Movie Review: Thirteen

Thirteen is one of my sister’s favorite movies, and I have seen it many times since we have it on DVD. The movie portrays many forms of addiction so I knew it would be easy to relate to class.

The main character, Tracy, is a seventh grade honors student, but she is considered a loser and is bullied by girls in her class. She wants to fit in and be popular, and she will do anything to achieve popularity. She is also coping with her parents’ divorce and the fact that her father is rarely around. Her mother is a recovering alcoholic and her mother’s boyfriend is a recovering cocaine addict. Tracy befriends a girl named Evie who becomes an extremely bad influence. The girls steal, do drugs together, smoke, drink, fight, and engage in sexual behaviors with many men. Tracy gives in to peer pressure to fit in, but she is still not happy with her life. At this point, she is about to fail her grade and her and her mother have an awful relationship. Along with doing drugs and drinking to cope, she starts the behavioral addictions of self-harm and anorexia. The movie follows Tracy’s struggle as a thirteen-year-old girl.

This video is the trailer to the film.

Because I’ve seen the movie so many times, the portrayal of addiction no longer shocks me. However, the first time I saw this movie a few years ago, I was extremely uncomfortable and honestly shocked. A thirteen year old should never be engaging in the activities that Tracy was. As a teen that went through a divorce myself, I have empathy for Tracy. Divorce is a lot to handle without trying to fit in at school. I have extreme anger towards Evie. I want to reach into the television and shake her. She is not only destroying her life, but she is taking Tracy down with her. Both of these girls need help from a counselor, and it hurts to know that they are not getting the help they desperately need. Thankfully this is just a movie, but unfortunately, girls like this do exist.

The other characters in the movie did not do much to help Tracy’s addictions. She did not have very supporting friends. Her friends before Evie are nowhere to be seen. Her mother can tell that there is something wrong with her daughter, but she is too busy with her job and boyfriend to notice how extreme the problems are. She also pushes her daughter away by constantly yelling at her. Tracy’s mother needed to pay more attention to her daughter and have better communication. At one point in the film, she asks Tracy's if she ate that day. They end up fighting and Tracy’s mom does not find out that Tracy has an eating disorder. The household also lacks discipline. Tracy's father is never around and is completely clueless. Tracy’s brother knows that she is doing drugs and drinking, but doesn’t say anything to their mother because he is getting high with his friends too. Evie supports and influences Tracy’s addictions.

I believe that this movie depicts addiction pretty accurately. Many teens experiment with alcohol and drugs while giving into peer pressure.  Cutting, a behavioral addiction is also shown in this film. Teen girls who struggle with depression and big life changes like divorce often resort to self-harm to deal with their emotions. Parents of teens who suffer with these addictions do not always recognize the problems. Nothing in the movie struck me as unrealistic.

It was easy to make connections between this movie and knowledge I learned in class and through assigned readings. The movie shows how addictions impact all aspects of someone’s life. Addictions can affect relationships and interfere with daily living. Tracy has weakened relationships with her family. She is usually angry and her mother is angry with her on multiple occasions. Tracy is struggling in many aspects. She is failing out of school and engages in risky behaviors. We recently learned about how people, places, and things can trigger addiction. Evie is a trigger for Tracy. At the end of the movie, Tracy and Evie are no longer friends. This will largely help Tracy recover and turn her life around. 

Chapter 8 Article Summary

Chapter 8 explores substance misuse with a co-occurring mental disorder or disability. The article I found titled Helping Homeless Individuals with Co-occurring Disorders: The Four Components explains how individuals who suffer with co-occurring disorders, who are also homeless, are affected and how they can be best helped.

Homeless individuals with severe mental illness and substance use disorder are one of the most vulnerable populations. This article explains four key components that must be addressed to ensure that these individuals receive the best help possible:

1. It must be ensured that individuals have effective transitions from hospitals, foster care, prisons, or residential programs back into the community. 

This is very important for those who were homeless or those who are at risk for being homeless because once they leave an institution, they need a plan instead of just ending up back on the street. Clients must be set up with a complete discharge plan that includes government assistance or employment, housing options, and treatment. This component includes the other three components.

