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SOC 12
Clean And Sober
Outcomes: Students will
 Know and understand the definition of social issue
 Identify and examine the types of social issues that exist in Canada today
 Investigate ways to solve various social issues such as poverty, child abuse,
gender inequality, and so on
 Examine the reasons for substance abuse
 Identify health-related problems and crime associated with substance abuse
 Examine the individual and societal consequences of substance abuse
Definition:
Social issues are matters that can be explained only by factors outside an individual’s
control and immediate social environment. They usually concern more than a single
individual and affect many individuals in a society. Social issues are contrasted with
personal troubles of a given individual, can be explained in terms of individual
shortcomings related to motivation, attitude, ability, character, or judgment. (Wikipedia)
Notes:
DRUGS & ALCOHOL (http://web.umr.edu/~pfyc212b/drugs.htm)
I. Common Terms:
Tolerance - decreased sensitivity with repeated use of a drug, so that increasingly larger
doses are required to produce the same effects which earlier appeared at smaller doses.
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metabolic tolerance - enzymes which degrade a drug or substance become more
efficient at this process*
cellular tolerance - target cells in the brain become less sensitive to effects of a
substance when administered chronically
Physical Dependence - the body develops a need for the drug or requires an external
source of the chemical because it is not producing enough of this chemical on its' own.
Psychological Dependence - a desire or craving to achieve the effects produces by the
drug.
Withdrawal - discomfort and distress with discontinued use of the drug.
* However, long-term use of many drugs eventually damages organs that produce
enzymes for degrading the drug so the metabolizing process eventually fails completely.
II. Major Classes of Drugs & Common Effects
Drug Class
Depressants alcohol,
barbiturates,
anti- anxiety
medication (i.e.
Seconal,
Valium,
Quaalude,
Rohypnal)
Desired Effects

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reduce
tension
induce
euphoria
induce sleep
Adverse Effects
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Stimulants caffeine,
nicotine,
amphetamines
(i.e. speed,
cocaine,
MDMA)
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Narcotics or
Opiates - any
derivative of
opium poppy,
e.g. morphine,
heroin, codeine
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Hallucinogens
- LSD, PCP,
peyote,
psilocybin,
marijuana

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
euphoria
increase
mental
alertness &
physical
energy
increase
sociability



rush of
pleasure
euphoria
pain relief
relieve
withdrawal
symptoms

distorted
perceptions
& sensations
relaxation or
euphoria

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Physical/Psychological
Dependence
increased anxiety
nausea
impaired reflexes
& motor
coordination
loss of
consciousness
convulsions or
coma
death


yes
yes
increase anxiety
paranoia
hallucinations or
psychosis
excessive ANS
arousal
vomiting
death


yes
yes
nausea, vomiting,
and constipation
painful
withdrawal
convulsions,
coma
death


yes
yes
extreme
delusions or
hallucinations
low motivation
or fatigue
possible
psychosis
death


