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Introduction
Nowadays, the social conditions of different people are changing for the better, but this does not entirely protect them from the emergence of adverse mental illnesses and addictions. Unfortunately, addiction to psychoactive substances remains a pressing problem (Rosen, et al., 2018). Such substances include alcohol (Class A), which causes many disorders and dangerous social behaviors. The story of Gwen Cummings, the main character in the movie 28 Days, is precisely about the harmful effects of alcohol on life. The plot begins with the wedding of Lily, Gwens sister, which turns into a meltdown. Sour moods, anxiety, and an unconscious understatement of guilt lead to legal problems, and Gwen is faced with a choice: a rehab facility or jail time. Gwen chooses rehab, and with that begins her journey to recovery from alcohol addiction.
Symptoms and Diagnosis
Gwen Cummings is a newspaper columnist who leads a dissipated life and neglects her health. She is unconcerned with carelessness, endless fun, and a desire to show her independence. Gwen often disregards her sister Lilys advice, not wanting to listen to her relatives opinions. Instead, her partner Jasper controls her life: for example, pushing her to use psychoactive substances. Gwen considers it fun and thinks she can stop at any time and stop. Very quickly, however, drugs and alcohol cease to be fun and a way to relax for a while. Gwen develops an alcohol addiction with co-occurring behavioral disorders.
The story of getting into rehab is entirely the result of alcohol addiction. The movie begins with Gwen waking up hungover after a party and realizing that she is late for her sisters wedding. While she is getting ready, she drinks a beer, the first symptom of addiction that characterizes the stage of alcoholism, when no action can be taken without stimulus. Gwen calmly gets behind the wheel while drunk and drives to her sisters wedding she is not embarrassed by drunk driving. Gwen spoiled the cake and does not feel much guilt and thinks the matter can be easily fixed another sign of addiction: denial of the magnitude of the accident that happened because of alcohol. Gwen gets behind the wheel of the limo again to buy a new cake, but this time with consequences. She crashes into someones house, and though she will not admit her illness, Gwen chooses rehab over the prison.
As mentioned, Gwen does not believe she is addicted and refuses treatment. This behavior is characteristic of most patients diagnosed with alcohol addiction (Rosen, et al., 2018). Gwen dominates other patients in the institution and contributes to other peoples habits: she helps find alcoholic beverages and shares the drugs Jasper brings her. Gwen is not serious about her diagnosis, believing she will stop using substances at any time; she does not feel like it right now.
She is always supported in the facility by counselor Cornell, who believes in Gwen and tries to guide her on the right path to recovery. Gwen gradually listens to other people and becomes aware of her problem. However, on Jaspers next visit, she takes alcohol, after which she becomes angry with herself and throws the bottles out the window. Gwen experiences withdrawal symptoms (abstinence symptoms): an agitated emotional state, sleep problems, hand tremors, and headaches (American Psychiatric Association, 2013). It causes Gwen to panic as she tries to escape through the window and return the alcohol, but falls and twists her ankle. Cornells counselor helps her, and she trusts him and accepts her diagnosis: alcohol addiction.
Among other characteristic symptoms of Gwens addiction, there is an anxiety disorder and some signs of depression. In addition, she constantly experiences psycho-emotional stress, which causes her to drink in excessive quantities. Her strong dependence on her lover Jasper does not allow her to fully cope with her problems, as she is too driven and believes that she only needs him. Gwen is easily influenced socially, has trouble sleeping and remembering, and probably has severely damaged inhibitory centers GABA neurotransmitters (American Psychiatric Association, 2013). The cyclical nature of affective disorder prevents her from overcoming addiction on her own. In my opinion, the rehab center was her salvation because otherwise, she would never have sought help.
