Heroin Addiction of Mark Renton in the movie TrainspottingLast Revised on May 14, 2010
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Heroin Addiction of Mark Renton in the movie Trainspotting
The story of the movie Trainspotting (1996) by Danny Boyle revolves around few friends who are frequently abusing drugs. The main character Mark Renton suffers from severe addiction to heroin. When he is not injecting heroin into his veins, he is constantly surrounded by friends who are engaged in self-destructive activities – violent sociopath, con artists, and drug dealer and junkies. Mark Renton is depicted from the beginning as a person who realizes he should be choosing life, career and good health. But he states that he chose none of them because he got heroin, as if thatÃ¢â‚¬â„¢s a good justifiable reason for himself. However, Mark Renton does make many unsuccessful attempts to stop substance abuse and was able to recover from it to some extent; he suffers from addiction and withdrawal symptoms throughout the movie and therefore will need nursing interventions that are specifically focused on these symptoms if here to recover fully this time.
Unsuccessful Attempts to Become Sober
Mark attempts to become sober three times in the entire movie; the first two attempts fail badly. The first attempt includes locking himself in his room with preparations such as supply of foods and drinks to stop hunger and dehydration, personal hygiene items by the bedside if he is unable to go to the bathroom, and Valium to fight off severe withdrawal symptoms. Unfortunately, the next day he calls heroin dealer Mikey to purchase two heroin suppositories. According to Mikey, suppositories are better for him as it takes effect gradually.
Relapse to Drug Addiction
The second attempt to quit heroin use comes out after baby Dawn at his friendÃ¢â‚¬â„¢s house dies when Renton and his friends were busy injecting heroin, after few days he gets caught stealing from a store and presented in the court for sentence. Judge places him into the state-sponsored addiction program. There Renton uses all the three Methadone pills he was prescribed to cope with heroin addiction at the same time instead of spacing them over a time period. Methadone can be used as a heroin substitute while the patient recovers; it affects Ã¢â‚¬Å“the opiate receptors in the brain but doesnÃ¢â‚¬â„¢t not give the Ã¢â‚¬ËœhighÃ¢â‚¬â„¢ that heroin doesÃ¢â‚¬Â (Drug Maintenance Programs, 2003). Renton starts to have a strong craving for heroin after few hours; knowing he couldnÃ¢â‚¬â„¢t get any more Methadone, he takes off from the addiction center to a heroin dealer. There he passes out quickly after one strong shot of heroin injection; the dealer sends him to the hospital through taxi.
Unclear Road to Recovery
During his third attempt, RentonÃ¢â‚¬â„¢s family and friends insist that he quit heroin use. It is unclear whether he succeeded or not because even though he starts to live a responsible life of working as an estate agent from then on, he does use drug one time before the end of the movie. He uses it when his friends ask him to test the strength of the heroin from the supplies in the bag before selling them to a dealer for profits.
Signs and Symptoms of Heroin Addiction
In the movie, the main character Mark Renton who we have been discussing above is also the one with the most obvious mental health alteration signs and symptoms. Signs and symptoms are two different health consequences of abusing drugs Ã¢â‚¬â€œ signs are Ã¢â‚¬Å“objective findings that can also be perceived by an examinerÃ¢â‚¬Â besides the individual who is suffering, whereas symptoms are Ã¢â‚¬Å“subjective indication as perceived by the patientÃ¢â‚¬Â and not the examiner (MosbyÃ¢â‚¬â„¢s Dictionary, 2008, p. 1707 and 1797). Since Mark Renton was always using heroin in the entire movie, he showed many signs and symptoms. According to the book Focus on Nursing Pharmacology by Amy M. Karch (p. 72), constipation is one of the physical consequences of heroin, and in the beginning of the movie Renton was suffering from constipation which he too admitted was due to heroin use.
