Addiction Requiem for a Dream:

¶ … Addiction

Requiem for a Dream: A Case Study

Darren Aronofsky's second film, Requiem for a Dream, repeats in many ways the frenzied, tragic trajectory of Pi. Where Pi's Max Cohen followed his mathematical obsession into insanity and self-destruction, Requiem now shows us the decline and fall of four individuals, Sara (Ellen Burstyn), Harry (Jared Leto), Marion (Jennifer Connelly), and Tyrone (Marlon Wayans). Sara gets hooked on diet pills, and her son, Harry, his girlfriend, Marion, and his buddy Tyrone are all junkies. Whereas the end of Pi leaves Max Cohen outside, smiling, looking up at the trees, the protagonists of Requiem all collapse in a gory heap: Tyrone ends up in prison; Harry is stuck in a hospital, his arm amputated; Marion maintains her drug habit by prostituting herself; and Sara is in a psych ward after undergoing electroshock therapy. As in Pi, the frenzied excitement of Requiem for a Dream is that of the world going to hell in a hand basket.

The attractive young people almost kill themselves through drugs. The film communicates addiction via both arrangement (quantity of intensification) and method (perceptual quality). As Harry and Tyrone shove the TV set around Brighton guests, 'anybody want some time?' then gives out the speed pills articulated in the jumpy cutting of party footage. The spatial warp of drugs is also forceful. Deep focus photography makes hollow, empty space a purpose correlative to the emptiness of addicts in line for their next fix. Light and reflections are utilized to express tilted states. Tyrone and Harry ignore the soft gold light quality at Brighton Beach in their eagerness to score. Paradoxically, the afternoon haze presents a visual equivalent to the state of tranquilization they seek. The harsh bare bulb in Tyrone's pad differs with the glow of sunshine from a window blocked by his back as he faces his electric predilection. When Harry and Marion thrust open an emergency exit door, it sparks white light like the drug's sudden increase of pleasure. White light also trickles in and blanks out the semi-naked image of Marion in the reflection in the mirror, flooding her in ecstasy beyond eroticism. Paradoxically, she ends up prostituting her mistreated body for heroin. Such self-absorbed fascination is common with Tyrone, who toys with mirror images of himself and pays no attention to his waiting lover.

The association of the viewer with cinematic methods is additionally extended in the physical grouping of projection and presentation to generate auto-productive craving machines. Rapturous with a drug rush, Tyrone dances to a hip-hop track. The rubbery motions of his legs and body winding with fluid nimbleness might appear as the unobstructed play potential to mechanical acts. As a type of force-field 'crossed by a powerful, nonorganic energy', though, this is not a body disjointed by addiction like Tyrone's. His overjoyed dance only imitates the cathartic possibilities of a BWO. In its early stage' the addictive drug happens to increase joie de vivre and incentive. Eventually, it weakens the users' creativity, whilst their plans, such as building a clothes design business, result to nothing. Tyrone's fake sense of safety is emphasized by the canting of the camera. High angle shots are employed often to create the constricted viewpoint of a trap. They give a kind of 'point-of-view' angle of the drug as imperceptible predator biding its time as the prey grows to be more trapped. Up-close imagery of Harry with Marion offer Deleuzian tactisigns. The soft warmth of their young skin is displayed in soft-focus sepia quality. The utilization of split-screen here puts side by side faces in conversation with fingers stroking skin and evokes the previous disjunction of Harry and Sara. Nevertheless close the friendly rapport of these close-ups, the screen stays worryingly split. Each lover is ensnared by his/her addiction and mutual betrayal is predicted by composition here. Their excited conversation is splotched out as the screen overflows with blinding light. Despite their affirmation of love, a gradually spinning image places them no longer in front of each other but confronting each other. As they lie poised in the cool grey glow of a heroin high, each partner is away on a personal high.

The 'Winter' progression persistently completes the characters' downfall. Rendered helpless in a down-canted roof-top camera angle, Sara roams the snow-covered sidewalks. People haze by her in the too-fast movement of chronological dissociation. Harry and Tyrone drive south, encouraged by their dream of a Florida drug paradise, keeping Marion to take part in live sex shows that pay for her drugs. In the middle of the lush greenery and blue skies of the South, Harry takes his last shot into the decaying sore in the middle of his arm and side-steps reality. After a frightening dream about losing Marion over the perimeter of the pier Harry wakes up with his arm cut off. Marion grins in her sleep as she holds onto her heroin earnings.

