Script(ing) treatment: representations of recovery from addiction in Hollywood film.
Addiction has appeared on the movie screen since Edison's earliest films (Starks, 1982); however, the now familiar images of modem institutional treatment did not appear until the late 1980s. After a decade of American cultural backlash against addicts and drug treatment during the years of the Reagan administration, public opinion seemed to shift throughout the 1990s toward encouraging people with substance-abuse problems to get help (White, 1998). Since that time, Hollywood has released several works with narratives focused on institutional treatment of addiction. Through their representations of addicts, substance abuse, treatment centers and the experience of recovery, these films help construct for their audiences a common cultural understanding of addiction. They can be viewed as a discourse in a Foucaultian sense--creating meaning and marking off the boundaries of how filmgoers should view and understand treatment.
The representation of drug treatment in America can affect society in several ways, including stigmatization. Elizabeth Hirschman (1992), in her study of cocaine use in films, argues that "motion pictures which focus upon addiction can serve as instructive, semiotically-rich texts for communicating cultural knowledge about addiction" (p. 428). This communication is not simply one-way, though; it exists as a continual feedback loop, with movies "both reflect[ing] and shape[ing] individual and societal values, attitudes, and behavior" (Wedding, 2000, p. 3). Thus representations from cinema can become received knowledge, which is incorporated into societal views. These shifts may then be mirrored and reinforced in subsequent movies. Obviously, films are no "magic bullet" with the power to instantly change public perceptions and beliefs; however, as a part of the culture industry, Hollywood does participate in teaching us about ourselves.
Films can speak to society as a whole, but they can also be instructive for individual groups. Previous research found that movies featuring substance abuse provide a strong point of identification for addicts (Hirschman & McGriff, 1995; Lalander, 2002). Films are part of a learning process about addiction, and the movie screen might be one of the few places where addicts can see their filmic counterparts receiving help.
This study compares the depicted reality the films present to audiences with previous addiction cinema and with real-world economic and cultural conditions. Since films privilege certain viewpoints through representational strategies and by leaving out alternatives, I also examine the ideologies of the films and issues of textual silence. The study offers a critique of these issues in the spirit of other well-known ideological film studies, such as Ryan and Kellner's (1988) Camera Politica.
In this article, I conduct a critical discourse/ideological analysis of the three major Hollywood films released since the 1980s that feature treatment as a major part of their narratives. After researching literature on addiction and film, I chose the films for the study and viewed each one many times, specifically looking for socioeconomic representations of characters, treatment of different races, sexes, and sexual preferences, methods of production as they relate to addicted characters and drug usage, and the depiction of treatment/ self-help groups. I then outlined the narrative of each film and compared the uses and meanings brought to addicts, addiction, and substances. I found that these movies construct a fairly unified image of treatment. In the films, 12-step-based substance abuse treatment is readily available to middle-class, non-minority addicts. The economic realities of treatment are ignored, as are alternative paths to recovery. Minority addicts are similarly disregarded or stereotyped.
Previous treatment film research
During the late 1970s, some film scholars and researchers involved in social, scientific and medical research of alcoholism began studying the ideological implications of alcohol and alcoholics in film. A 1978 conference sponsored by the British Film Institute generated several papers about the representation of movie alcoholics, including the only study devoted to examining the depiction of treatment. In his paper, Bruce Ritson (1979) writes: "If I were worried that I was becoming an alcoholic and decided to seek help on the basis of the films about alcoholism which I had seen, I would know that I must avoid hospital[s] at all costs" (p. 51). He discusses how most movies ignore treatment altogether, but those that do, feature "a blur of needles, burly attendants, locked doors and terrifying screams" (p. 51). No further research on treatment depictions in film has been published since that time.
When combined with the more general literature on addiction in films, Ritson's analysis provides a good starting point to question whether certain ideologies continue to appear in substance-abuse cinema, and how recent treatment films rework older concepts. Much of this previous research specifically centered on alcoholism; however, modern treatment facilities and psychiatric models tend to focus less on particular substances and group them all under the heading "addiction" (White, 1998). I adopt the same language and use "addiction" in place of substance-specific terms.
