Introduction
The diagnostic and Statistical Manual of Mental Disorders (DSM-5) is a manual that contains criteria, causes, treatment methods, and consequences of diverse mental health problems. As mental health may be affected by a wide variety of diseases, there are several dimensions in which DSM-5 approaches the issue. One of these dimensions is represented by substance use disorders. Such disorders may include cognitive, behavioral, and psychological symptoms, which may serve as criteria for disorder identification. In most cases, substance use disorders are closely linked to the excessive use of drugs that can be harmful. Substance-related disorders can be divided into three groups, including substance use disorders, substance intoxication, and substance withdrawal (Morgen, 2017). Use disorders may cause harm due to the consequential intake of substances. Intoxication refers to the direct consequences of a recent overuse of a particular substance. Substance withdrawal is a combination of symptoms that may occur when an individual stops using an addictive substance. DSM-5 also outlines ten significant groups of the above-mentioned disorders based on the substance (Morgen, 2017). These ten groups include alcohol, caffeine, cannabis, hallucinogen-related disorders, inhalant-related disorders, sedative, hypnotic, or anxiolytic disorders, stimulant-related disorders, tobacco-related disorders, and others.
Some substances such as caffeine that may cause minor effects and related disorders are relatively harmless, whereas others may be highly dangerous and cause severe consequences. For instance, stimulant-related disorders may involve such drugs as cocaine, which may lead to the deterioration of mental functionality. Even though the extent to which mental health is affected may differ from one substance to another, the diagnosis criteria provided by DSM-5 frameworks are similar for all ten groups. In some cases, it may be challenging to diagnose such disorders as stimulant use disorder. For instance, the development of tolerance and withdrawal may serve as essential indicators of addiction. However, addiction may occur without consequential development of tolerance and withdrawal. As it is complicated to identify the disorder with insufficient criteria and frameworks, it may be vital to expand DSM-5 indicators further and provide a more comprehensive approach to both assessment and treatment. Substance use disorders represent a significant problem that requires an appropriate response on an international level. As timely diagnosis may significantly influence outcomes, it may be essential to implement sufficient criteria into practice.
Movie Synopsis
The movie New Jack City is a crime thriller that was released in 1991. The initial story was written by Thomas Lee Wright and Barry Michael Cooper. The story is structured around Nino Brown, who was a gang member in Harlem in 1986. Nino and his gang decide to enter the drug market and start selling crack cocaine in New York City. The gang succeeds and controls the streets of Harlem for several years. Moreover, they manage to capture the Carter apartment complex and use it as a base, where the gang manufactures and sells drugs. At the same time, an undercover police officer Scotty Appleton desires to collect evidence on Nino’s gang to achieve justice and put Nino Brown in prison. Another essential character is Pookie, who is a street drug dealer. At the beginning of the movie, Pookie encounters Appleton but manages to escape even though he gets shot in the leg. Later, they meet again, and Appleton helps Pookie overcome his addiction and receive the necessary treatment.
The police department decides to send Pookie to an undercover operation to collect evidence on Nino’s gang. However, Pookie starts using substances again, which leads to his exposure and death. As the initial mission fails, detective Appleton decides to infiltrate the gang by himself and gain the trust of Nino to access information. He succeeds and manages to bring Nino to justice. Due to legislative nuances, Nino only gets 12 months of imprisonment although he pleaded guilty. Police officers and Appleton were shocked by the court’s decision, yet they could not do anything. Nonetheless, Nino gets shot by an older man who was furious about his actions and disagreed with the court’s decision.
Character Description
As the movie’s story is built around a gang that sells drugs, multiple characters demonstrate certain symptoms of substance-related disorders. In most cases, people who suffer from these disorders are represented by supporting characters. However, Pookie may serve as a prime example of an individual that suffers from substance use disorders, substance intoxication, and substance withdrawal. Pookie is a young African-American man approximately between 18 and 25 years old. At the beginning of the movie, Pookie is selling drugs in the streets. Insufficient information is provided regarding his living situation, yet he ends up on the streets after he gets shot in the leg. He also asks Nino to give him food, which may indicate that he has no money. Moreover, Pookie uses the substances that Nino’s gang sells. Overall, his involvement in criminal activities, as well as his addiction to crack cocaine, significantly worsen his living conditions.
Stimulant Use Disorder
Unfortunately, the movie does not label Pookie’s disorder as it focuses on other elements of the plot. In general, his addiction to substances plays a significant role in the story and is used to show the harm that Nino’s gang does to ordinary people who buy their products. However, even though the movie does not focus on Pookie’s disorder, it provides sufficient scenes and details that can be used to identify his diagnosis. There are multiple instances when he uses substances throughout the movie. In most cases, Pookie is using cocaine, or crack cocaine, to be more specific. Cocaine frequently serves as a prime example of a stimulant type of substance, and hence, Pookie’s disorders may be identified as stimulant-use related. Nevertheless, as already mentioned, he represents all three dimensions of substance-related disorders. Therefore, his diagnoses include stimulant intoxication, stimulant withdrawal, and stimulant use disorder.