no
maybe
III. Alcohol - History & Reasons for Use
Alcohol was used as a major anesthetic for surgery during the 1800s and early into the
twentieth century when other anesthetics were unavailable. Today, alcohol is no longer
used for medical purposes. However, researchers are currently studying whether
drinking one glass of red wine per day will reduce risk of heart attacks among high risk
populations. Other forms of alcohol may actually increase risk of heart disease.
Other depressant drugs are commonly prescribed for a variety of anxiety disorders, such
as phobias, obsessive compulsive disorder, and so forth. People use alcohol for a variety
of reasons, e.g. to dull or numb feelings of anxiety, frustration, boredom, hurt, sadness, or
anger.
IV. Alcohol Use & Alcoholism - physiological & behavioral effects
A. Physiological Effects - Alcohol is absorbed through the stomach & small intestine
into the blood stream, then distributed throughout the body; this small chemical
messenger easily crosses the blood/brain barrier.
In the brain, alcohol depresses functioning of the reticular formation (a.k.a. reticular
activating system or RAS). Normally, the RAS monitors the environment, sorting out
which stimuli to respond to and which stimuli to ignore. Alcohol also depresses
sympathetic nervous system (SNS) activity by blocking norepinephrine receptors.
Current research suggests that alcohol, as do most other drugs, interferes with dopamine
systems in the brain.
Alcohol interferes with the ability to transfer short-term memory into long-term storage
and REM sleep - perhaps because of depressed RAS functions.
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Alcohol is metabolized by the liver at an average rate of 1/3 to 1/2 ounce per
hour.
Larger, heavier people have more body fluid and will have a lower blood alcohol
level (BAL) than smaller people drinking the same amount.
Women have a higher percentage of body fat than men (i.e. less body fluid), so a
typical woman will have a higher BAL than a man of the same weight drinking
the same amount of alcohol.
B. Behavioral Effects - initially, people seem more animated when drinking alcohol in
that they talk louder, laugh more, and engage in more sexual behavior. As a person
becomes more intoxicated, reaction time becomes slower, accuracy of responses is poor,
speech becomes slurred, motor coordination diminishes, self-awareness decreases, and
judgment is impaired.
As a result, people are more sexually promiscuous when drinking: they are more willing
to have sex with a stranger & less likely to use contraceptives. Men, in particular, tend to
become more sexually aggressive. But depressed SNS activity makes physiological
arousal more difficult. When sober, women often report regrets about sexual experience
during an intoxicated state. Domestic violence research shows that in about 65% of
violent interactions, the abuser and / or the victim have been drinking. Similarly, the
majority of convicted rapists report having used alcohol before committing a rape.
Beliefs about the effects of alcohol also influence behavior - even when these beliefs are
false. Because alcohol use precedes the majority of domestic violence, sexual assault,
and rape incidents, many people believe that alcohol causes aggressive behavior. Several
experiments have been conducted to determine if alcohol use causes aggressive
behavior. For example, participants are randomly assigned to an experimental condition,
then given the opportunity to administer electric shocks to someone who had insulted
them, socialized with members of opposite gender, or complete questionnaires about
handling arguments. What do you expect the results of these experiments show?
Experimental
Conditions
People believed they
were drinking alcohol
People
believed they
were not
drinking
alcohol
Consumed
Alcoholic
Beverage
Consumed NonAlcoholic
Beverage
Experimental
Conditions
Consumed
Alcoholic
Beverage
People believed they were
drinking alcohol
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
higher rates of shocks
greater likelihood of
hitting someone
more sexual advances
People believed
they were not
drinking alcohol



Consumed NonAlcoholic
Beverage



higher rates of shocks
greater likelihood of
hitting someone
more sexual advances


lower rates
of shocks
less
likelihood
of hitting
someone
fewer
sexual
advances
lower rates
of shocks
less
likelihood
of hitting

someone
fewer
sexual
advances
C. Alcoholism
There is some disagreement whether or not alcoholism should be viewed as a disease.
When a disease model is adopted, there are 4 phases of alcoholism.
Phase I - Prealcoholic
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drinking daily or almost daily
drinking is a panacea for everyday stressors
some physical tolerance develops
Phase II - Early Alcoholism


surreptitious drinking
amnesia or blackouts
Phase III - Addiction

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life situation deteriorates
feelings of guilt
promises but fails to quit
Phase IV - Chronic Alcoholism


drinking sprees or bingers for days or weeks
brain and / or liver damage
D. Alcohol Withdrawal
First 24 hours



