Films or screenplays for a long time now have been applied as a depiction the society. Filmmakers have focused on issues that affect society like addictions, alcoholism, domestic violence, mental illnesses and so forth. One of the main focuses is mental health that is associated with substance abuse. An example of such a film is When a man loves a woman a 1994 drama film. The paper aim at addressing a mental health issue as played in the movie and how it can be diagnosed and treated.
Synopsis
The movie When a man loves a woman produced in 1994 is a dramatic treatment to the viewers of a family torn apart by alcoholism. From a romantic beginning, Alice Green (Meg Ryan) a school counselor falls in love with Michael (Andy Garcia) who is a pilot. Alice Green has a serious drinking problem. Alice is however shown as a loving and lighthearted but is reckless when she is drunk that she even neglects her responsibility as a mother. It is during a vacation in Mexico that Michael admits that Alice has a drinking problem that leads her to neglect her children, Jess Green a nine-year-old daughter from the previous marriage and Casey a four-year-old daughter. After an accident, Alice realizes that she had hit a rock bottom and she needed professional help to help with her condition. Alice goes to rehab. Her return home she returns as an independent woman who is not dependent on alcohol. Michael has a problem adjusting to the new Alice as he was used to her being weak and helpless (Avnet, Kerner, & Mandoki, 1994).
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Character Assessment
The Client, in this case, is Alice Green, a 32-year-old female with a history of alcohol use. Alice says that she started drinking at the age of 9. Alice says that she feels that she is not adequate in a relationship which is her reason for drinking as a coping mechanism. Alice's dependency on alcohol leads to impairments that affect her ability to attend to her responsibilities as a wife, a mother and a public servant.
Alice in the movie is first depicted as a loving and responsible woman. However, stress from work and a depressed from her feeling insufficient leads her to drink. Alice looks healthy and fine but interacting with others you realize she has an underlying problem of the feeling of being weak.
Alice is economically stable as she is a counselor in a school and her husband is a pilot. The income from both is sufficient to afford a decent life. The entire family of Michael and Alice is economically stable as they can afford to go for a vacation in Mexico. Alice's stable economic situation allows her to access alcohol whenever she needs it. We can conclude her economic condition supports her being an alcoholic.
Alice's developmental milestone is that she had a rough childhood where she was introduced to alcohol at the age of 9 years. There is a chance that she was abused as a child. Among her strengths is that she is a loving individual, and takes her work and life serious.
Alice has a family, Michael is her husband and both have two daughters. Alice says that she feels insufficient to her husband which is the reason for her drinking. Alice hides a lot from her husband also which is another reason for her problems.
Diagnosis
The client (Alice) is diagnosed with severe Alcohol Use disorder (303.90 F10.20) in combination with chronic depression (311 F32.9). Alice's diagnosis is based on the assessment made. When Alice visited the clinic after her accident she tells the doctor that she depended on alcohol to cope with. Taking alcohol is something she was exposed to since she was 9 years old. Alice, when she was a child, may have experienced abuse and she has to depend on alcohol in order to cope in relationships. The client depended on alcohol so much that it leads to impairment of her daily duties hence poor judgment. She also had slurred speech gaps in memory, the poor making of decisions, and difficulty concentrating. The client however, was willing to stop taking alcohol and to get treatment.
Using the DSM-5 criteria for determining the disorders associated with substance abuse, Alice portrays the characteristics of consuming alcohol for long periods as well as the inability to control her behavior ( American Psychiatric Association, 2013) . Alice also is unable to engage in her daily activities such as taking care of the children and even continues to use alcohol even when it causes a lot of problems in her relationship ( Wackernah, Minnick, & Clapp, 2014) . The way she consumes alcohol is to the extreme and she needs to take it in order to be tolerant. Alice therefore, shows signs and symptoms of Alcohol Use Disorder (AUD), a disorder of substance abuse.
Based on the above explanation, the reason for diagnosis the patient with AUD and depression is the fact that her character falls under the various category as explained in the DSM-5 (APA, 2013). From the assessment of the patient the only conclusion is that the patient was alcoholic because she used large amounts of alcohol, Alice had a recurrent behavior to use alcohol that resulted to her failure to fulfill her obligations as a mother, she continues drinking excessively despite persistent use of that caused social and interpersonal problems as a result of effects of alcohol (Avnet, Kerner, & Mandoki, 1994). Alice still continues to drink a lot of alcohol despite having the knowledge that alcohol was the cause of recurrent psychological or physical problems.