Harry and Marion are a defiant, thrill-seeking couple that start the movie as impulsive and zealous lovers. In the initial dialogue between the two, Marion conveys her feelings of being ensnared by her parents', and her dependence on their caretaking. Harry tries to provide for Marion in the one way that he understands how, by distributing and seeling heroin. Tyrone, is the companion and enabler of Harry's heroin distribution and addiction team, Harry's accomplice on the street. Harry becomes surrounded by the deceptive power of his new authority-he stops over to visit his mother only to ensure her that his pleasant job downtown at the bank was going to provide for her and Marion. The films exact use of flashbacks lines Tyrone's disproportionate self-indulgence with childhood memories and experiences-more than simply junkies and fixes,

The character are lifelike and completely complex for one to reprimand in a strict sense. In one prominent scene, Harry and Marion are in bed next to each other. Aronofsky splits the screen in two, with one half focusing on Harry and the other half focusing on Marion. In spite of the reality that we recognize they are lying next to each other, their presence is hardly felt beyond the edges of the other's frame. In this fashion, Aronofsky efficiently conveys how the couple is with each other, and still vastly apart -- a facade of their relationship which becomes more and more pronounced later on in the film, when a scarcity of drugs forces them to desperate alternatives. In such situations, the lovers are hollow figures, eventually disappointed by their own realism and representation. Hopelessly artificial blue lights that highlight (emotional/physical) distance restore the tender and warm caresses confined across split-screen close-ups of their bodies. A once-precious summer-lit snap of the couple ultimately offers Marion's entry to the sex business and prostitution at drug fuelled parties. The telephone digits for the sleazy pimp/dealer Little John (Keith David) is scribbled on the rear of the snap, thus discovering the snap's original hopes as all the more emotional and unreachably hopeless. Marion visits the pimp, who, Harry told her prior to their departure, has heroin but is not selling it, in its place selling it for sexual favors and prostitution. After the meeting with Big Tim, he gives Marion a humble supply of heroin, and tells her she can get additional supplies at a party he's throwing next week. He does not specify what precisely she will have to do to be paid, but she recognizes it will be sexual. In the beginning, Marion refuses the offer, and starts to leave Big Tim's place feeling terribly sick, most probably from a combination of withdrawal symptoms and revulsion at her deprivation. Big Tim, who has seen many addicts, tells her, "See you next week." When her first stock of drugs dries up, she in fact returns for the gathering thus beginning her depraved descent into regular prostitution and creating a rift with her boyfriend.

Harry's mother Sarah, who tries for to reclaim the misplaced glory of her dead husband and gifted memories of her son, will do everything to get in shape and into the red dress she put on at Harry's high school graduation day. She ultimately undergoes electroconvulsive treatment, and for Sarah strange consequences are uncovered as the perverse means to her goal move forward -her increasing madness due to amphetamines is a disgracefully human depiction of what keeps our lives important.

Aronofsky also wanted us to see that the 'world of the film [is] much more like a dreamland. Thus he set Requiem in Coney Island, tinted the screen, shot through filters, used split screens to show multiple subjectivities, and added pulsing, atmospheric electronic music. As in Pi, there are numerous hallucinations, almost all of which are nightmares. Even the pleasant dreams, such as when Harry imagines Marion by the ocean, burst apart to prove once again the agony of illusion. The substantial artifice of the film, in sum, is given over to distortion and insanity. There seems to be no way for Aronofsky to imagine artifice in a positive way. Even though Aronofsky speaks of art and artists relatively more often, I would say, than other young directors, there is a strong idea that nature still grounds art, in contrast to the illusions and hallucinations of artifice. In Selby's novel, Marion is a painter, and her dream is to open a store that sells clothing based on her sketches. Marion is terrifically cultured, and her mind is filled with ideas about Italian museums, Renaissance music, and light: 'All that summer and fall she painted, mornings, afternoons, evenings, then walked around the streets that were still echoing the music of the masters, and made out of interior monologues, and a film is necessarily more visual, more exteriorized.