tremulousness
feelings of unease
can recognize hallucinations
Days 2 - 4
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may have convulsions
may loose consciousness
may loose control of other body functions
Days 3 - 6
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Delirium Tremens (DTs)
may be unable to recognize hallucinations
may experience serious problems with racing heart, heat exhaustion, and
increased respiration
approximately 15% of patients die
For additional information on effects of alcohol and others drugs, see
http://faculty.washington.edu/chudler/introb.html#drug
OPIATES
A. History & Reasons for Use (see http://faculty.washington.edu/chudler/hero.html)
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Opiates include any drug derivatives from opium poppies, e.g. opium, morphine,
heroin, codeine.
Opium has been used in many cultures around the world for thousands of years.
Medically, opiates have been used for relief of severe pain, reducing anxiety,
controlling diarrhea, and inducing sleep.
In 1803, a French chemist isolated the active ingredient in opium & called it
morphine - for the Greek god of dreams, Morpheus.
Throughout the 19th century Morphine was used as an anesthetic, a sleep
medication, and an anti-diarrhea agent.
The hypodermic needle was invented in 1853; morphine was used throughout the
Civil War to treat soldiers' injuries.
Chemists with the Bayer Company, a German pharmaceutical company,
developed heroin, then aspirin while searching for a medical alternative to
morphine, in the late 1800s.
Heroin is used to treat morphine addiction - until it is realized that the addictive
properties are stronger that with morphine
All uses of heroin are outlawed by 1924.
B. Physiological & Behavioral Effect
1. Physiological Effects - Opiate drugs are chemically similar to endorphin
neurotransmitters (enkephalon and substance P). Acting as antagonists, opiates
bind to endorphin receptor sites. Neurons with endorphin receptors are located in
the spinal cord, midbrain and limbic systems, and regions of the brain stem.
Opiates also increase the production of histamines, increase the availability of
dopamine, and decrease the level of inhibitory neurotransmitters (e.g., substance P
and GABA).
Opiate use causes tolerance, then physical dependence or addiction. With
increasingly larger doses of these drugs, respiratory centers of the brain are
inhibited. Withdrawal symptoms include cold or flu-like symptoms,
- regions in the spinal cord with endorphin receptors are the first transmission
stations of sensory information from the body to the brain;
- the amygdala, in the limbic system, regulates emotion such as fear,
aggression, euphoria, and reactions to pain;
- the affected regions in the brain stem regulate eye movement and pupil
control.
2. Behavioral Effects
a) experience of heroin - immediate effects of an intravenous injection include:
- a rush sensation of extremely pleasurable feelings
- a tingling warmth sensation in the abdomen
b) within a few minutes, the user also experiences
- body itches
- red, watery eyes and runny nose
- then a stuporous state of sedation
- vivid pleasant dreams and intense imagery
- no worry or concern for anything, no motivation
- decrease appetite and loss of sexual desire
c) Addiction - leads to preoccupation with and pleasure from preparation and
injection activities. Some people become "needle freaks" who insert a needle, withdraw
and re-inject blood for the sensation associated with the "rush" of getting high.
Addicts generally have poor eating habits, loose weight, and suffer vitamin
deficiencies. This poor physical condition often causes nausea & vomiting when using
opiates - but addicts sometimes call this a "good sick" because the pleasurable sensations
of being stoned seem to override the physical sickness.
d) Overdose - Large doses of opiates inhibit respiratory centers in the brain stem.
With high levels of opiates the automatic process of breathing is lost. The stoned user
needs continuous instructions to breath - otherwise s/he will fall asleep, stop breathing,
and die.
C. Withdrawal and Treatment
Withdrawal

about 4 hours after last use - vague feelings of anxiety and strong craving for
drug;
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about 8 hours after last use - yawning, perspiring, and assorted cold-like
symptoms
about 12 hours after last use - pupils dilate, body hair stands on end
(piloerection), muscles twitches especially in calves and feet, bone and muscles
ache.
about 24 hours after last use - SNS is running on overdrive; increased blood
pressure, pulse, respiration, body temperature, and perspiration; the person
vomits, has diarrhea and orgasms.
about 36 hours after last use - symptoms subside and physical dependence is decreasing.
Treatment


