce. Both medicines to treat cravings and withdrawal symptoms, as well as medical drugs, should also be used when treating cocaine dependence (Dubovsky et al, 2021).
Engaging family of Daryl in family therapies may go a long way and facilitate finding practical solutions to family conflicts (2020). In family therapy, Daryl can get a chance to patch up the relationships that he saw get broken, improve his communication, and receive the support he needs for his recovery process (Dubovsky et al., 2021). My mediation for Daryl includes decline prevention strategies that will play a key role in Daryl’s treatment. This will include remembering the causes, emotional control, and creating a decline avoidance plan. The highlight of the intervention will be increasing Daryl’s self-monitoring and self-regulation skills to stay sober (DSM-IV-TR_-to_DSM-5).
Attention-skills-based interventions will greatly enhance Darvis’s sensitivity toward his thoughts, feelings, and bodily sensations (DSM-IV-TR_-to_DSM-5). These tools will help him to overcome the situations that cause a craving as well as the stress. The stress management techniques that would be used for him would also be explained to him. Besides individual therapy, he may also be involved in peer support groups that are designed for all individuals like Daryl in similar situations, maybe NA or CA. The groups will serve as a means of belonging and sharing experiences so that he will be able to develop an understanding and keep himself responsible throughout his recovery ()
Culturally Relevant Theory-Based Techniques and Interventions
We will implement culturally sensitive approaches to ensure Daryl’s cultural background will be considered in our treatment program. Integration of the community and culture is crucial; as such, Daryl is encouraged to engage in one’s cultural activities and practices that promote happiness and health. The injury reduction strategy of our plan includes minimizing the harms of drug use through the provision of services such as peer counseling and overdose prevention. It is an exposure that the approach does not only focus on total self-discipline as a quick solution but also relies more on small, noticeable changes (Dubovsky et al., 2021). Considering the path spirituality and belief take with Daryl’s essence, faith-based treatments will be included in his treatment plan, and he will have some meaning and support. Implementing his strong faith in himself may be crucial to his recovery. Evaluation of cultural ability issues in providing interventions will be conducted continuously to verify that the intervention is current and correctly applied. This includes cultural factors like sources of stress and support systems, as well as his treatment carefully packed and addressed to his culture (2020)
Conclusion
The movie “Clean and Sober” deals with drug and alcohol addiction and the recovery process, in which we watch Daryl Poynter’s journey to get rid of his destructive habits. The article, in-depth, examined Daryl’s experience as a basis for discussing the causes, evaluation, detection, and treatment of addiction, applying the various addiction conceptions such as the psychological, biosocial/genetic, familial, cultural/social, and environmental perspectives. The assessment process reminded me of the role of genes and heredity, psychological factors, family impact, cultural attitude, social reality, and their initiates. Daryl’s symptoms, as defined under DSM-5 standards, are exhibited to be Substance Use Disorder and can be comorbid with Major Depressive Disorder. The recommended course of action involves admission to a rehabilitation center, detoxification, use of Mental Behavioral Therapy, medicine, family therapy, and relapse prevention strategies. Culturally significant and theory-based strategies and interventions given to him have his cultural heritage treated appropriately. A cultural competence evaluative process will continue to be implemented to ensure the programs are on target to be effective. This combination might be the beginning of the road of recovery for Daryl, who is a human being with every specific cultural, social, and personal were taken into consideration.
References
Dubovsky, S. L., Ghosh, B. M., Serotte, J. C., & Cranwell, V. (2021). Psychotic depression: diagnosis, differential diagnosis, and treatment. Psychotherapy and psychosomatics, 90(3), 160–177.https://karger.com/Article/FullText/511348
Highlights of changes from DSM-IV-TR to DSM-5. (n.d.). https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/APA_DSM_Changes_from_DSM-IV-TR_-to_DSM-5.pdf
Vanderbleek, E., & Gilbet, K. (2018). Too much versus too little control: the etiology, conceptualization, and treatment implications of overcontrol and undercontrol. Radically Open, 41(3), 125.https://www.researchgate.net/profile/Rachel-Egan-3/publication/324497934_Group_Radical_Openness/links/5ad092730f7e9b18965d6504/Group-Radical-Openness.pdf#page=17
YouTube. (2020, April 16). Clean and sober – “You an addict?” – Michael Keaton x M. Emmet Walsh. YouTube. https://www.youtube.com/watch?v=U9mM2EZiVwo&t=5s
[PDF] A contemporary approach to substance use disorders and addiction counseling by Ford Brooks. Perlego. (n.d.). https://www.perlego.com/book/997282/a-contemporary-approach-to-substance-use-disorders-and-addiction-counseling-pdf
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