Section II

Behavioral Couples Therapy:

Harry and Marion

It is clear from watching the movie that the extent and depravation that results from the profound acts of violence and addiction that plagues the beautiful young couple could have been saved by intervention therapies. However, there are a number of cautions and clarifications about BCT and partner violence in treating substance abusing patients. First, it is important to realize that BCT was not designed as a treatment method for partner violence. BCT is a couples-based treatment for alcoholism and drug abuse. We simply learned through our clinical experience treating couples and through our research that male patients seeking help for substance abuse problems are a high risk group for perpetrating partner violence, and that the violence should not be ignored.

Second, data currently available support the use of BCT for a specific subgroup of men with co-occurring problems of addiction and partner violence. BCT is recommended for married or cohabiting male substance abusing patients who have sought help for their substance abuse problem if there is not an acute high risk of severe, injurious, or lethal violence (as already described above). BCT is not recommended for substance abusing patients seeking help but not currently living with a partner. A dual-focused intervention program may be better suited to the substance-abusing, violent male who is not in a partner relationship as one means of prevention of future domestic violence (Palmer, et al. 2002). BCT has not been tested on batterer clinic male patients with substance abuse problems, and is therefore not currently recommended for this population.

Third, we do not know why partner violence is reduced after BCT. Several possible explanations exist (Gorney, 2007). First, violence may be reduced because alcohol and drug use are reduced or eliminated. Second, violence may be reduced because one or both members of the couple learn constructive communication skills that prevent arguments from escalating to violence. Finally, a combination of these factors may explain the violence reduction associated with BCT (Giles-Sims, 1983).

Some results seem to support the importance of reduced substance use after BCT in reducing violence risk. For example, in one study for both the first and second year after BCT, violence was significantly reduced; further, the extent of violence and of clinically elevated verbal aggression levels were associated with the extent of the alcoholics' drinking (Healey, et. al 2007). Frequency of post treatment drinking was positively correlated with frequency of violence and verbal aggression, and remitted alcoholics no longer had elevated violence and verbal aggression levels when compared with matched controls, while relapsed alcoholics did. These results were observed even after baseline violence levels were taken into account (Gondolf, 2003).

Several studies that show reduced violence and an association between substance use and continued violence after individual (not couple) treatment also seem to support the importance of reduced substance use in reduced partner violence after treatment. One study of drug abusing men with comorbid alcohol problems found that partner violence was significantly reduced from the year before to the year after receiving individually-based substance abuse treatment (Shultz, 2004). This study showed the same pattern of results found with BCT. The greatest violence reductions occurred among patients who were remitted after treatment; and those remitted after treatment experienced similar levels of violence as did a nonalcoholic normative control group. Downs, (2006) also found that, in the year after individually-based treatment, the likelihood of male-to-female violence was 18 times higher on days when the man used alcohol or illicit drugs than on days when he did not. These findings and greater violence among relapsed than remitted patients remained significant and of similar magnitude when baseline violence levels were controlled. Finally, two other longitudinal studies of partner violence after individual alcoholism treatment reported high levels of violence before treatment that were significantly reduced in the year after treatment (Shultz, 2004).

Other results suggest that couple relationship factors may be important in reduced violence after substance abuse treatment. For example, a randomized study of male drug abusing patients found that BCT was more effective than individual treatment in alleviating partner violence (O'Farrell, et al. 2000). A second study, which investigated differences between partner violent and nonviolent male alcoholic patients, found that relationship distress and alcohol problem severity had independent associations with partner violence (Downs, 2006). Further, relationship adjustment remained considerably associated with partner violence, while alcohol trouble severity did not, after controlling for demographic variables and patient antisocial traits.

Researchers have noted that BCT is contraindicated if there is an acute high risk of severe violence that is potentially injurious or lethal (Giles-Sims, 1983). However, once cases with acute risk of serious injury or death have been eliminated, it is not completely clear where to draw the line on the violence severity continuum when considering the use of BCT. For example, in two studies using the Conflict Tactics Scale (Healey, et. al 2007) definition of severe violence (i.e., kicked, bit, or hit with fist; hit with something; beat up; threatened with knife or gun; used knife or gun), 20%-30% of male alcoholic patients entering and accepted for treatment into BCT have engaged in severe violence toward their female partner in the year before BCT (Downs, 2006). Prevalence of severe violence is significantly reduced to 8%-12% in the two years after BCT in these studies, suggesting that some cases of severe violence can be helped by BCT.

