Tell me something boy
Aren’t you tired tryin’ to fill that void?
Or do you need more
Ain’t it hard keepin’ it so hardcore?
I recently watched “A Star is Born.” I did not expect his movie to have such a heavy mental health component, but it certainly showed how a main character’s life (career, status, relationships) was shaped by his addiction.
Throughout this movie, characters had different reactions to this addiction and its related behavior. His significant other stated that it was a disease, not blaming him for the consequences of his addiction. His brother seemed to have a different view, thinking of substance use as more of a decision rather than an illness.
Addiction, whether it is to alcohol, prescription pills, or illegal drugs, is a heavily stigmatized category of illness.
The professional world regards addictions as serious medical conditions. In fact, the DSM dedicates an entire section to “Substance-Related and Addictive Disorders” which includes alcohol-related disorders (i.e. alcohol use disorder), drug addiction (i.e. opioid use disorder), and non-substance-related disorders (i.e. gambling disorder).
On the other side, I’ve heard laypeople claim that labeling addictions as medical conditions just excuses bad personality, choices, or behaviors… that they are not legitimate conditions.
Well, which is it? Is addiction an illness or is it a poor excuse for bad behavior?
Let’s further explore the criteria behind alcoholism by looking at the movie’s character Jackson and the DSM’s definition for Alcohol Use Disorder.
Alcohol Use Disorder:
A problematic pattern of alcohol use leading to significant impairment or distress, as manifested by at least two of the following, occurring a 12 month period.
a. Alcohol is often taken in larger amounts or over a longer period than was intended.
b. There is a persistent desire or unsuccessful efforts to cut down or control alcohol use.
c. A great deal of time is spent in activities necessary to obtain alcohol, use alcohol, or recover from its effects.
d. Craving, or a strong desire or urge to use alcohol.
e. Recurrent alcohol use resulting in a failure to fulfill major role obligations at work, school, or home.
f. Continued alcohol use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of alcohol.
g. Important social, occupational, or recreational activities are given up or reduced because of alcohol use.
h. Recurrent alcohol use in situations in which it is physically hazardous.
i. Alcohol use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by alcohol.
j. Tolerance, as defined by either of the following:
- A need for markedly increased amounts of alcohol to achieve intoxication or desired effect.
- A markedly diminished effect with continued use of the same amount of alcohol.
k. Withdrawal, as manifested by either of the following:
- The characteristic withdrawal syndrome for alcohol
- Alcohol (or closely related substance, such as benzodiazepine) is taken to relieve or avoid withdrawal symptoms
Based on the DSM and my observations, he definitely had alcohol use disorder. If you look at the components of the disorder, you see that it is not related to one’s personality (i.e. “They are just a bad person”) or solely one’s decisions.
A major part of the illness is the biological component (i.e. cravings, withdrawals), the biological part which drives the behaviors of the illness. The behaviors then impact every aspect of his life severely, illustrating why it is a condition and not just a minor drinking problem.
The addiction impacts his career, his relationships (with significant other, brother, friends, coworkers), and health, among other facets of his life. It is interesting how sometimes people are almost enablers for his excessive drinking, while at other times they attack him for drinking. Part of this probably had to do with his high celebrity status; partying or drinking all of the time is seen as just part of the life of a musician. He started drinking at a very young age, so he probably does not remember what it is like to really live life sober.
The addiction can be all-consuming, shaping every hour of the day.
Wake up drinking and drink until you pass out… that is his daily reality.
I think that the movie does a good job in demonstrating the complexity and severity of alcoholism, and that stopping is not as simple as just putting the bottle down.