Although many Hollywood films include depictions of addicts and addiction, only three recent movies have devoted considerable screen time to depicting substance-abuse treatment: Clean and Sober (1989), When a Man Loves a Woman (1994) and 28 Days (2000). The structure and plot of these films share a common debt to earlier movies about alcoholism. Denzin (1991) has labeled the mid-1940s to early 1960s the "classic" period of Hollywood alcoholism films. Bracketed by The Lost Weekend (1945) and Days of Wine and Roses (1962), this era also corresponds to the height of the social-realism movement. Social-problem films fell out of favor in Hollywood, but they found a home with the oft-maligned "made for TV" movie during the 1970s and 1980s. Although alcohol continued to appear in major film releases, "excessive drinking was not automatically connected to the problems that appeared in drinkers' lives" (p. 129). Addiction was no longer the focus, merely a subplot. The only major American motion pictures addressing substance abuse during the 1970s were either comedies, such as Cheech and Chong vehicles, or biographical stories like Lady Sings the Blues (1972).
The 1980s signaled a return to the representation of addiction within a social-realist framework with Clean and Sober. The film follows an addict from drug abuse to treatment and back into society, with over half of the film occurring within a treatment facility. Since the release of Clean and Sober, many other movies have included characters entering treatment, trying to quit using, or seeking out self-help groups; however, only two other films also include extended depictions of life inside a treatment facility and the methods used to get addicts clean: When a Man Loves a Woman (1994) and 28 Days (2000). These three movies present surprisingly similar narratives about drug treatment. Taken together, the films create a depicted reality of treatment for viewers who have never struggled with substance abuse or known addicts seeking help.
In Clean and Sober, Daryl (Michael Keaton) is a real-estate broker who is unable to give up cocaine and alcohol. After embezzling company money and becoming implicated in a woman's overdose, Daryl checks into a treatment center to hide. While in treatment, he tries to get drugs and romantically pursues another patient named Charlie (Kathy Baker). After they are released from treatment, Charlie dies in a car wreck as she is trying to snort cocaine. The film ends with Daryl speaking in front of an Alcoholics Anonymous (AA) meeting.
When a Man Loves a Woman chronicles the destruction addiction visits upon a family. Alice (Meg Ryan) and Michael (Andy Garcia) seem to be the perfect upper-middle-class couple, but Alice clearly drinks too much. While intoxicated, Alice hits her oldest child, Jess (Tina Majorino). She agrees to enter treatment and slowly begins to get her life back together. Michael finds it difficult to accept his wife's new friends and way of life, and he moves out. The film closes with Alice speaking at an AA meeting; Michael emerges from the crowd and they reconcile.
In 28 Days, Gwen (Sandra Bullock) is a party girl who is unable to stop partying. She steals a limousine at her sister's wedding and drives it into a house. Subsequently she is court-ordered to enter a treatment program, where she rejects the feel-good camaraderie of the facility. However, after some initial escapes and drug episodes involving her boyfriend, Jasper (Dominic West), Gwen begins to participate seriously in the activities at the treatment center. Once she is released, Gwen chooses to leave Jasper in order to pursue her new way of life.
Representations of addicts
I have divided my analysis into two main categories. First I examine how these films represent addicts and addiction, and what these representations suggest. I then discuss how treatment is depicted in the films, and analyze and compare their constructed reality with the real-world treatment field.
The question of how addicts are portrayed is central to understanding the ideological positioning of addiction within these films. It is also instructive to compare these representations with earlier films to see how certain ideas reappear or become reworked by newer filmmakers. The familiar devices of the addict "hitting a bottom" and seeking out help remain. Likewise, the addicts who seek treatment in these newer movies continue to be upper-middle-class and white, as in the classical films. As we shall see, one of the major shifts between the classical Hollywood approach and contemporary approaches is a lessening of the stigma of using substances and being an addict.
Like all cultural products, films traffic in stereotypes. Filmmakers develop and borrow easily recognizable "shorthand" devices that stand in for complex cultures and segments of society. Problems develop when these representations are seen as absolute, already existing boundaries that define a larger whole (Dyer, 1979). Such stereotypes also work to mask the power struggles lying behind all such naming and representational activities. Cape (2003) identifies four stereotypes of addicts appearing in drug cinema. All the main characters in these subject films fall within his "tragic hero" mold: a flawed yet "likeable, readily identifiable character" (p. 168). Many of the stereotypical qualities identified in other substance-abuse cinema research also appear in treatment movies; however, representations within these three films do show some signs of departure, especially in their depiction of female addicts. I return to a discussion of gender within these films later.