Pookie has the symptoms of stimulant intoxication during the scenes that show him shortly after stimulant use. For instance, in most scenes, he is sweating, which is an indicator of stimulant intoxication according to DSM-5 (Livne, Stohl, Shmulewitz, Mannes, & Hasin, 2020). Euphoria and sociability changes can also be seen in a scene where Pookie starts acting strangely and reveals that he is on an undercover mission. He also demonstrates symptoms of stimulant withdrawal when he interferes with the substances after going through the treatment program. For example, it is shown that he has sleep problems and fights the urge to start using again. However, his primary diagnosis may be represented by stimulant use disorder.
Diagnostic Criteria
DSM-5 outlines a considerable number of diverse criteria that may be used to diagnose stimulant use disorder. One of the main criteria is the use of Amphetamine-like substances, cocaine, or other stimulants. As already mentioned, Pookie uses crack cocaine multiple times throughout the movie. He also demonstrates a strong urge and desire to use it again when he starts his undercover mission. As he got unemployed and homeless, Pookie abandoned several social, occupational, and recreational activities as a consequence of substance use. Moreover, he desired to restore these activities as soon as he went through the treatment and stopped using cocaine. He also demonstrated unsuccessful efforts to control stimulant use, which also correlates with DSM-5 criteria (Livne, Stohl, Shmulewitz, Mannes, & Hasin, 2020).
In most cases, the symptoms were portrayed well and corresponded to reality. However, some of the criteria outlined in DSM-5 were not shown. For instance, Pookie does not demonstrate such symptoms as significant stimulant-related physical or mental health problems. His addiction also does not seem to cause considerable impairment or distress. Unfortunately, little background information about Pookie is provided, and hence, it may be challenging to assess other features of the diagnosis. Age and gender distribution throughout the movie may be portrayed relatively accurately, as it shows how any person, regardless of age and gender, may develop stimulant use disorders. Environmental factors, including social and economic factors, are also accurate. Pookie is financially unstable and is exposed to substance abuse by people around him. Nonetheless, such features as an increased risk related to a family history of stimulant use are not reflected due to insufficient background information.
Disorder Etiology
As mentioned before, the movie does not provide sufficient information regarding Pookie’s background. Hence, it may be challenging to identify the impression the movie gives the audience about the etiology of stimulating use disorder. However, several predictors may lead to the development of the disorder demonstrated in the movie. First, the environment may serve as a decisive factor that may lead to the use of substances. In most cases, the movie depicts people who have the disorder as financially troubled citizens who are oppressed and have unhealthy social relationships. Moreover, most of these characters were badly influenced by older people in childhood. Consequentially, they tried such substances as cocaine and became addicted. To some extent, the movie’s interpretation of the disorder’s etiology is accurate. Several existing predictors were not shown or mentioned, yet, the etiological grounds that were presented in the movie correlate with reality.
Treatment
With the help of Appleton, Pookie receives treatment and seems to overcome the urge to consume substances. As it turns out later, Pookie did not manage to resist the temptation and started using it again. Unfortunately, the treatment process was shown schematically, and it may be complicated to evaluate the methods. However, it appears that behavioral therapy was utilized, which is one of the most common options. Restructuring the behavioral patterns of the patient is the most critical aspect of treatment, and hence cognitive behavioral therapy and contingency management should be used (Mitton & Mooney, 2018). Even though stimulant withdrawal symptoms are not as harmful as in the case with some other substances, it may still be challenging to introduce an effective treatment. Therefore, it is vitally important to establish trusting relationships with the patient and rely on the principles of patient-centered care.
Other Characters
As the movie focuses its attention on the issue of the drug industry, multiple characters suffer from different types of substance-related disorders. For instance, one of the gang members called Gee Money was shown to experience stimulant intoxication in several scenes. Another gang member called Duh Duh Duh Man can be diagnosed with a childhood-onset fluency disorder. He matches several criteria listed in the DSM-5 assessment frameworks. For example, he repeats sounds and syllables multiple times and prolongs the sounds. In some cases, words are broken, and it seems that they are formed with an overload of physical tension. Therefore, there might be sufficient evidence to conclude that Duh Duh Duh Man has a childhood-onset fluency disorder. There are several possible treatment options, including cognitive-behavioral therapy. Childhood-onset fluency can also be treated by controlled fluency methods and even diverse electronic devices. However, it may be essential to diagnose the disorder during childhood and implement an appropriate treatment plan as it may be challenging to mitigate its effects in adults.
Conclusion
The DSM-5 provides valuable knowledge regarding a wide variety of mental disorders. In most cases, the effectiveness of treatment correlates significantly with the timeliness of disorder identification. Therefore, it might be highly beneficial to utilize DSM-5 criteria to diagnose such disorders better. The same principle is relevant in the case of substance-related disorders. Even though it may be optimal to develop comprehensive frameworks to prevent substance overuse and addiction, it may not be possible to avoid these disorders completely. Hence, it is vitally important to assess individuals who have the symptoms and introduce appropriate treatment.
References
Livne, O., Stohl, M., Shmulewitz, D., Mannes, Z., & Hasin, D. (2020). Agreement between DSM-IV and DSM-5 measures of substance use disorders in a sample of adult substance users. doi:10.1101/2020.10.26.20219840
Mitton, A., & Mooney, L. J. (2018). Integrative approach to stimulant-use disorder. Oxford Medicine Online. doi:10.1093/med/9780190275334.003.0007
Morgen, K. (2017). Substance use disorders and addictions. Los Angeles: Sage.