Alice's diagnosis is supported by her character in the movie. In one instance Alice comes home in the afternoon in an incoherent drunk state. Alice asks the caretaker to go home as she is left with the children. Alice continues drinking in the presence of her daughters. Jess the first daughter is concerned by her mother’s situation but Alice slaps Jess violently. Jess runs crying. Alice is unable to control her balance she goes after Jess calling her when she falls through the bathroom door and falls on the floor (Avnet, Kerner, & Mandoki, 1994).
DSM-5 shows that when a person has self-hatred or feeling of worthlessness it is a characteristic of depression. Everyday inappropriate guilt which the client showed is a sign of a depressed person. For example, Alice says that she feels worthless in her relationship with Michael and it was the reason for her to drink (Avnet, Kerner, & Mandoki, 1994).
Alice is also depressed as she talks of the hate she had for herself and how she turned that hate on Michael and blamed him for making her feel small and worthless when Michael tried to help her. Alice noted that there is nobody who can make you feel worthless or small rather we do that to ourselves. She says how she shut Michael out because he would not love what he would see in her what was a sad, self-hating and depressed individual (Avnet, Kerner, & Mandoki, 1994).
Treatment
Those individuals who have AUD have depression disorders which sometimes tend to be so chronic especially with family conflicts arising. The treatment that is recommended for the treatment of a patient with AUD and depression is cognitive-Behavioral Therapy (CBT) ( Wackernah, Minnick, & Clapp, 2014) . The main goal of CBT in patients with Disorders of substance abuse is to identify the main rewards that the use of substances offers to the patient and then provides alternatives that are healthier to achieve the rewards (DeVido, & Weiss, 2012).
Evidence exists on the effectiveness of CBT as a treatment for individuals with depression and AUD. CBT specifically helps an individual to abstain for longer days and reduces the number of days in which the patient drinks alcohol while reducing the severe symptoms of depression in the patient. This treatment is, therefore, the best in this scenario since it will also reduce conflicts with the family which results from alcohol consumption (Cornelius et.al, 2013). This treatment, when combined with other therapies such as motivational enhancement, has shown significant effectiveness in treating patients with depression and AUD.
Multisystem therapy is the suggested treatment for the family of this patient. This treatment includes family therapy combined with the group, community, and individual treatment approaches. This behavioral treatment involves the observation of the patient’s behavior and how the family could have contributed to the patient’s use of alcohol. The attitude of the family towards alcohol is determined and through the use of support groups, the family is helped to understand the underlying causes of a patient resulting in alcohol abuse and the different measures that they can take to help the patient overcome the habit. In this kind of therapy, the family learns how to handle the patient to prevent them from making the patient’s condition worse through increasing the patient’s depression levels which can increase the need for consuming alcohol.
Critique
The movie the effects of alcohol on the life of an individual and the family in reality. The movie shows how a drunkard parent can affect the life of the family through violence, finances and increasing the responsibilities of one parent. It also showed the inaccuracy of how much patients of alcohol take to recover. The film also captured a lot on how much denial and recognition of a patient's situation assist in receiving the necessary help to recovery.
The movie has been criticized for capturing the issue of alcoholism passively. The issue of alcoholism is not as present as depicted in this movie. The movie also takes too long to get to the point and thus most of the viewers might lose focus of the direction.
I loved the movie because of the actors and how they were able to play their roles. The storyline to the movie is well outlined in four major phases of cause, effects, denial, recognition, and rehabilitation of alcohol use. Moreover, I learned more about the physiology of the film. From the movie, I learned how underlying problems such as depression can result in substance abuse. I learned the negative impact that the use of alcohol can have on a family and how a family can play part in helping the recovery of a patient of AUD.
References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders. BMC Med , 17 , 133-137.
Avnet, J., Kerner, J., & Mandoki, L. (1994). When a Man Loves a Woman . United States: Touchstone Pictures.
Cornelius, J. R., Douaihy, A. B., Kirisci, L., & Daley, D. C. (2013). Longer-term effectiveness of CBT in the treatment of comorbid AUD/MDD adolescents. International journal of medical and biological frontiers , 19 (2).
DeVido, J. J., & Weiss, R. D. (2012). Treatment of the depressed alcoholic patient. Current psychiatry reports , 14 (6), 610-618.
Takahashi, T., Lapham, G., Chavez, L. J., Lee, A. K., Williams, E. C., Richards, J. E.,.. & Merrill, J. O. (2017). Comparison of DSM-IV and DSM-5 criteria for alcohol use disorders in VA primary care patients with frequent heavy drinking enrolled in a trial. Addiction science & clinical practice , 12 (1), 17.
Wackernah, R. C., Minnick, M. J., & Clapp, P. (2014). Alcohol use disorder: pathophysiology, effects, and pharmacologic options for treatment. Substance abuse and rehabilitation , 5 , 1.