Films in the first half of the 20th century, as well as those in the 1970s and 1980s, often associate alcoholism with so-called creative professions, such as writing, acting, etc. (Room, 1989; Denzin, 1991). By the late 1980s, substance abuse on the screen diversified to include other walks of life, including portrayals from inside the world of corporate America and from the inner cities. The addicts in the films included in this study, like those in earlier movies, begin their stories firmly entrenched in an appealing, upper-middle-class lifestyle. In Clean and Sober, Daryl is a real-estate broker who works for a large company and makes very lucrative deals. In When a Man Loves a Woman, although Alice is a teacher (a profession not commonly associated with a glamorous life), she and Michael have a roomy, upscale townhouse in San Francisco and go on vacation in Mexico. 28 Days, by contrast, never mentions whether Gwen has a job. Her apartment is not especially luxurious; however, the film begins with her partying in a posh club. Although these films may present a less glamorous lifestyle than 1980s cocaine films such as Less Than Zero (1987), these addicts are still financially well off and living attractive lives prior to "hitting their bottom." They all have financial and social resources that prevent too hard a fall from their normal life of privilege. There are no scenes of living on the street or the desperation associated with the continual hunt for substances. These are most assuredly "upper-class addicts."
In her comparison of 1920s and 1960s alcoholism films, Herd (1986) found that the movies shifted from portraying external causes for alcoholism to the (now familiar) assumption that internal factors cause alcoholism. Despite acceptance by the medical community and much of the public that addiction comes from within, recent filmmakers still find it necessary to provide a necessitating external factor for a character's substance abuse. As is discussed later, this may be attributable to the AA concept of "hitting a bottom." Regardless, all three treatment films do offer precipitating events based on anxiety, stress, or failure for each character's addiction.
Clean and Sober provides no pre-existing cause for Daryl's addiction. Daryl seems to be quite content with his lifestyle, until the police start pursuing him. He responds by increasing his drug use and then checks into a treatment program. Unlike Clean and Sober, both 28 Days and When a Man Loves a Woman link their characters' addiction to their family history. During detox, Gwen flashes back to scenes of her childhood with her sister and addicted mother. The sequences show how their mother put them into danger and eventually died from her using. Through the flashbacks and sequencing, Gwen's addiction is directly linked to her mother's substance abuse.
The concept of addiction affecting entire families is endorsed by many self-help groups, particularly Adult Children of Alcoholics (ACOA), and it became incorporated into addiction films during the 1980s (Lynch, 1999; Denzin, 1991). This approach is even more evident in When a Man Loves a Woman. The film suggests several factors for Alice's addiction, including her father's drinking and Michael's controlling nature. Although these family issues could be seen as external factors, they are presented less as a cause of substance abuse than as links to an addiction-prone personality that, in turn, causes substance abuse.
Beginning in the 1980s, an increasing number of films began to focus on addicts who use multiple substances. The classical social-realist films were almost exclusively inhabited by alcoholics; in current substance-abuse films alcoholics are almost a quaint exception. While Daryl splits time between alcohol and cocaine, Gwen is equally happy with pills or alcohol. When a Man Loves a Woman offers the sole throwback to the classical alcoholism film in the character of Alice; however, the people Alice befriends in recovery admit to using a variety of substances. It almost seems that Alice's roles as mother and wife preclude all but the most socially acceptable substance abuse, feeding into ideologically conservative notions about women and motherhood.
In her discussion of 1920s alcohol films, Denise Herd (1986) notes: "Romantic goals dominated the entire plot of the melodramatic film, thus creating the primary situational context of alcohol problems" (p. 216). This remains true for the treatment films under discussion here. Their increased focus on addiction therapy does nothing to diminish the importance of romance within their narratives.
These relationships are easily explained away as a classical feature of Hollywood scriptwriting, but they do hold a deeper meaning within alcoholism films: "The resolution of his/her drinking becomes a symbol for the resolution of the problems of the relationship" (Denzin, 1991, p. 249). Thus the fate of the couple is tied to whether the addict will choose a life of sobriety or continue using. Since Gwen's fiance continues to use in 28 Days, Gwen's decision to stay clean is reinforced when she tells him, "Everything has to be different, and that includes us." After a brief kiss she bids him goodbye. Daryl is unwilling to let go of his girlfriend, even after he finds drugs in her purse. Her death allows him to resolve the situation within the classical alcoholism motif without having to actually choose staying clean over remaining in the relationship. By contrast, in When a Man Loves a Woman, Michael tries his best to be supportive of Alice, but he has to learn his limitations before they can reunite. These relationships are a central focus of all three films, and their resolution implies a direct correlation between the choices the characters have made about their addiction and their recoveries.