Mental Health Alterations Due to Heroin Use
Besides constipation, our textbook Foundations of Mental Health Care lists some of the mental and other physical health alterations that individuals usually undergo during and after heroin use, such as constricted pupils, emotional and respiratory depression, nausea, and euphoria (Valfre, 2009, p. 312). Mark Renton exhibited majority of these health alterations at some point in the movie. Whenever he injected heroin into his veins, he underwent euphoria and showed his blissfulness with smiles and laughs. It was hard to tell whether or not his pupils were constricted too, but his pale skin and dark circles under the eyes were clearly there as a result of the drug abuse. He was addicted to drug so much that he didnÃ¢â‚¬â„¢t find any reason to look for a career, family, health, home, develop a self worth, take care of himself and other lists of good things in life he stated at the beginning, instead he used heroin as a purpose of life, almost up to the end of the movie. The website HelpGuide claims that there are some very noticeable symptoms of drug addiction in people Ã¢â‚¬â€œ lack of motivation, poor sanitation, hygiene and grooming appearance, and Ã¢â‚¬Å“you continue to use drugs, despite knowing it is hurting youÃ¢â‚¬Â (Smith, 2010). Places where Renton was living and using drugs were matches these descriptions of filthy and very disorganized.
Physical Signs of Drug Overdose
Renton was overdosed with heroin many times and every time he went into coma. Valfre also states that the heroin overdose can be easily exhibited by shallow respirations, clammy skin, coma and convulsion (2009, p. 312). The most remarkable incident of unconsciousness resultant of overdose happened after he fled from the drug rehab center and received a heroin shot from the dealer. He was immediately unconscious and was short of breath. He had also taken three Methadone pills not long ago at the center. Even though he might have developed some level of tolerance to the drugs for using over a period of time, this time it was the extreme combination of methadone which he was legally prescribed but he took them non-therapeutically and the heroin injection shot that he bought from a dealer. Both of these drugs target our Central Nervous System and the same receptors in our brain (Lavelle, 2003).
Withdrawal Signs and Symptoms
Mark Renton also tried heroin withdrawal either all by himself or with the help of a designated program. All of these treatments were ineffective. Whenever he tried to get rid of the drug abusive behavior by himself, he lacked a good coping mechanism and ended up purchasing heroin the next day. The day when he locked himself in his room to stay away sober, he was starting to develop withdrawal symptoms right away. He was nauseated and vomited when he came out of his place. At the drug addiction therapy center ordered by the judge, Renton didnÃ¢â‚¬â„¢t have a good support and contact with his counselors. He only went there to get the drugs which would have supposedly treated his drug withdrawal symptoms if followed the administration directions correctly. However, due to lack of supervision at the rehab center Renton fled the place and relapsed severely. After he was too sick to move out of bed due to overdose, he tried to maintain sobriety with the help of his parents at their house. But he developed many withdrawal symptoms that were described in the textbook Foundations of Mental Health Care, which included watery eyes, sweating, panic, nausea, tremors, etc. (Valfre, 2009, p. 312). He began to hallucinate about the dead baby Dawn, a Doctor asking his father about infectious disease HIV that is transmitted via needle injection in a game show, etc. He was panicking, shivering, anxious and confused.
Nursing Process Involving Mark Renton
As a nurse, when we see Mark Renton as a patient we should be planning for his discharge from the first day by planning on goals and interventions to meet the expected outcomes from the treatment. But these couldnÃ¢â‚¬â„¢t be done without establishing the nursing diagnosis first (Tucker & Flannery, 1996, p. 47-50); we already have all the data necessary from assessments by observing Renton in Trainspotting. All of Mark RentonÃ¢â‚¬â„¢s nursing diagnoses will be related to the drug abuse as manifested by his behaviors in the movie that we discussed in the previous sections. The main nursing diagnoses are risk for aspiration when vomiting due to drug overdose, risk for infection through injection, ineffective health maintenance, disturbed sensory perception, potential for risk taking behaviors, impaired social interaction, deficient diversional activity, adult failure to thrive, ineffective therapeutic regimen management and ineffective coping mechanism (NANDA International, 2009).