2. Access to resources must be increased.

It has ben found that not many homeless people use all of the resources that they have, including Food Stamps and Medicaid. This could be due to a few reasons: Homeless individuals have a lower sense of self-efficacy, which leads to deficient service-seeking behavior, agency and staff discrimination discourage homeless individuals from seeking services, or homeless individuals consider their housing needs the top priority and do not pursue the secondary sources of aid. Social workers must make sure homeless clients seek and apply for all government programs.

Homeless individuals with co-occurring disorders also struggle to find work due to bias in employment and trouble working with their disorders. Also, many times, these individuals do not want to lose their government assistance when they get a job. As a helper working with these clients, it is important to instill hope about a client's ability to recover and to work. Clients should be linked with job opportunities that supports recovery. The article uses bartending as an example of a job that does not support recovery. Money management needs to be taught and treatment options that do not conflict with work should be coordinated.

3. Individuals should be linked to supportive housing options.

These individuals are suffering from multiple disorders while also trying to find a place to sleep every night. To help these individuals, it is important to find them housing, whether it is public housing or not. Some studies show that housing individuals with disabilities and/or addictions before they are treated increases the chances of their treatment success. 

4. Individuals should be found the best treatment option. 

Multiple types of treatment are available for those with co-occurring disorders but the struggle is finding one that is successful. Research on treatments stress that it is a long-term process, harm reduction, outreach techniques, establishment of a trusting relationship, skills and support to manage illnesses, and relapse prevention. Methods that are commonly used include modified assertive community treatment, motivational interviewing, cognitive-behavioral therapy, contingency management, and COD specialized self-help groups.

This article relates very closely with what we are learning in Chapter 8. We have been learning about individuals with co-occurring disorders. This article pairs this with the homeless population. I feel as though helping homeless individuals who are also affected with CODs has to be one of the hardest things social workers face. This task must be extremely challenging and complex. This article shows all of the components and tasks that must be completed for individuals to successfully complete treatment and no longer be homeless.

Sun, A. (2012). Helping homeless individuals with co-occurring disorders: The four components. Social Work, 57(1), 23-37. 

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Alcoholics Anonymous

Yesterday, I attended an Alcoholics Anonymous meeting with another classmate, Adam. I was really nervous to get out of the car  because I had no idea what to expect. We pulled into the parking lot at a building called the 521 Club. We knew we were in the right place because many people were outside smoking. Once we finally worked up the courage to get out of the car, we walked inside. We were welcomed by a very nice man who told us to grab some coffee and take a seat anywhere. We were 15 minutes early but a good amount of people had already arrived and more continued to file in. 

Me and Adam sat at one of the tables that surrounded the outside of the room. All the seats in the inner circle were filled and many of the tables were too. There were about 40 people there. The best way to describe them is as average. Everyone in the room was someone you could pass on the street and never know that they are an alcoholic. There were many more men than women, about 30 men and 10 women. The age of people in the room ranged from about 25 to 65. More members were older than younger. Most of the people were Caucasian. About half the people have been sober for over a year. The rest were in the process of getting there. 

 

The meeting was ran by one women in the group. The members alternate the running of the meetings. The meeting opened with a reading of the preamble, which was followed by the reading of the 12 steps of the program. She asked if anyone wanted to introduce themselves to the group. Me and Adam introduced ourselves and let everyone know that we were there to observe. They were accepting of it and just told us to not take pictures because it is anonymous. Everyone laughed. After that, the women asked if anyone had a topic that they wanted to discuss at this meeting. A lady raised her hand and said that she wanted to talk about acceptance. The room was then open for discussion. Members were all told to avoid crosstalk and profanity. One at a time, people started discussion how acceptance has played a part in their daily lives and in their recovery. Each member began by stating their name and "I am an alcoholic." Everyone would say "Hello" followed by their name. At the end, they would say "thanks for letting me share" and the group would respond "thanks for sharing." After the discussion was over, pins were handed out to members celebrating anniversaries. No one was celebrating anything but one man said his son celebrated 25 years of sobriety at the 12 o'clock meeting earlier that day! The meeting concluded with everyone holding hands in a circle. The Lord’s Prayer was said and everyone ended by saying “Keep coming back; it works if you work.” After the meeting, many people stood around and talked. They all seem to have a close bond on one another. We did not participate in discussion during the meeting, but afterwards, many people came up to us with question about where we are from and what we thought of the meeting. They welcomed us back anytime.