There are other characteristics of addicts common to these three films that researchers have not generally identified with the larger group of addiction cinema. Each movie recognizes that drug use was, at one time, fun for the addicted character. Many of the earlier alcoholism movies focused almost exclusively on the progressive decline of characters, rarely acknowledging their pleasurable periods of using. "Demon alcohol" was the villain of the classical social-problem film, but recent movies suggest that the substance itself is not the cause of the problem. Spouses, co-workers and friends drink and use drugs in these films. For example, in When a Man Loves a Woman Michael usually drinks with Alice, but there is no suggestion he is an addict. Instead, the films imply that the nature of addiction is found within the individual character rather than in specific substances--an approach familiar to treatment professionals.
The representations of addicts in treatment films do replicate some of the conventions of earlier alcoholism movies. Characters are upper-middle-class and employed, and they encounter adversities that seem to precipitate an increase in their consumption of substances. Recent films, however, reflect subtle changes in stereotypes of addiction in society. Substance abuse is viewed more as a disease than a moral failing (at least among the economically well off), and most of the characters consume multiple types of drugs. These more obvious representational strategies combine with connotations within the text to establish a fairly consistent ideological stance.
Reading between the lines
The depictions of addicts within these treatment films raise several ideological questions about their handling of issues such as race, sexual orientation, class, and gender. I address these categories in this section and show that these treatment films present a consistent view of middle-class Caucasians' addiction while ignoring or negatively stereotyping addicts from different races and socioeconomic backgrounds.
As mentioned previously, the main characters of all three films could be described as middle-class to upper-middle-class. The only "poor" addict developed as a character is Charlie in Clean and Sober. She is also one of only two addicts (the other is Gwen's teenage roommate in 28 Days) to die in these films. Unlike other characters, who have more options because of their money, Charlie is locked in a dead-end mill job with an abusive boyfriend. In these films staying clean seems to be fairly easy if you have the financial resources and a supportive environment.
Filmmakers might have chosen to focus on middle-class characters in order to subvert cultural stereotypes about who abuses drugs. Earlier films about alcoholics certainly pursued this goal (Room, 1989). While this approach might be understandable, addicts on the lower rungs of the social and economic ladder end up being left out of these tales of redemption. Instead, addicts on the fringes of society are primarily featured in bleak, cautionary tales such as Menace II Society (1993) or Requiem for a Dream (2000). Through exclusion and negative portrayals, the subject films seem to limit recovery through treatment as a possibility for the working class.
All three leading actors who portray addicts in these films are white. These characters' middle-class lives before treatment seem to be populated entirely by Caucasians (excepting Andy Garcia, who portrays Michael in When a Man Loves a Woman), with minorities existing only in stereotyped servant roles like "cleaning woman" and babysitter. Denzin (1991) found the same problem with representation in his study, saying that films "systematically excluded certain classes and types of subjects," resulting in a "dominant middle-class ideology about who had this problem" (p. 238). Hollywood perpetuates racist stereotypes by excluding minorities from these stories of redemption and then foregrounding them as addicted criminals and similar negative portrayals in other films. The more socially acceptable "alcoholic" is white, and less appealing stereotypes like "crackheads" are usually minorities. Such an approach also seems to open up treatment as an option only for the first group, while largely excluding minorities from institutional help. Although most major characters are white, these treatment movies do include some diversity in their depictions of treatment.
All three films feature African-American actors playing treatment professionals and patients, though few other racial minorities are represented. The presentation of black addicts inside the facilities in When a Man Loves a Woman and Clean and Sober stands in stark contrast to the presentation of white characters. When Daryl enters the detox ward in Clean and Sober, he walks into the television room and sees Xavier (Henry Judd Baker), a large African-American man, talking to himself. Xavier then throws something through the television, storms out of the room in a flurry of fists and curses, and begins pacing the halls, physically lashing out at the staff. Comparing this image of a deranged, hulking black addict with the dazed, peaceful expressions of the white patients as they detox, it becomes apparent that these images play on cultural stereotypes about black drug addicts. The angry, dangerous black man is a stereotype often evoked in popular cinema (see Guerrero, 1993) and might be expected to emotionally distance the audience from minority addicts in the film. The African-American characters in Clean and Sober receive barely any screen or speaking time, instead existing primarily for laughs and plot mechanics.
