Each of the four protagonists suffered through drug dependency — or rather, they particularly enjoyed it, for most of its run. It was Sarah Goldfarb (Ellen Burstyn) though, who was the only character dependent on legal prescription drugs, showcasing that dependency is not limited to just illegal drugs, and that prescriptions can be just as dangerous.
Sarah begins taking the weight loss drugs (a type of amphetamine) for positive reinforcement, to achieve her desired weight loss. She consistently loses weight gradually as she takings all of the pills as prescribed. When she begins taking the drug, before she is addicted, the first stage of addiction, drug intoxification, occurs. At this stage, Sarah is only taking the drugs to achieve the drug’s (positive) reinforcing effects. Sarah’s approach to taking drugs was very different from Harry’s.
As suggested from early on the film, Harry was only taking the drugs recreationally – to merely achieve the effects of the drug, whereas Sarah was taking the drug or an intended, socially-acceptable purpose. When Sarah begins taking the drugs, she is not addicted, but only wants to take the drug to achieve its desired effect (weight loss). After long-term use of the drug, she becomes dependent on it; when she no longer has access to the drug after long-term use, she experiences withdrawal symptoms such as disorientation.
Negative and positive reinforcement also played a role in the drugs. She embodied positive reinforcement (pills = weight loss) and negative reinforcement (“if I stop taking the drugs, I will gain my weight back). More, according to the associative learning theory, she ssociated the drugs with weight loss, good memories of her husband, a healthy relationship with her son, and being on television, i.e., a perfect life.
Sarah’s drug use would be classified as substance dependence. First, she never intended to abuse the drug (especially for recreational purposes), but merely intended to only take a medical prescription for a desired effect (reinforcement) to lose weight to “fit in the red dress.” The drug never led to her violating major role obligations, making hazardous decisions, and getting involved in legal problems (her son and Tyrone were involved in drug abuse), but rather, by the time Sarah was showing signs of abnormally, she was victim to the long-term effects of the drug. She showed signs of a lack of free choice when taking the drugs; routinely, she took the drugs as required, sipped her coffee, and stared at the monstrous refrigerator and hallucinated the guests in her home, she acted as if she was a victim to the drug’s effects, as if she had no free will no control over the drug.
At this point, Sarah’s amygdala, which controls focus, along with her nucleus accumbens was being altered. With frequent time on the drugs, Sarah’s cognitive ability showed signs of being delayed. When Sarah noticed that Harry came to visit to surprise his mother with the new television, the filmic techniques suggested that Sarah had a delay before her mind registered that it was her son. Harry noticed his mother was on “uppers” when she started grinded her teeth abnormally and uncharacteristic jitteriness. At this point, the “uppers” were turning around the dopamine transporter causing her high levels of dopamine in the brain.
After long-term use, Sarah develops a tolerance to the drugs. She called her doctor’s office to ask why the drugs were having a weaker effect on her, and she was informed that the drugs were same potency as when she started, only Sarah is becoming “adjusted” to them. Thus, in order to substitute for the increased tolerance to the drug, and to achieve the same elevation in mood as when she began the prescription, she started taking 3 pills at once. At this point, Sarah begins chronic use of the drug to reach the desired effect. Sarah unfortunately illustrated an example of the opponent-process theory, which indicates that she had to take more of the drug to feel normal. Moreover, she began to develop a “craving” for the drug because now, with the drug present in her central nervous system, she was not feeling the same change in effect as when she first began the drug, but now she had to take more with an attempt to reach that effect, as illustrated in the Psychology Dependence mode. Sarah’s body learned to tolerate and expect the drug, therefore her euphoric effects decreased over time with each use of the drug.
Sarah was eventually able to fit in that red dress, but unfortunately, her mind, and how others perceive her, was affected. When drugged-out, sweaty, battered Sarah was brought to the treatment center, she, with her saying, “I’m going to be on television,” was inferred by others as a senile old lady.
The most appropriate treatment option for, at least mid-way through the film, would be drug-replacement therapy, in which she could have replaced her strong amphetamines with less powerful drugs that gave her energy as well as contributes to weight loss. By the time her central nervous system was damaged, first detoxification from the drug would be necessary, then perhaps a drug acting as an antagonist could be used to bind to the neurotransmitter which may lower excess dopamine levels in the brain.