Another issue in any form of couples' therapy is whether being in therapy has an impact on participants' perceptions regarding the integrity of the relationship and their decision-making regarding its possible dissolution, as well as how responsibility is construed. In BCT, participants do not need to have an open-ended commitment to maintaining the relationship. In fact, many couples enter BCT as a last chance to salvage their relationship; often the non-addicted spouse has made it clear that if violence or serious substance use recurs, then the relationship is over (Hardy, et al. 1998). However, in our work on BCT, participants both need to be willing to work to see if the relationship can be improved and to agree to refrain from threatening separation or divorce in anger (Gondolf, 2003). Couples promise not to continue to make threats of separation or divorce in the heat of anger at home because such threats usually sabotage the couple's progress and can lead to heightened anger than can escalate to violence or substance use. However, they also agree to discuss serious thoughts they may have about possible separation or divorce during BCT sessions where they can get help from the therapist in dealing with this issue. In this regard, BCT therapists are careful to stress that the spouse's role of assisting the male substance abusing patient's recovery does not mean that the female partner is responsible for the male's substance use or violence.

Evidence, Rather Than Ideology, Should Guide Interventions

The problem of domestic violence is too weighty, both as public health and social issues, to be content with intervention approaches that sound good or look right based on some conceptual model, but that have no empirical support for their efficacy (Gorney, 2007). Unfortunately, this has been the tradition regarding interventions in this field-many earnest appeals and opinions, very little data (Ganley, 2008).

It is important in conceptualizing interventions for partner violence to distinguish between interventions that are inefficacious and interventions that are harmful. The limited available evidence suggests that a lot of partner violence interventions, both lawful and psychosocial, may be relatively inefficacious when scrutinized and compared to no-treatment managed conditions (Hassan, et al. 2000), although combined legal and clinical interventions may have small, additive effects on outcome variables such as criminal recidivism (Healey, et. al 2007; Giles-Sims, 1983). To date, no intervention has been shown to have large, powerful effects in ending partner violence in controlled studies. Thus, the search for highly efficacious intervention approaches remains a major and urgent priority in the field.

With respect to the harmfulness of interventions, although a great many articles have warned of the harmfulness of couple's interventions for partner violence, and many states explicitly forbid the use of couple's interventions for court-mandated abusers, we know of no empirical evidence indicating that such interventions are, in fact, harmful. Two controlled trials have found couples interventions to be no less effective than the widely promoted gender-specific interventions for wives with a violent husband (Hassan, et al. 2000). O'Leary and colleagues (1999) further demonstrated that couples intervention did not produce greater attributions by women of self-blame for their partner's aggression relative to gender-specific treatment in women's groups, nor was there any evidence that the content of couples' sessions provoked abusive incidents. Hansen, (2003) found that couples treatment was somewhat more effective than gender specific treatment for cases with co-occurring substance abuse and domestic violence. Finally, as noted above, O'Neil and colleagues (1999) found that BCT for drug abusers was more effective than individual treatment in alleviating domestic violence.

Another important concern involves the presumption that battered spouses are a homogenous population with regard to the goals of intervention, and the assumption that alternative victim services are efficacious. Even the best available victim advocacy interventions have somewhat discouraging outcomes as demonstrated by Hardy, et al. (1998). They found that a community-based advocacy program for battered women after they left a shelter had a substantial, significant impact on violent revictimization, as compared to treatment as usual with normal shelter services. Despite these significant findings, 76% of the battered women who received the intensive advocacy intervention reported that they were physically abused during a 24-month follow-up period (compared to 89% of the treatment-as-usual control group) (Palmer, et al. 2002). Although the intervention significantly reduced violence exposure, the absolute levels of revictimization indicate that a high degree of long-term safety has not been achieved with either standard shelter services or the enhanced advocacy program.