In When a Man Loves a Woman, Michael comes to visit Alice in the treatment facility, where he meets Malcolm (Bari K. Willerford), a large African-American man who tells him, "Your wife is amazing." Michael is visibly uncomfortable. After Michael leaves the building, he sarcastically comments, "I like your new friends." When Alice asks if he met Malcolm, he replies, "Big black guy?" She smiles and tells Michael, "He's a cokehead (pause), the girls are with him." Michael reacts with a start, but Alice quickly adds, "He's not a child molester, he's an armed robber." The scene is played for laughs, but it also illustrates that Alice has looked beyond the exterior of her fellow patients and has recognized their common "affliction." However, the "humor" of the exchange comes from stereotyped images of the menacing black addict who must be kept away from white women, especially little girls. The underlying message is "Malcolm can be trusted because he is off the street and in this nice treatment center." He becomes an "exception" to the stereotype rather than transcending it. The audience can laugh because Malcolm is not a "normal" black drug addict. Neither film favorably portrays an addict who is a racial minority. So while the audience is encouraged to identify with white substance abusers, none of this empathy is shared with minorities.
Interestingly, each film does include African-American actors portraying treatment professionals. They are more well-rounded characters (especially Morgan Freeman's in Clean and Sober) than the black addicts depicted; however, they could be viewed as "exceptional cases" set apart from the other stereotyped characters. In some ways, like many representations of black judges or police officers, these officials reinforce dominant ideological positions by becoming the point of contrast with the dangerous "Other" most minorities represent to mainstream audiences.
Although 28 Days does not include as troubling racial representations as the other two films, its depiction of the sole homosexual identified in any of the three movies is just as problematic. Gerhardt (Alan Tudyk), speaks in a German accent (further setting him apart from the other patients), cries throughout the film, is unable to articulate himself without becoming emotional, and is the subject of most of the movie's jokes. There are no tragedies or life-and-death considerations in his addiction and recovery. Inside the facility he is forced to wear a sign saying "no male contact," and once he is released, his main concern is "I'm never going to get laid." His substance abuse is secondary to his role of buffoon in the film. The serious process of recovery in all three films is associated only with white heterosexual characters, usually females.
While largely ignoring or marginalizing racial minorities, these films seem to overrepresent female addicts. Three out of the four major addicted characters are women: Alice, Gwen, and Charlie. During the early 1990s, women comprised 27% of addicts in treatment facilities (NIDA & NIAAA, 1996), rising only slightly, to 30%, in 2002 (SAMHSA, 2004). Do female addicts take center stage because they are better able to elicit the sympathy of the audience? In Clean and Sober, Daryl tends to be a frustrating character who alternates between deep depression and fits of rage. The movie itself tends to be darker and less comical than the other two films. Extreme emotional displays are commonly linked to women, so perhaps filmmakers thought audiences would be more at ease and willing to identify with addicts like Gwen and Alice. Previous research has found that cinema usually equates female alcoholics with promiscuity (Herd, 1986; Room, 1991), yet none of these films reflects this cliche. By casting mostly women in the lead roles of addicts and removing the threat of out-of-control sexuality, filmmakers may have been attempting to broaden the appeal of their stories.
Although the representations of some of the female addicts may have improved, the films still feature several sexist assumptions in their subtexts. In a study of female alcoholics and teetotalers in popular media, Thelma McCormack (1986) found that both images of women were devalued. The characters in her study had no ability to act decisively and no authority. Similarly, both Charlie in Clean and Sober and Alice in When a Man Loves a Woman are never entirely free to make their own decisions. Alice seems to turn to drinking largely in response to the power her husband wields over her. Charlie is manipulated either by Daryl or by the other men in her life. She tells Daryl that she has security at the steel mill where she works "as long as once a month I forget to wear a bra and show them my high beams." In the end, she pays the ultimate price for her indecisiveness and her inability to stay clean. Like the women in McCormack's study, Charlie not only lacks agency, she is bereft of any qualities that might allow her to assert control over her own life.
Both 28 Days and When a Man Loves a Woman suggest that Gwen's and Alice's addictions can be ascribed to family-relationship problems. Daryl, by contrast, has no apparent cause for his substance abuse. This stereotypical move of linking female using to relationship problems has a long history in addiction films (see Denzin, 1991; McCormack, 1986; Lynch, 1999). Such a move results in a loss of agency for these characters. Viewers are given the impression that these women are truly victims, while Daryl is often incapable of inspiring the same pity. Perhaps society is more comfortable with the figure of a helpless woman driven to use than with one who has just chosen to use substances but is unable to stop.
The depictions of addicted characters affect the way these films construct addiction for their audiences. They also carry ideological messages that teach society which addicts can be helped and how. Female addicts require additional excuses for their using and are burdened with emotional and familial issues that males do not have to face. The overwhelming percentage of white, upper-middle-class men and women in these films seem to successfully choose a life of abstinence after treatment. The poor and the minorities do not fare so well--they receive relatively little screen time and mostly unflattering portrayals. The absence of positive representations of minorities (along with the scant attention paid to them) creates a limited picture of the addicts society should help. If they are not members of society's dominant caste, there seems to be little hope for them.
