Candy and Drugs

At the turn of the twentieth century there was a discovery in the medical field. Concerned about the addictive properties of morphine scientists set out to find an alternative. Heinrich Dreser found that when treating morphine with an inexpensive chemical (acetic anhydride) it would convert into a much more powerful analgesic termed heroin (Butcher, Mineka, & Hooley, 2013). At first this discovery was praised given its incredible value to the medical field, however it was to be a destructive disappointment. Not long after its acceptance into the mainstream it was found that, not only did heroin act far more rapidly than morphine, but it was an even more addictive analgesic – the very thing scientists had tried to handle with its introduction! The U.S. Congress (in the form of the Harrison Act in 1914) later legislated against the use of numerous narcotics (heroin included), and pharmacists and physicians were held accountable to each administration. Given the significant restriction in the availability of addictive substances many turned to illegal means of acquiring their substance of choice (Butcher, et al., 2013). This perceptively created a problem given the destructive properties inherent in many addictive substances – a problem persisting close to one century following the introduction of the Harrison Act.

Fast-forwarding to the twenty-first century and there is continuing observable trouble inherent in the maintenance of the use and abuse of addictive substances not only in the U.S., but also across the world. The Australian Bureau of Statistics (ABS; 2009) records the number of illicit drug users in 2007 (aged between 15-24) within the past 12 months as 683,500 (6,835 of which were users of heroin or other opioids) – a concerning figure given the devastating effects heroin has on a young persons body. However, regardless of the negative effects of illicit drugs around the world, there continues to be recurring interest in engagement of drug-taking behaviours. When these behaviours are displayed in various mediums such as films, television shows, and books, there is a potential compounding of concerning behaviour in the population. Thankfully, although many films seem to “glorify” drug use and attribute a sense of high stature to associated behaviours, there are other films that seem to display the world of the addict in a very real fashion. One of these films, for example, is Candy (Armfield, 2006). The content of the current case study contends to apply a real-world understanding and overall considerations relevant to the alcohol and other drugs counselling field to an opiate dependent character in the motion picture, Candy. In doing so, familial, societal and ethical considerations, and potential treatment options shall be addressed.

Case Background

Candice (or Candy as she is more often referred to) is in love. She is an art student who has fallen for Dan, a Bohemian poet. However it seems that Candy has placed herself in a love triangle – the third member being the opioid, heroin. Candy is as hooked on heroin as much as she is hooked on Dan and they spend most of their time in activities that revolve around obtaining the substance and getting that “high.” Some of her activities include lying to and stealing from her parents and others, becoming a mentee to a functional opioid addict (Professor Casper), selling herself, and borrowing from others all in the name of the acquisition of her sweet “candy”.

Despite her role as a student she does not seem to extend herself to any friendships outside those that are inextricably linked with her next dose of heroin. The film comments on the life of a junkie: Where one is a junkie for ten years, seven years are spent in waiting. This line describes Candy and Dan to a tee. It seems that all Candy is doing is waiting… waiting for her next dose, engaging with those instrumental for her obtaining the next dose, ignoring or rebelling against those that might serve to inhibit her acquisition – a life spent, as one would perceive quite correctly, wasted.

Assessment

Candy visibly satisfies virtually all the specifiers (s.) necessary for diagnosis of severe substance-use disorder with physiological dependence (DSM-5 as cited in, National Alliance on Mental Illness, n.d.). Candy’s days are taken up with her securing the substance (s. 8) given her intense cravings (s. 11) and difficulty in cutting down (s.7). She continues to use despite the effects it has on her producing artwork (s. 9) and pays little cognition as to the negative effects heroin has on her body and mental functioning (s. 10). Her university obligations are for naught when she is engaged in her substance use (s. 1) and despite the strain on her family and relationships (brought most to light in her relationship with Dan) the drug is continuously injected (s. 3), if only to dull her recognition of the aforementioned problems.

As the film progresses, withdrawal symptoms become more and more evident (s. 5a and b – the latter in full effect when she and Dan decide to engage in methadone treatment) as a result of her pregnancy and her want of change. She later relapses and admits herself to a psychiatric facility, which in turn, facilitates her abstinence from the substance. Where she is finally “clean” it is established (through her and Dan’s encounter at his place of work) that she and Dan no longer have anything in common to hold onto given the drug is now absent from both their lives. Thus sees the impact heroin had on their relationship and its instrumentality at serving as the glue holding them together. My assessment ends with the assertion that where a drug addict places their substance of choice as a driving force in their relationships, even when abstinence is achieved the relationship is not always salvaged.