Nature or Nurture
Gwens disease is the result of several factors, primarily social and psychological. It may be noted that women, in general, have more difficulty coping with alcohol addiction. Still, a genetic component does not play a role here, but rather the mothers social influence on the child. An analysis of the reasons for Gwens behavior must begin with an overview of her childhood and teenage life. Gwen and Lilys mother was an alcoholic who believed that if fun does not accompany you, that kind of life is terrible. Alcohol was constantly in little Gwens house, her father was not around, and there were no other good examples. Her mothers influence was strong, and after her death, Gwen probably has PTSD, a traumatic experience disorder that led her down the same path.
Gwen grew up, and as an adult, after meeting Jasper, the addiction picks up. Gwen is easily suggestible, so she is subject to other peoples influence. The social causes of alcoholism are always related to the people who accompany the alcoholics life. Gwens addiction is a product of various factors, dominated by her dysfunctional environment and traumatic experiences. Even after treatment, she reaches out to Jasper in an attempt to change him but finds the strength to pull back, which already speaks volumes about her as a strong person who was able to find a way out. It is impossible to pinpoint which factor was the determining factor in Gwens disorder; in my opinion, it is a combination of social influences and the mental illnesses that accompanied her.
Treatment and Prognosis
The following therapeutic principles were used in the film: group therapy, family sessions with Lily, and equine therapy methods. In addition, Gwen listened to lectures on the dangers of alcohol: she was especially struck by the class on liver cirrhosis; she never thought about the severe consequences. This scene reaffirmed how much of an addict she was and the need for treatment. In many ways, I like the therapies used in the film, but I would like to add what techniques I would use.
First, I offered Gwen a CAGE questionnaire and assessed her condition on the signs of reduction, irritation, guilt, and action. I think it would help to be specific about what her problem is and her reasons for drinking. Based on the DSM-5, I would assess the criteria that Gwens behavior meets. I would also like to use detox as a first step, as it would help follow the four-step principle of recovery from addiction: awareness, submission, action, overcoming. If not to help with full awareness of the habit, detoxification would at the very least open your eyes to the fact that it is possible not to be permanently stressed.
I found a study that confirms the effectiveness of 28-day inpatient hospitalization. At the end of treatment, most patients felt much better, which contributed significantly to a decrease in relapses (Rosen, et al., 2018). It seems to me that in the case of Gwen, efficacy can only be achieved with entire hospitalization. Of course, family and friends cannot be forbidden to visit her. Still, before doing so, I would gather a complete life and family history, which would greatly assist in identifying the causes of alcoholism. I also liked the schema of assessing cognitive, psychological, and affective functions with information technology. In my opinion, this would have shown current and final efficacy and showing Gwen the results would have helped her reduce her psychological stress.
I like the idea of equine therapy in the film, but I would emphasize personal and group counseling. In my opinion, the application of complex treatment will show positive dynamics. The outcome will be favorable only if the psychologist will purposefully help to rid the patient of psychological stress and cautiously get rid of harmful social factors. Withdrawal from alcohol addiction can be carried out thoroughly, but both the patient and the doctor must be involved in the process.
Conclusion
To summarize the overview, I can point a few main things. Firstly, in the film, Gwen demonstrates the traditional behavior of an addicted person: excessive use, denial of the problem, withdrawal syndromes, refusal of treatment. Secondly, Gwens disorder is dual: social factors, upbringing, and psychological traumas are involved. I think the film is an excellent demonstration of the effectiveness of group therapies, in which the CAGE system and reinforcement of personal counseling will fit harmoniously. The film realistically demonstrates alcohol addiction but does not fully reveal the difficulties of the path to recovery. Nevertheless, 28 Days is an adequate representation of alcoholism and the consequences to which it leads.
References
Rosen, A. S., Sodos, L. M., Hirst, R. B., Vaughn, D., Lorkiewicz, S. A. (2018). Cream of the crop: Clinical representativeness of eligible and ineligible cannabis users in research. Substance Use & Misuse, 53, 12, pp. 1937-1950.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders: DSM-5 (5th ed.). American Psychiatric Publishing.
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