Representation of treatment
Having previously shown the limited representational strategies used to depict addicts in these films, we should ask how their images of treatment compare with the reality of America's substance abuse field. I show that these treatment films offer a consistent yet highly limited representation of treatment that is unrealistic in light of the economic pressures of the time.
The images of treatment in these three films stand in stark contrast to the pre-1980s addiction movies. Lewington (1979) wrote of "the image of the locked door or barred window" and the "sadistic or pessimistic male nurse" (p. 28), but the facilities in these three films become progressively warmer and more lavish. In Clean and Sober, Daryl walks through swinging doors into a swirl of activity and voices. With the sterile interior of a hospital, the place is more reminiscent of the institution depicted in One Flew Over the Cuckoo's Nest (1975) than the resort look of the other two treatment films. Patients are afforded some freedoms, though: There are no guards, no barred windows, and always-available television, exercise classes, and field trips to AA meetings. Alice checks into a roomy facility resembling a New England inn in When a Man Loves a Woman. Patients are provided with gardens to stroll in, a television room with a pool table, and a craft room. With Serenity Glen in 28 Days, treatment makes the transition to country club. The facility features a horse stable and a lake where patients canoe. The bleak images of institutional treatment wards transition to elaborate rehabilitation/vacation spots for the financially well off.
In addition to drastically altering the previous image of treatment centers in film, these movies also contradict the economic facts of the treatment profession. In his chronicle of the history of addiction treatment, William White (1998) points out that an expansion of patients and posh facilities during the 1980s met with resistance from insurance companies. The maximum stay for patients slowly decreased until, in the mid-1990s, insurance companies decided that "future benefits for addiction treatment, where they existed, would be offered almost exclusively for outpatient rather than inpatient or residential treatment" (p. 285). These outpatient programs, though much more numerous in the real world, have not captured the imagination of Hollywood as residential facilities have. Thus moviegoers are shown an experience that, except for those who can afford to foot their own bill, few can have.
The statistics on the success of treatment programs vary widely (Frater, 2001). Part of the problem with gauging success are such questions as "How long does someone have to stay clean before the process is successful?" and "Can similar statistics be applied to drastically different treatment programs?" Regardless, for leading characters in these three films, success is 100%. The characters leave the centers clean and are still not using at the end of each film. As mentioned previously, two characters do die as a result of their using, and one returns to treatment after relapsing; however, the viewer is left with the impression that they are anomalies. By contrast, even the most optimistic surveys show that at least 50% of people in treatment relapse within the first couple of years after release; relapsed characters are actually representative, not atypical.
Similar to earlier alcoholic films, all three movies divide the treatment experience into stages of detoxification, confrontation, and submission (Denzin, 1991, p. 223). As the major characters go through detox, they exhibit signs of delirium tremens, or the DTs. In his study, Ritson (1979) claims that DTs are estimated to occur in roughly 5% of alcoholics (p. 51). He argues that the images appear unrealistically often in movies because of their "dramatic appeal." In these treatment films, I would claim that they also serve to add a further note of seriousness to treatment, especially given the posh facilities and the frequent jokes included in all three movies.
These films feature recurring scenes that work to create what I call a "narrative of treatment" for the viewer. Each character and his or her belongings are searched for drugs upon entering the facility. The characters either ask or try to use the phone, only to discover they cannot make a call until sometime after they detox. After detox (with appropriate physical symptoms), they meet other patients and their counselor(s). They attend AA-like meetings, leave the facility (after a touching farewell moment with other patients and their counselor), and then in society implement what they have learned by attending AA or similar meetings. The whole treatment process is distilled into a familiar narrative.
As noted in the treatment narrative above, AA (although not always clearly defined as such) is a key feature of the films in this study. Since the 1940s, AA has continually played a major role in films about alcoholism, both as a plot device and during the production process (see Room, 1989). Ritson (1979) complained that pre-1980s films included very few scenes about professional treatment, opting instead to present AA as the only solution. By contrast, recent movies depict the reality that self-help groups are now an integral part of the treatment process (White, 1998; see also Denzin, 1987); as such, much of AA's culture is reflected in these movies. All three films include "meetings," which "not only provide the scheduled program for the alcoholic, they also provide a social environment supportive of abstinence" (Wilcox, 1998, p. 58).
