¶ … client, whose name is Kate and is the main character in the 2013 film Smashed, displays compulsive behavior and a marked addiction towards alcohol and the classic symptoms of alcoholism in the scene in which she parks her car before going to teach elementary school. This scene takes place early one in the film, and indicates the sort of behavior that will characterize Kate's descent into alcoholism. Despite the fact that she is late for work because she is hung over, she still cannot refrain from consuming more alcohol -- in the form of whiskey, straight. This scene indicates that not only is Kate psychologically addicted to this substance, but it is also affecting her ability to engage in normal activities (such as work). Drinking hard liquor prior to beginning a work day in which one will be grooming the future of young children is extremely dysfunctional behavior. So is continuing to drink the morning after a night spent drinking and waking up hung over. This scene certainly indicates the fact that Kate has a problem with alcohol, and with addiction in general since she cannot keep from consuming the substance. Diagnosis/Symptoms

Although the movie is not very realistic in how it portrays Kate's substance abuse disorder (it is highly unlikely that Kate could spend the night passed out with crack heads and still wake up with her car and its keys intact, for instance) the symptoms of this disorder are portrayed accurately. One of the symptoms of clinical addiction is that the client feels as though he cannot help but to commit the addictive behavior. Kate obviously feels guilty about her binge drinking; early on she tells Charlie that she thinks she needs help which indicates the fact that she wants to change her behavior. But as the pair resolve to "slow down" on the alcohol, and promptly resume drinking to intoxication, it becomes clear that Kate is not capable of breaking the cycle of addiction on her own. Thus, she has a strong craving to use a substance (alcohol) and continues to use the substance despite knowing its harmful effects.

Kate displayed withdrawal symptoms when she took a sip of a beer prior to taking a shower after she woke up hung over in the opening scene. Her substance abuse led to her dearth of fulfilling her role at work when she had to go home that same day because she was hung over. Her drunk driving when she smoked cocaine was indicative of her using alcohol in situations which could be physically dangerous. The scene in which Kate stole a bottle of wine, despite all of the resistance she got from the store owner, was demonstrative of the symptom in which client's spend great deals of time attempting to procure their substance of choice. One of the only symptoms that Kate did not display was giving up valued social pursuits because of her substance abuse, largely because her social life consisted of drinking.

Aetiology/Formulation

Smashed makes it perfectly clear that the origins of Kate's disorder is partly rooted in a biological framework. The film alludes to this fact by showing that Kate's mother is an alcoholic; she chooses to "celebrate" Kate's visit by drinking cocktails, and openly disparages Alcoholic Anonymous. Kate's mother also alludes to the fact that Kate's father left them because he was able to overcome his own alcoholism. These details mean that there is a genetic trait predisposing Kate to an alcohol-based substance abuse disorder. However, it is key to note that one of the protective factors that helps Kate to overcome this disorder is her penchant for honesty -- a trait which was honed by her disorder meetings. This protective facet helps her to overcome her biological predisposition for alcoholism, which is demonstrated by her honestly revealing to her mother that she stopped drinking.

The movie also makes it clear that there are social factors which are perpetuating Kate's disorder. These factors largely consist of the influence of her husband and his network of friends/family. All of these individuals drink heavily and recreationally, making it difficult for Kate to be around them and not do the same. Thus, Kate has little choice but again to rely on her own sense of honesty and tell her husband that she cannot remain sober around him -- and then leave him.

The psychological factors that contributed to Kate's disorder are alluded to in the film and require viewer inference. It appears as though Kate's environment played a profound role in her developing this disorder. Since both of her parents are alcoholics, she has probably always associated drinking with most aspects of life which psychologically maintained her proclivity to drink. She evinces her strength and reliance on honesty to eventually...

Such a nexus is fairly natural for the simple fact that for several people, those that are the principle contributors to their biological or genetic makeup (their parents) frequently play a large role in the environment in which these individuals grow up. There is a surplus of research that denotes a positive correlation between an individual's family history and his or her propensity to develop an alcohol-based substance abuse disorder. Beseler et al. (2008) have discovered that "family history significantly interacted with 2 baseline drinking motives in predicting new onsets of DSM-IV alcohol dependence: drinking to reduce negative affect…and drinking for social facilitation" (p. 607). This quotation is particularly insightful regarding Kate's disorder. It implies that the origins or her disorder were in the familial history of her two alcoholic parents. Kate certainly drank to decrease negative effects after she lost her job. Finally, this quote explicates the fact that drinking for social reasons was natural for Kate to do because of her family's background.
Therefore, when examining the origins of alcoholism as a manifestation of a substance use disorder, it is important to consider familial background to encompass aspects of both social and biological factors. The aspect of family background that directly relates to the environment in which an individual matures and grows up in is part of his or her environment -- which is intrinsically linked to social development. The family is oftentimes the initial socializing mechanism for a child, and children soon learn to adopt the habits of those immediately around them: their parents, their brothers and sisters, and other family members. And, as alluded to earlier in this document, research in this subject confirms the fact that there is a direct correlation between the role that the social factors of environment play and genetic dispositions that are part of biological factors influencing an individual. According to the National Institute on Alcohol Abuse and Alcoholism (2003)

Research has shown conclusively that familial transmission of alcoholism risk is at least in part genetic and not just the result of family environment. The task of current science is to identify what a person inherits that increases vulnerability to alcoholism and how inherited factors interact with the environment to cause disease.

The contribution of genetics to the biological factors influencing alcohol-based substance use disorders is an interesting one, and not just because of its ties to environmental or social factors. Heredity is one of the chief components of the biological considerations that scientists take into account when evaluating the biological influence present in certain conditions, such as alcoholism. Specifically, research has indicated that an individual's DNA (which consists of various chromosomes that help to make up the genetic constituency of a person) certainly demonstrates traits and proclivities for certain behaviors, tendencies, as well as conditions. Certain maladies such as cystic fibrosis, for instance, are imprinted in a person's DNA. It is due to this reason that there is such a raging controversy over stem cell research and the pursuit to eradicate diseases by altering the gene pool within people. Although substance abuse disorders and alcoholism in particular are not as well defined by their genetic data as other types of debilitating conditions, there is no denying the genetic influence of this biological factor -- nor its relationship with social and environmental factors for such a disorder to manifest within someone. The subsequent quotation readily demonstrates this fact. "Recent research…reports that 50 to 60% of the risk for alcoholism is genetically determined…Genes alone do not preordain that someone will be alcoholic…gene-environment factors account for the rest" (NIAAA, 2003).

In addition to understanding the dual effects that biological and social factors have on an individual for originating and maintaining an alcohol-based substance use disorder, it is necessary to comprehend the fact that there is also a significant psychological component involved which also interacts with these other two factors to increase the likelihood of an individual suffering from such a disorder. The relationship between social factors and psychological…