cold turkey in hospital
methadone maintenance
Stimulants - cocaine, amphetamines (e.g. Benzedrine, Dexedrine, and Methadrine collectively known as speed), caffeine, and nicotine
Physiological Effects - Amphetamines closely resemble norepinephrine and / or
dopamine so they act as agonists simulating or increasing the actions of these
neurotransmitters. Cocaine and speed also affect the neurotransmitter - catecholmine which affects the production of norepinephrine & dopamine. Overall, stimulants increase
the amount of excitatory neurotransmitters in the brain which causes a higher frequency
of neural impulses. Finally, there is also an increased amount of serotonin in the brain.
The collective effect of these neurotransmitter alterations are:
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speeded up nervous system with increased heart rate, increased blood sugar, and
constricted blood vessels;
reaction time is faster but thought processes or information processing is
incomplete; a person makes faster, but more error-ful judgments;
coordination may be enhance and the user is more resistant to fatigue (i.e. steroid
use among athletes);
changes in sexuality, with increased desire and decreased ability;
low doses increase energy, feelings of vitality alertness and cause a lose of
appetite;
higher doses can change alertness into feelings of being "driven", concentration is
difficult, the user feels tense and irritable, then depressed when drug wears off.
Hallucinogens (or Psychodelics) = include LSD, PCP, mescaline, peyote, psilocybin
mushrooms, marijuana, etc.

This is a wide variety of chemicals with varying molecular structures . . . with a
variety of effects on the nervous system and behavior.