The jargon and trappings of AA have become adapted parts of the lexicon of these films. The main characters in all three movies have a "sponsor" to help them. Phrases and ideas featured in these films, such as "one day at a time" and "keep it simple," come directly from AA (Wilcox, 1998). The concept of "hitting a bottom" can also be attributed to this self-help program and has been widely adopted by addiction cinema. According to this belief, all alcoholics reach a final point of desperation, at which point they become willing to change. Reflecting this idea, each character has a major calamity that can be identified as an obvious sign of "unmanageability" and a need to stop using: Daryl steals and wakes up next to an overdosed woman, Alice slaps her daughter, and Gwen drives into a house.
The treatment films do diverge from AA's practices in two important ways. First, rather than calling themselves merely "alcoholics," which is the accepted moniker of AA, characters in these movies use a string of identifiers. For example, Steve Buscemi, who plays a counselor in 28 Days, introduces himself as a "drug addict, alcoholic, compulsive gambler-slash-liar." Only 13% of treatment centers catered solely to alcoholics in 1990 (White, 1998, p. 268); these three films probably reflect the reality that treatment facilities work with people addicted to widely differing substances. Although AA may focus specifically on alcoholics, most treatment centers accept any addict (as long as funding is available).
The second point of departure from AA is the lack of a spiritual dimension to the programs: "Reminding ourselves that we have decided to go to any lengths to find a spiritual experience, we ask that we be given strength and direction to do the right thing" (Alcoholics Anonymous, 1976, p. 79). Room (1989) noted this same omission in his study of films featuring AA during the classical alcoholism period. The search for spirituality may be too difficult to translate on the screen, or filmmakers may just fear their movies would be interpreted as endorsing religion. By neglecting to mention this aspect of AA, however, the films present an incomplete view of that organization.
Recent movies dramatically alter the face of substance-abuse treatment from its previous screen depictions. Facilities shift from stark institutional interiors to sumptuous living and recreational quarters despite a real-life decrease in such facilities. The films focus upon the successful treatment of characters, utilizing AA-like programs and methods. These narratives establish such a common treatment experience that audience members can assume they have learned what addicts go through in treatment.
Films create an ideological position both by presenting and by omitting information and viewpoints. Having discussed the image of treatment conveyed in these films, I now turn to treatment issues ignored within their narratives. All three movies neglect to address economic and policy issues surrounding treatment, as well as the limitations of the disease model of recovery.
Like most Hollywood fare, recent treatment films do nothing to question dominant economic notions of capitalism or socialized health care. The film industry, like the medical field, is structured to benefit from the capitalistic system; it should not be surprising, therefore, that its products do little to critique the inequity of America's health-care structure.
The treatment system underwent huge shifts in the 1980s as for-profit companies entered the field, forcing non-profits to adopt their practices in order to compete. Most treatment agencies became firmly planted within a purely capitalist system, where "addicts became less people in need of treatment and more a crop to be harvested for their financial value" (White, 1998, p. 281). Only one of the three subject films addresses the financial aspects of treatment at all. In Clean and Sober, Daryl asks if the agency takes Blue Cross just before he is admitted--the only reference to the high cost of treatment in these motion pictures. These films ignore economic reality, because insurance companies were pointing customers toward outpatient care during the same time period, and "waiting lists for publicly funded residential programs grew unconscionably long" (p. 285). One comedy made during the 1990s at least tangentially critiques the situation: Gridlock'd (1997) features the adventures of two drug addicts wading through red tape to get into a government detox facility. By ignoring the economic factors at work within the treatment field, the subject films also overlook the true motivations behind such programs and misrepresent the availability of treatment services.
These films also fail to explore any of the myriad political issues surrounding treatment of addicts. Public funding is never mentioned or examined. Broader questions about the arbitrary nature of government distinctions between substances, such as minimum sentencing of drug offenders and even the legality of possessing certain substances, are likewise ignored. In writing about representations of the war on drugs, Viano (2002) actually identifies Clean and Sober as a return to films such as Reefer Madness (1936)--films that toed the government line when it came to drug policies. In 28 Days, when Gwen is sentenced to go to a treatment center rather than serve jail time, there is no questioning of whether the government should be supporting (what one can guess is) a private business by mandating that prisoners attend such facilities. Ignoring such questions helps strengthen both the government's and the treatment centers' public stances about addicts and the appropriate ways of treating them.