I believe these meetings really help those who attend them. The members opened up and discussed parts of their life that are struggles for them and how much this process and sobriety has changed them. As a group they can get things off their chest and be honest. They encourage and accept each other. No one has to feel alone in the process. They are there to help others through the process. Each member is at a different step, and they can exchange advice. Through the discussions everyone bonds and it seemed like true friendships were formed. As someone who is not suffering from alcohol addiction, I could still  relate to people's stories, and I felt like I took something away from this experience. 

This meeting was quite the learning experience. In class, we discussed the 12 steps of the program and the addiction cycle. The people in the meeting were living examples of these.  Each member was was at a different stage in the process but the main topic was step 1, acceptance. In part with the steps, some people discussed how hard the addiction cycle is to break. Overcoming their addictions to alcohol must start with them, but the group helps them to maintain it. One man asked another women, "How are you today?" She replied, "Well, I'm here."

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Strengths-based Approach

Harm Reduction refers to policies, programs and practices that aim to reduce the many health, social and economic consequences of the use of legal and illegal drugs without necessarily reducing drug consumption. This approach towards substance misuse and addiction goes beyond the one size fits all model of abstinence ("What is harm," 2013).

Since its initial identification in the 1980s, harm reduction has evolved to combat the negative consequences of a multitude of addictions. G. Alan Marlatt, PhD was a professor of Psychology and director of the Addictive Behaviors Research Center at the University of Washington. His pioneering research with harm reduction has had a huge impact on the treatment of addictions in the United States and abroad (Victor & Yalom). 

There is no concrete formula for how harm reduction works, but it is a respectful, client-centered and individualized approach to reducing the harm caused by using substances, engaging in risky behavior and other addictions. It aims to keep people safe and minimize death, disease, and injury ("What is harm," 2013). Harm reduction accepts that many people who use drugs are unable or unwilling to stop using drugs. Instead of forcing abstinence, reduction provides support services and strategies to provide knowledge, skills, resources, and supports for individuals, families and communities to be safer and healthier (Bigier, 2005). This approach works by helping individuals from "where they are". From there, small steps are taken to increase safety and well-being while completing individuals' goals. This approach views people as responsible for their own choices. G. Alan Marlatt, PhD explained that in this program, "We'll help you, whatever your goal is. You want to quit, we'll help you. You want to cut back, we'll help you. We're not going to shut you out." Many other traditional treatment programs would say, "Unless you're totally committed to abstinence, we're not going to work with you" (Victor & Yalom).

Addiction: This approach can have a large impact on the addiction cycle. In the cycle, an individual experiences depression and negative feelings so they use their addiction to cope with these feelings. The negative feelings disappear and they feel good. However, then the individual experiences some kind of negative consequences. Then, the individual feels guilty, shameful or angry about their actions. They become upset again and the cycle continues (From class notes). The harm reduction approach could stop this cycle before negative consequences occur. If the individual is educated and steps are taken to prevent these negative consequences, the individual might be less likely to give into their addiction again. Even if they continue to engage in their addiction, they will be more educated about how to be safe while using. 

Example of Harm Reduction: Needle exchange programs are one major harm reduction strategy. These programs aim to reduce the spread of viruses such as HIV and Hepatitis C among injecting drug users. With an estimated 1 in 5 injecting drug users worldwide infected with HIV, these programs are key to getting the epidemic under control ("Needle exchange and," 2013). It is hard to get users to stop, but we can at least make sure they are safe while using. If we do not give them clean needles, they will use use dirty ones anyway. These programs have proven to be successful. A study of HIV among IDUs in New York, between 1990 and 2001, found that HIV prevalence fell from 54 percent to 13 percent following the start of needle exchanges ("Needle exchange and," 2013). However, these programs are subject to much criticism. It can be thought that "there’s a mixed signal when we're telling kids stay off drugs, but in some cases 200 feet away, we're allowing people to exchange needles" ("Needle exchange and," 2013). This video further explains needle exchange programs:  http://youtu.be/wQYWw2UERHE

