Addictions are prevalent in our society. From substance such as drugs and alcohol to process addictions like sex, gambling, and eating disorders, it is likely that someone in your work or friend circle has struggled with an addiction. Addictions counseling takes knowledge and patience from counselors. In this paper, I have chosen to apply the knowledge from this addictions course to “28 Days” starring Sandra Bullock. In this paper, I will be focusing on the Gwen Cummings, the main character played by Sandra Bullock. She is a city newspaper columnist that struggles with substance abuse, specifically alcohol
I would use the CAGE questionnaire, it is a simple verbal test, composed of four questions, which can be quickly administered to identify patients at risk for alcoholism but has been adapted to include drugs. I would use the CAGE assessment once rapport has been built and the client feels comfortable to tell me the truth. The key feature when using this assessment is gaining honest subjective data that will guide future treatment.
The CAGE questionnaire consists of four questions:
- Cut down: Have you felt you should cut down on your alcohol consumption?
- Annoyed: Have people annoyed you by criticizing your drinking?
- Guilt: Have you felt guilty about your drinking?
- Eye opener: Have you ever had a drink first thing in the morning (i.e., had an eye opener) to steady your nerves or to get rid of a hangover?
Gwen is the child of an alcoholic. We can see that Gwen’s mother was an alcoholic from her childhood flashbacks. Her mother has bestowed the disease of alcoholism, along with the philosophy “If you’re not having fun, what’s the point?” Her mother often drank when Gwen and her older sister, Lily, were around, and she was often found passed out on the floor of their home drunk. Gwen’s father was not shown, so his role is unknown. There were several things that made Gwen vulnerable to substances. Her mother’s substance habits, feelings of loneliness, and sociocultural factors (i.e. age, school, and societal messages) are all contributing factors that made it easy for Gwen to fall prey to alcohol and the cyclical effects. Alcohol is a sedative. According to Miller, Forcehimes, Zweben (2011), “sedative drugs have as their general effect a suppression of the central nervous system. Sedative increase the activity of a certain class of inhibiting neurotransmitters called GABA. In reference to the above resource, sedatives have been commonly identified as downers. Low doses can decrease anxiety while giving a euphoric effect. However, there are also adverse effects. Alcohol can interfere with memory capabilities, induce blackouts, and can be dangerous when combined with activities (i.e. driving or operating machinery). The long-term effects of alcohol include dependency, lethal overdose, hypertension, and congestive heart disease.
Another cause of her alcoholism is due to the people she hangs out with; her boyfriend is a big influence on her. In the beginning of her stay in rehab, he tries to have fun through drinking until their intoxicated. He even tries to bring her alcohol and drugs into the rehab facility. An option for people with addictions is to go to a good rehab facility and to get away from all the people who bring them down. Through the support of many people, and with the support of her sister and everyone at rehab, Gwen was able to overcome her addiction.
Throughout the movie, Gwen straddles from the active addiction stage to the transition stage. In the Active Addiction Stage, the family is caught in the double bind of active addiction. The family is dominated and organized by the realities of drinking/using or other out of control behavior, which everyone must deny and explain at the same time. In essence, the family says: “There is no alcoholism or addiction and here is why we have to drink, take pills, gamble or spend: because of the stress of Dad’s job, because the children fight, or because Mom is such a rotten wife.” The first step to getting help for alcohol abuse is to admit that there is a problem and realizing you need to make a change. Change can mean managing how you cope with stress differently, changing who you spend your time with and what you spend that time doing, and changing how you look at yourself and your own life. The step after that is surrendering to a higher power and allowing other people to help you with the addiction, which happens when Gwen finally allows the rehab therapists and nurses to help her recover. Gwen’s reactions to the treatment and withdrawal seem realistic as to how people usually do react. She stops seeing her boyfriend and realizes that she should not be around the people she used to hang around with if she wants to continue to be sober. In the end, she overcomes her addiction.
I will use the psychological model of addiction. As stated in Dr. Clark’s handout (2015), it is one of five different lenses to view and treat addiction. This model of addiction is focuses on the psychological stressors that drive the addiction. It sees substances as mechanism to cope with internal and external psychological stress. Therefore, the addiction is not the main problem; the psychological stress is. It also perpetuates that there is an “addictive” personality. I believe that this model would be effective in working with Gwen because it hones in on the psychological stress that she is going through (i.e. guilt and loneliness). By applying this model with Gwen I would target the reasons why she drinks, and co-create a treatment plan that would help her to process those reasons and stressors. Then I would empower and support her while she tried new behaviors and coping mechanism to utilize when encountering her stressors.
By addressing Gwen’s underlying causes to her addiction, I hope to decrease the likelihood of relapse. This is one of the advantages of the psychological model of addiction. I also hope that Gwen would embrace a hope of recovery by utilizing this approach to address her psychological stress and learning new coping skills to counter her addiction. If I was meeting Gwen for the first time, I would complete an assessment. I would choose the CAGE assessment. I believe it would answer several of my questions about her substance use, such as frequency of substance use, defensiveness or denial about use, guilt, and other people’s concerns about their drinking. I would also want to gather information about when she started drinking, her drinking habits over time, and important life events.
The goals to include in Gwen’s treatment include abstinence from alcohol, to change cognitions about alcohol use, decrease anxiety, and empower the client to build a support network around abstinence. Progress for Gwen looks like a detox treatment followed by maintained abstinence, effective use of coping skills for her cognitions related to alcohol use, effective use of coping skills to manage her anxiety without substances, and interacting with her support network in order to receive accountability as well as encouragement on her journey. These big picture goals serve as the platform for the changes she will undertake during therapy, and provide her with the necessary direction to do so. It addresses internal changes as well as external changes, which is necessary in working with clients working on substance abuse issues.
Gwen’s treatment plan would include several recommendations. A residential level of care for detoxification (ASAM level three), with medical staff on site would be the first step. After medical clearance was achieved, the other recommendations could be started. Treatment at the residential center would last a month, and include individual therapy twice a week, group therapy five times a week, and weekly family sessions if her family could make it. After a month of level three treatment, I would recommend ASAM level 1 outpatient treatment. This would include weekly individual therapy and a local 12-step Alcoholics Anonymous group for one year. Upon discharge from individual treatment, I would recommend regular attendance to a local 12-step Alcoholics Anonymous group and scheduling an individual counseling appointment as needed.