Contextual Considerations: Familial and Societal

Candy organises itself into three chronological and sequential periods, each of which hold with them numerous periods of highs and lows: “Heaven”, “Earth”, and “Hell”. “Heaven” depicts Candy and Dan experiencing euphoria characterised by sex and the enjoyment of the “high”. This stage can only be sustained by the collection of money in order to purchase the substance. Whether selling items that they have procured illegally, lying to Candy’s parents, scamming unsuspecting businessmen, or borrowing from their eccentric professor friend, their habit must be maintained in order to secure the thrill of the ride.

Candy’s parents are obviously dismayed at their continuous efforts to borrow money on the promise of a return, and Casper seems to evaluate Candy and Dan’s requests with an insight that they would not return the funds. It is evident from the beginning that Candy’s drug-seeking behaviours have put a strain on her and her parents’ relationship. It is also evident through expressions exhibited by their “mentor” that their transactions will not always be well received, thereby potentially putting a strain on their relationship as depicted in “Heaven”.

“Earth” displays the confrontations evident in Candy and Dan’s relationship as they get married and realise the difficulties in their maintenance of their addiction with family life. It is here that familial and societal pressures converge. Candy prostitutes herself while Dan attempts any way he can to procure cash – although not very successfully for the most part considering Candy’s resentment of his staying at their home for most of his days. Candy’s prostitution, and funds collected thereof are not only used to fund their addiction, but to escape eviction when the homeowner’s corporation comes knocking. Brown and Lo (2000) have noted that many aspects of an addict’s wellbeing (in this case, Candy’s sense of self-worth) deteriorate with the use of opiates. This however is not necessarily due to the ill effects the substances have on the users body (though there are many), but are rather the products of an improper diet, sacrifices to money, social position, and self respect (Butcher, et al., 2013).

Given Candy’s increasing frustration with her situation and the outbursts directed to her husband it is evident that her personality has been greatly affected by the situation she has placed herself in. No longer is she achieving euphoria once felt when they were using, but now her degrading circumstances continue to feed into her resentment with life.

“Hell” – although at first a positive signifier that her drug use is taking its toll and something must be done about it – represents the most difficult period in Candy’s life. Now pregnant she decides to give up heroin. It is this decision that presents a plethora of challenges, both physiological and psychological in nature. The withdrawal effects take their toll (intense sweating and urges to use, goosebumps, hot and cold flushes, poor sleep, agitation, with a host of other symptoms; National Centre for Education and Training on Addiction, 2004) and she is admitted into labour prematurely, subsequently losing her baby.

Following this experience, Candy and Dan decide to attempt methadone treatment and move into the country so as not to face the same temptations as present in the city. This works relatively well until Candy cheats on Dan with a drug addict situated close to where they live. Following their separation and her relapse, she admits herself into psychiatric care – an action that separates her ties with those around her, but one that is instrumental to her eventual quitting of the substance.

From euphoria, to the trials of marriage and pregnancy, and finally to letting go of the substance, these behaviours are not without their context. Whether her failed relationships with her parents and husband, to the loss of her baby and repercussions therein, there is more to consider than her actions alone. Lack of funds lead to prostitution; ill health lead to abstinence; reminiscence lead to relapse; and ultimately motivation lead to remission.

Treatments Options and Considerations thereof

Opiate addiction is treated in much the same way as alcoholism is treated. Both alcoholics and heroin addicts require substantial guidance in order to battle the physiological and psychological effects of the withdrawal period (Butcher, et al., 2013). Following the withdrawal period there is cause for concern if the subsequent period is not tackled in a proactive manner. Given cravings for the substance are not diminished but are generally intensified, Candy would benefit in pharmacological treatment, specifically methadone (other prescriptions could include, in place of methadone, buprenorphine; Johnson, 2012). Given the film portrays her engagement in a methadone program (though not used in conjunction with any other rehabilitation program) I shall continue this recommendation with a further suggestion: Further rehabilitation programs to be used in conjunction with the methadone treatment in order to achieve the best results.

Motivational interviewing (MI) and cognitive behavioural therapy (CBT) would assist Candy’s methadone treatment in order to create an adjustment in cognition so as to reduce the chances of relapse. However, it would be beneficial that I make a referral for Candy’s admission into a residential rehabilitation program (RRP) so as to provide a certain structure and to achieve the best ultimate ends, given her financial difficulties the RRP may assist in her therapeutic goals  (Candy may benefit with a 12 month stay as opposed to short-term treatment; NSW Department of Health, 2012). Following this process Candy will encounter the possibility of re-establishing social networks following her dismissal from the program given her perceivable difference in behaviour and ability to cope outside clinical conditions, MI and CBT being instrumental in this process.