Nursing Diagnoses and Expected Outcomes
These nursing diagnoses can be categorized in many different ways and so can be the expected outcomes or goals for our patient Mark Renton. We will categorize the expected outcomes into immediate, stabilization and the community. The immediate goals for Renton are those that he will need to achieve in a short period so that he could be physically safe before moving onto the next step of the treatment. The immediate goals are that Mark Renton will be free from injury and physiologic changes, establish healthy eating, sleep, rest, activity, grooming and personal hygiene behavior, express the feelings of anxiety, take medications as needed, refrain from non-prescribed drugs, demonstrate focus on self, and oriented to time, place and environment. Stabilization is the other goal that Renton will need to work on during that period to become stable and work on his personal skills. The stabilization expected outcomes are that Renton will demonstrate ability to engage in spontaneous activity for the sake of having fun in drug-free environments, assess own strengths and weakness realistically, get educated about health consequences of drug abuse, experience decreased withdrawal symptoms, continue with medication compliance, and maintain physiologic stability and agree to the drug addiction therapy. The final goal is to be able to survive in a community. For that, Mark Renton will continue to abstain from drugs, follow through discharge plans about his financial and legal problems, look for a career, demonstrate effective communication skills with others, use non-chemical methods of coping with stress or desire for happiness, participate in community support programs, verbalize plans to follow up with the treatment, express feelings without sense of guilt but strength, make decisions and solve problems independently, demonstrate self-care skills and daily routine of physiologic well-being (Schultz & Videbeck, 2008).
Nursing Interventions Specific to the Goals
Now to achieve all the expected outcomes, we have to develop nursing interventions specific to them. The book LippincottÃ¢â‚¬â„¢s Manual of Psychiatric Nursing Care Plans (2008) has long list of nursing interventions for people going through substance-abuse withdrawal symptoms. The interventions for Mark RentonÃ¢â‚¬â„¢s goals include offering and monitoring food intake so that he can become healthy; he has always put heroin before nutrition and it might be difficult for him to eat sufficiently. The physiological problems resulting from substance abuse has to be addressed with the patient from the beginning of this intervention. We will encourage client to explore ways other than drugs to deal with stress or achieve happiness, as was the care with Renton. Nurse has to teach him the risks for HIV infection from needle sharing he was doing for heroin through intravenous injection. The focus of this nursing intervention should be on RentonÃ¢â‚¬â„¢s strengths so that he could build on them and use them to work on his weakness in between. One of the RentonÃ¢â‚¬â„¢s biggest strength was his willingness to enroll in drug addiction treatment or even attempting to do by himself. He needs to be learn better effective coping mechanism if he were to try himself again. Since the patient is very high risk for abusing drugs again, offer him only the medication for that specific time and watch him take it and educate about the drug interactions with medications. The physician might prescribe him Buprenorphine or Naltrexone, alternatives to Methadone, to prevent relapse during the treatment; Buprenorphine produces less risk for overdose and withdrawal symptoms than Methadone (NIDA InfoFacts: Heroin, 2009). The only thing Renton has been doing in his life is using heroin, he needs help for planning his daily tasks and schedule. We will also need to provide resources that are available within the community for people with drug abuse problems as part of the nursing intervention (Valfre, 2009, 319).
Treatment Facilities for Mark Renton
The closest substance abuse treatment facility within our college area community is Avalon. They are licensed adult chemical health facility treating individuals in an outpatient basis; and if the patients need more help they can easily refer to any other Meridian Behavior Health network of 18 health facilities across the Twin Cities metro areas. Many of them also offer in patient treatment, where individuals can reside at the center during the therapy. AvalonÃ¢â‚¬â„¢s target group is both men and women who are older than 18 years of age. The treatment of chemical dependency is done through group activity, education, reality and rational emotive therapy, 12- step principles, and one and one counseling. Their service is provided very flexibly based on patientÃ¢â‚¬â„¢s needs and can include day or evening. Avalon is located at 1230 Eagan Industrial Road, Suite 100, Eagan, MN 55122.
Another treatment facility that is located within the college vicinity is the Dakota Treatment Center in Burnsville on 11939 River Hills West Drive Road. It is run by parent company Colonial Management Group which has many facilities located all over the United States. At Dakota Treatment Center, they help patients who are suffering from chronic substance abuse problems. Their medical director performs the initial assessments of patients for the admission and formulates a treatment plan with patients. Then the patients start to work with their personal counselor on varying flexible schedules to reach the goals to become sober.
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Karch, A. M. (2008). Focus on Nursing Pharmacology (p. 72). Philadelphia: Lippincott Williams & Wilkins.
Lavelle, P. (2003, November 13). Drug maintenance programs. In Heroin – Health & Well Being.
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Smith, M. (2010, February). Drug abuse and addiction. In HelpGuide.Org: Understand, Prevent, and
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