What’s going on with Lee Sa-Ra?
I recently finished watching a Korean TV show called "The Glory," and found one of the antagonists—Lee Sa-Ra—an interest of study when examining addiction.
Sa-Ra comes from a wealthy family with dreams of becoming an artist. She struggles with drug and substance use causing her to be mentally unstable, experience brain fog, and have uncontrollable anger. Due to her insobriety, she often slept on the streets and hallucinated images of snakes and voices from nonexistent people. Although becoming an artist was her main goal in life, her drug use hindered her from painting and working at an optimal level. She would also later rely on others to do her artwork for her.
Her relationship with her caring parents and friends worsens as her drug intake increases. Her parents’ initial reaction to Sa-Ra’s drug and substance addiction was to send her away to another foreign country such as Paris; however, this would only exacerbate the situation as she was isolated in a country where communication was an issue and no one took care of her. Hence she would go on to use more drugs such as cannabis to mitigate the loneliness of being in a foreign country with no family or friends. In addition, during her daily life, there are not a lot of substance-free activities as her wealthy friends all spend lavishly on clothing, parties, drinks, and other substances. All of these factors would drive Sa-Ra to increase her use of drugs.
According to the neurobiological cycle of addiction, there are three stages of addiction. Sa-Ra goes through all these stages with the initial binge or intoxication stage during adolescence (the most vulnerable age due to the development of the brain) where she feels the rewarding effects of drugs that negatively reinforce—reduce loneliness and the feelings of unwantedness her parents—and positively reinforces—feeling happier—her to use it. Sa-Ra is not thinking about the long-term consequences hence during this stage she behaves impulsively. The second stage or when Sa-Ra feels withdrawal symptoms such as stress and other negative emotions after not using drugs. She experiences withdrawal symptoms such as anxiety, irritability, and most notably hunger. Sa-Ra would lie on the floor and binge eat whatever she could find in the fridge such as cold pizza and eating a whole chocolate cake with her hands. Although Sa-Ra understands that abusing drugs is unhealthy and damaging to her future of being an artist, she engages in it anyway due to the compulsivity associated with this stage. In addition, painting and making art—non-drug reinforcers—brings less pleasure than usual relative to smoking and using drugs. The third stage of addiction is preoccupation or anticipation. Sa-Ra begins to seek out and crave drugs after a period of abstinence due to withdrawal. She was willing to do anything and pay any price for drugs from her dealer and friend Son Myeong-o.
For treatment, Sa-Ra could benefit from the community reinforcement approach (CRA) which attempts to change an individual’s behavior by reducing the relative value of one behavior and increasing the relative value of alternative behavior. This method will change Sa-Ra’s lifestyle by increasing the value that she places on her hobbies such as painting and making art and reducing the significance of drugs. There can also be positive and intermittent reinforcement such as a reward for staying sober. CRA has been effective in treating alcohol disorders, opioid use, and cocaine use. This approach often has one to two sessions per week that include learning about coping mechanisms, positive and negative consequences of substance use, and how to build healthy relationships with others. In addition, CRA can improve Sa-Ra’s behavioral skills such as critical thinking, decision-making, communication skills, and focusing on long-term goals.