The difficulties with my recommendations for Candy are that she is also married to a heroin addict (my recommendation would preferably take effect following her admittance into hospital, where she is still partnered to Dan). This union would need to be taken into consideration when applying the recommendations as it would be supremely beneficial if both Candy and Dan were to undertake the therapeutic process together. It seems that, given their wilfulness to begin a methadone program, that Dan would not object to undertaking a comprehensive rehabilitation program together with Candy. Important to consider would be the initial contact and admittance to the relevant program given Candy’s situation (although I have already recommended that the hospital admittance might serve to facilitative her participation). The latter consideration as to the inception of the therapeutic process would be ideal given the potential for correspondence with a number of relevant services in order to instigate the action.

Ethical Considerations

Any ethical considerations would be that which revolve around whether Candy would be an involuntary client or not. Were she an involuntary client (e.g. the hospital acted following the miscarriage so as to involve the relevant authorities in order for Candy to engage in the latter considerations) there would be difficulty assessing whether she would have as optimal an outcome as to whether she had engaged in process voluntarily. Following the withdrawal stages, and maintenance through methadone, the outcomes of CBT and/or MI would be dependent on her willingness to participate. Also, any recommendations made would need to be done so while addressing Candy’s case in depth. When recommending a potential incentive special attention must be paid to the relevance of that incentive. Were any incentives potentially irrelevant, or in the worse case detrimental to therapeutic outcomes, a malpractice suit may be instigated and the reputability of the alcohol and other drugs counselling field be brought into disrepute.

Thankfully, given careful consideration of Candy’s case and the relevant literature investigated so as to apply successfully, I am confident that were these recommendations passed and engaged in Candy would be experiencing a much better quality of life than when she was under the influence of heroin.

Conclusion

Therefore, given Candy’s addiction to heroin was one fuelled by her love for her partner (who was also an addict) this must be taken into consideration when assessing her case. Physiological degradation along with perceivable mental health problems were at the forefront of this case study, and the inseparability of Candy and her partner (especially in “Heaven”) needed to be understood. Where recommendations are made they must be done so as to include both herself and her partner and how both could benefit. It was observed that methadone treatment along with RRP would benefit the couple, especially seeing that many RRP’s include counselling services (NSW Department of Health, 2012). Through these recommendations (especially when undertaken as early as possible) Candy would expect to rebuild social and familial networks following her completion of the programs. Although her relationship with Dan seems to be unstable, were they both to engage in rehabilitation together positive outcomes may be achieved. As a heroin addict there is no one “cure” for abstinence. Candy must be assisted by a number of services if she is to expect a positive outcome – one that would prove to be both difficult, but achievable when assisting those addicted to any number of damaging narcotics.

References

Armfield, N. (2006). Candy [Motion picture]. Australia: Dendy Films.

Australian Bureau of Statistics (2009). Risk taking by young people. Retrieved from

            http://www.abs.gov.au/AUSSTATS/abs@.nsf/Lookup/4102.0Chapter5002008

Brown, R., & Lo, R. (2000). The physical and psychosocial consequences of opioid addiction: An overview of changes in opioid treatment. Australian & New Zealand Journal of Mental Health Nursing, 9, 65-74.

Johnson, K. (2012, August 13). Alcohol detox programs. Retrieved from http://www.webmd.com/mental-health/alcohol-abuse/alcohol-detox-programs

National Alliance on Mental Illness. (n.d.). NAMI comments on the APA’s draft revision of the DSM-V: Substance use disorders. Retrieved October 24, 2013 from http://www.nami.org/Content/ContentGroups/Policy/Issues_Spotlights/DSM5/Substance_Use_Disorder_Paper_4_13_2010.pdf

National Centre for Education and Training on Addiction (2004). Alcohol and other drugs: A handbook for health professionals (Publication No. 3315). Canberra, ACT: Australian Government Department of Health and Ageing.

NSW Department of Health. (2007). Drug and alcohol treatment guidelines for residential settings. Retrieved from

            http://www0.health.nsw.gov.au/pubs/2007/pdf/drug_a_guidelines.pdf

World Health Organization. (1983). The ICD-10 classification of mental and behavioural disorders: Diagnostic criteria for research. World Health Organization, Geneva, Switzerland. Retrieved from http://www.who.int/classifications/icd/en/bluebook.pdf

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