Most hallucinogens inhibit serotonin neurons in the brain stem. Typically,
serotonin is involved in sensory perception . . . especially in filtering relevant and
irrelevant sensory information. The effect of hallucinogens is to reduce this
filtering process.
- person may experience transmutation or synesthesia (i.e. seeing sounds, hearing colors)
- details and objects seem very important
- objects may appear to be moving as in undulation
- visual perception tends to take on a red or purplish tint
- time perception is distorted so that simple tasks taking only a few minutes seem to take
hours.
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Many hallucinogens also tend to enhance emotional reactions or moods; if the
user feels happy, the hallucinogen exaggerated this feeing into silliness,
relaxation, and even greater happiness.
"bad trips" can occur when a user's negative emotions, such as fear or anger, are
exaggerated.
some hallucinogens may impair short-term memory
hallucinogens are not addictive; in some cases, such as marijuana, there may be a
reverse tolerance effect. This is when smaller doses of the drug produce the same
effects previously caused by larger doses.
Questions: Clean And Sober
1. Why do people become attracted to and addicted to drugs/alcohol?
2. What kind of risky behaviour did Daryl engage in as a result of his
addiction?
3. Why did Daryl enroll in the rehab program initially?
4. How long was the program, and what happens during withdrawal? How do
some people act during this stage?
5. What rules and restrictions were there while Daryl was in rehab? Why
weren’t addicts allowed to use the phone?
6. Why was a former addict, Craig, working with addicts?
7. Why are addicts involved in (a) group sessions and (b) exercise?
8. Why was Craig so tough on Daryl (phone incident)?
9. In what ways was Daryl out of control, and how did he try to use others to
his advantage?
10. Why was Daryl’s first attempt at rehabilitation unsuccessful?
11. Why does Daryl return to the treatment program?
12. What is a sponsor, and why do addicts need one?
13. Why should recovering addicts attend AA meetings?
14. What challenges must Daryl face, and what demons must he confront to
overcome his addiction? Is he successful, or is this an ongoing challenge?
Explain.
15. How is this portrayal of an addict indicative of addicts today?
Cast overview, first billed only:
Michael Keaton
.... Daryl Poynter
Kathy Baker
.... Charlie Standers
Morgan Freeman
.... Craig
Tate Donovan
.... Donald Towle
Henry Judd Baker
.... Xavier
Claudia Christian
.... Iris
J. David Krassner
.... Tiller
Dakin Matthews
.... Bob
Mary Catherine Martin .... Cheryl Ann
Patricia Quinn
.... June
Terri Hanauer
.... Admissions Counsellor
David A. Kimball
.... Doctor
Veronica Redd
.... Head Nurse (Detox)
Sharon Medearis
.... Nurse
Nick Savage
.... Gary 'Ike Turner'
CLEAN AND SOBER
Date of publication: 08/10/1988
By Roger Ebert
It's the kind of thing that could happen to anybody. Just plain rotten luck, really. He picks up a
woman in a bar, and they do some cocaine together, and the next morning when he wakes up,
she's dead. She had a heart attack or something. How was it his fault? What happens to the hero
of "Clean and Sober" during the next several weeks of his life is that he decides that although it
could have happened to anyone, he doesn't want it to happen to him anymore.
The guy is named Daryl Poynter, and he is played by Michael Keaton with a kind of wound-up,
edgy tension that is just right for the character. He's a hotshot Philadelphia real-estate salesman,
but by the time the movie opens, there is nothing in his life of any importance, really, but cocaine.
He doesn't even question the fact. It's not that he needs cocaine to function - because he doesn't
function, really; he just goes through the motions - but that he needs cocaine to still himself from
the savage, restless angers of his need for the drug.
It doesn't go over very well that the woman woke up dead in his bed. The police are interested.
Although it was her "fault" ("I didn't give her cocaine, she gave me cocaine," he argues), the
victim's father plasters Poynter's neighborhood with posters branding him as a murderer. At work,
things are not too good, either, because he has borrowed $92,000 from an escrow account and
invested it in the market, hoping to make a lot of money, and he has lost most of the money
instead.
So he needs a place to hide out, and when he hears on the radio about a confidential,
anonymous drug-rehabilitation program, he figures that might be a good place to disappear into.
What he doesn't count on is that the program is run by a hard-headed counselor (Morgan
Freeman) who has heard everybody's story before, and sees right through him.
"Clean and Sober" is the story of how the Keaton character is forced to look at the fact that his life
is wildly out of control, and that cocaine addiction is the cause, not the solution. He fights this
discovery every step of the way, and is far from being a model client in the rehab center. He calls
friends and asks them to send him cocaine in overnight Federal Express packages; he slips out
of the center on wild, undefined missions, and of course, he thinks he's God's gift to women especially to one of his cute fellow patients.
She's played by Kathy Baker, as a woman who has two addictions: one to booze, the other one
to the man she lives with, who beats her and then comes whining to her for forgiveness, telling
her he's nothing without her. Her self-esteem has been so seriously wounded by her alcoholism
that she clings to this relationship, perhaps believing that this loser is the only man who will
accept her.
In his first few days in the center, Keaton finds himself at war with Freeman, the counselor.
Freeman has met so many, many others just like him, and knows the alibis and evasions, and
knows that unless this guy gets serious, he is going to go right back out and get screwed up
again. The relationships between the counselor and the patients are at the heart of the movie,
which also shows Keaton going to an Alcoholics Anonymous meeting and trying, on Freeman's
orders, to get himself a "sponsor" - a veteran AA member who will advise and help him. Of
course, Keaton goes for the prettiest woman at the meeting, but eventually he winds up with wise,
lethargic M. Emmet Walsh, who looks at him quizzically because he knows what a lost cause he
could easily be.
"Clean and Sober" is not the story of an ideal recovery from drug or alcohol addiction, because
Keaton is not an ideal candidate for recovery. He tells too many lies, especially to himself, and he
doesn't much like to accept advice. He is still somewhat seduced by the notion that he can do
some repairs on his old lifestyle, and it will still work. But by the end of the movie there is some
hope that he may be able to get straight.
Although the subject matter of this film is commonplace in our society - for every celebrity who
checks into the Betty Ford Center, there are thousands of ordinary people who check in
somewhere else, or who pick up the phone and call AA. Everybody knows somebody like this.
But the actual process of surrender and recovery is hardly ever the subject of films, maybe
because it seems too depressing. One of the strengths Michael Keaton brings to "Clean and
Sober" is his wild, tumultuous energy, which makes his character seem less like a victim than like
an accident causing itself to happen. Surrounded by superb supporting performances - especially
by Baker, who also co-starred with Freeman as the prostitute in "Street Smart" - Keaton makes
this general story into a particular one, and a touching one.
(mfw)