Use of Harm Reduction in my Career: I am a social work major, and as a future social worker, I will be using many strengths-based approaches with my clients. The preamble to the National Association of Social Worker's Code of Ethics notes that the primary mission of the social work profession is to "enhance human well-being and help meet the basic human needs of all people, with particular attention to the needs and empowerment of people who are vulnerable, oppressed, and living in poverty" (Bigier, 2005). I may encounter many people who suffer from addiction and are also vulnerable, oppressed, or living in poverty. I believe that the harm reduction approach can help these people the most. I can offer many strategies to my clients that will minimize the potential harm that may result from their behaviors and environment while helping them reach their personal goals. 

References:
Victor, R., & Yalom, A. Alan Marlatt on harm reduction therapy. Retrieved from http://www.psychotherapy.net/interview/marlatt-harm-reduction

What is harm reduction?. (2013). Retrieved from http://www.ihra.net/what-is-harm-reduction

Needle exchange and hiv. (2013). Retrieved from http://www.avert.org/needle-exchange.htm

Bigier, M. (2005). Harm reduction as a practice and prevention model for social work. Retrieved from http://www.olc.edu/~jolson/socialwork_old/OnlineLibrary/Bigler 

Photo Links:
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Behavioral Addiction

Bulimia nervosa is one type of eating disorder. Bulimia nervosa is characterized by the following symptoms:

• Repeated episodes of binge eating, known as binging, characterized by eating excessive amounts of food within a small period of time and lack of control over eating
• Recurrent behaviors, such as self-induced vomiting or misuse of laxatives, enemas, or other medications or excessive exercise, to prevent weight gain, called purging (Van Wormer & Davis, 2008)

 When bad-habits become addiction:

When both of these behaviors, binging and purging, occur on average at least twice a week for 3 months and create a cycle, it becomes an addiction (Van Wormer & Davis, 2008). However, many people with bulimia binge then purge, on average, 11 times per week. Bulimia becomes long-term, chronically relapsing, and life threatening. Food serves as a drug that stimulates mood enhancers in the brain that can curb the feelings of shame, self-disgust, and depression ("Statistics on bulimia," 2013) 

Who suffers from bulimia?

• approximately 1 in 50 women between the ages of 15 and 24 years suffer with bulimia
• most common among Caucasians
• most common during the late teens and twenties
• at least 95% of all bulimics are female  
• of the few males with this disorder, those on a wrestling team are 7 to 10 times more likely to develop bulimia
• it has been found to occur in children as young as six years old and can occur in older adults
• far more common in industrialized, westernized countries with media images of thin women
• individuals often have history of weight gain or come from families in which being overweight is a problem
• many bulimics suffer from depression or drug abuse
• 35% of women with severe bulimia reported that they suffered childhood sexual abuse ("Statistics on bulimia," 2013)

 Treatment:

The successful treatment of bulimia includes both medical and psychological treatment as well as nutritional counseling. Treatment needs to be ongoing, lasting a total of three to six months or more. Treatment is very important because eating disorders can be fatal in as many as 20 percent of all cases.

The choice treatment for bulimia is cognitive-behavioral therapy. Cognitive-behavioral therapy targets the unhealthy eating behaviors of bulimia and the negative thoughts that go along with them. The steps of therapy are breaking the binge-and-purge cycle, changing unhealthy thoughts and patterns, and solving emotional issues ("Bulimia nervosa," 2013)

Sources:

Bulimia nervosa. (2013). Retrieved from 

    http://www.helpguide.org/mental/bulimia_signs_symptoms_causes_treatment.htm

Statistics on bulimia. (2013). Retrieved from 

     http://www.mirror-mirror.org/bulimia/statistics-on-bulimia.htm

Wormer, Katherine & Davis, Diane Rae (2008). Addiction treatment: A strengths perspective. 

     California: Brooks/Cole

Picture Links:

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