While encouraging youths to "just say no" and helping to fund public-service announcements, the United States government primarily battles addiction through law-enforcement efforts (see Belenko, 1993; Reeves & Campbell, 1994). Local governments vie for increased federal funding to fight a war where addicts seem to be the most easily identified enemy. The incarceration of the addict, whether in a jail or a treatment facility, represents a statistical win to be used for more federal dollars. Since states partially pay facilities for drug offenders sentenced to treatment, this represents a win/win situation for law enforcement and treatment centers. The benefit for the addict is rarely questioned.
This brings us to the last major issue ignored by these films: the lack of any alternative concepts of addiction and substance-abuse treatment. In a recent book questioning addiction from a cultural-studies perspective, the authors note that "addiction, therefore, is nothing if not a cultural concept, despite its affiliations with scientific and medical discourse" (Redfield & Brodie, 2002, p. 4). All three treatment films in this study take for granted what has come to be known as the "disease model" of addiction, a cultural concept popularized by AA during the mid-twentieth century. This approach, roughly defined, holds that some persons are genetically predisposed to compulsive substance use. The idea of self-control has combined and morphed into a personification of the desire to use, pitting addicts against an internal disease for control of their lives. I am unwilling to argue against a model that seems successful in treating people who want to stop using; however, the problem is that this "model" is presented as scientific truth--especially in these films. Social science research shows a much broader range of understanding about the nature of addiction (see Valverde, 1998, for example) that is ignored by these films. The effect is to cut off dialogue and to construct only one possible view of addiction. This model has become naturalized in American society and is the lens through which all addicts and treatment efforts are viewed.
Recent treatment films support dominant American ideology concerning addiction and drug treatment. Despite the lack of public funding, posh residential treatment centers are constructed as the only realistic option for keeping addicts clean. The interdependent nature of law enforcement/ government and such institutions is occasionally depicted but never questioned or explored. Concepts of addiction as a disease and AA-based recovery as the best solution are naturalized in the film texts and close off any alternative interpretations for the audience. The movies are a direct reflection of American society's ideological positioning toward addiction.
Conclusions on treatment films
While earlier films either lacked depictions of treatments or presented a montage of needles and DTs, recent representations have created a stock experience where any moviegoer can learn what it is like to go through drug treatment. Since these are the only three modem Hollywood films to offer an "in depth" look at treatment, their realism and assumptions should be questioned.
Recent treatment films construct addicts as middle-class, white, and attractive. Although the depiction of women is more progressive than in previous addiction films, these movies still reference racist and sexist stereotypes. African-American addicts are largely connected with the "ghettocentric" cycle of Hollywood films from the 1990s. Popular culture constructs treatment as an option for whites, while blacks are seemingly left with death or incarceration as their only escape from the vicious circle of addiction. Filmmakers may have feared appearing racist if they centered on African-American users; however, many addicts are left with no one of their own race with whom to identify.
The representation of treatment centers that emerges from these films also raises questions. While some addicts might be able to afford treatment, they are vastly overrepresented in these movies. The treatment programs depicted in these films would be unavailable to many addicts with little money and no insurance. Instead, they would probably receive outpatient services, leaving them no safe place to detox or live. Going into treatment with unrealistic expectations might decrease an addict's desire to get clean and also make it easier to quit a program.
These treatment films also offer limited understandings of addiction and options for treating addicts. While the "disease model" seems to help some people with substance-abuse problems better understand their experience, there are alternatives. Some addicts have been able to manage their using or to utilize alternative therapies. In presenting a single answer for all addicts, there are no options for persons who may be opposed to this particular approach. In addition, these films serve as a virtual public-relations/marketing campaign for what are usually for-profit treatment centers.
But despite the representational shortcomings of these motion pictures, the filmmakers should be recognized for at least attempting to address the complex issue of addiction treatment. Rather than asking why filmmakers make certain creative decisions, perhaps we can ask why these are the particular narratives Hollywood is willing to produce. Do executives believe audiences require a romantic relationship and a happy ending to watch a film about treatment? Are the fleeting, one-dimensional minority representations compromises for telling a story filmmakers are passionate about? Although such questions do not absolve responsibility for content, they do acknowledge a filmmaker's reality of working within certain institutional bounds in order to make a film. The existence of such pre-existing boundaries is precisely why ideological studies are needed to reveal the constructs and unspoken assumptions films make about addiction.
AUTHOR'S NOTE: I would like to thank Dr. Ted Friedman, Dr. Robin Room, Karen Hersey, and the journal reviewers for their suggestions and comments on this article.
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|Publication:||Contemporary Drug Problems|
|Date:||Sep 22, 2005|
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