Euphoria—the most tweeted-about TV show of the decade in the U.S.—has thrust teenage drug use into the cultural spotlight. The HBO show follows 17-year-old Rue Bennett, a sweet but troubled teen played by Zendaya, as she navigates a deepening drug use disorder. It’s not pretty. Rue takes the powerful opioid fentanyl, injects morphine, and drags around a suitcase filled with thousands of dollars worth of drugs (a stash she can’t resist dipping into). Meanwhile, she rips apart her life: tearing through her house, ransacking strangers’ homes, and screaming at the people she loves the most.
Yet the show’s season two finale, which aired on Feb. 27, ends on a hopeful note for Rue’s recovery. Here’s what addiction experts who watch the show say that Euphoria gets right about teen drug use and treatment—and where it misses the mark.
What Euphoria gets right: Drug use isn’t rare among teens
The show has sparked controversy over how it portrays teen drug use. In January, D.A.R.E.—the Drug Abuse Resistance Education program—criticized the show for “glorify[ing]” high school drug use and making it seem “common and widespread in today’s world.” But drug use is not uncommon among high school students today. In the U.S., about 1.6 million kids ages 12 to 17—6.3% of the adolescent population—had substance use disorder in 2020, according to the Substance Abuse and Mental Health Services Administration (SAMHSA). “That’s a huge problem,” says Dr. Lynn Fiellin, professor of medicine at the Yale School of Medicine and Child Study Center, who is trained in addiction medicine and behavioral health (and who is a fan of the show). The problem seems to be growing, too; in 2020, millions more kids tried drugs for the first time. “Euphoria depicts exactly what is going on,” she says.
Rue takes many different types of drugs throughout the show—from marijuana to Xanax—but she most commonly uses opioids. This is a major concern, because opioid use is often deadly in young people: in 2020, nearly 6,000 youth ages 15 to 24 died of an overdose involving opioids in the U.S, amounting to 84% of all drug overdose deaths in that age group, according to National Center for Health Statistics data.
The show excels at portraying the “chaos” that can happen when a young person’s substance abuse gets out of control, as Rue’s does, says Fiellin. In the first episode, Rue’s little sister discovers her overdosing in a puddle of her own vomit; the two seasons follow Rue as her drug use continues to wreck her closest relationships.
What Euphoria gets wrong: Treatment options aren’t so limited
Something the program does less well is showing the range of options people have to help them recover from substance use disorder. While psychiatrists and experts agree that Rue—or someone like her—faces a difficult recovery, she hasn’t explored all of her options, or even the best ones.
On Euphoria, Rue has participated in two main treatments: inpatient rehab in season one and Narcotics Anonymous (NA)—which, like Alcoholics Anonymous, is a 12-step-model emphasizing spirituality and abstinence from substances. While these programs can help some people, they’re not for everyone, and come with certain drawbacks, psychiatrists say. Rehab programs can vary in quality and be very expensive, while NA can sometimes alienate people who are less religious—like Rue, who declares she doesn’t believe in God. However, NA does enable Rue to develop a powerful connection with her sponsor, Ali Muhammad, who pushes her to change the way she looks at the world. Fiellin says that relationships like this with “folks who are supporting you and listening,” can be essential for recovery. That proved to be true for Rue.
Dr. Sulman Aziz Mirza, a psychiatrist who specializes in adult, child and adolescent, and addiction psychiatry (and who watches the show), says he wishes Rue’s storyline would show her trying different options that could help her recover. “There’s just an inevitable [sense] that we’re going to see Rue die” in future seasons, he says. “I’m hoping that at least there’s some acknowledgement that, ‘Hey, there are options there.’”
So far, the show has not depicted one of the most successful treatments for opioid-use disorder: medications like buprenorphine. According to Robert Miranda, professor of psychiatry and human behavior at Brown University (who knows about the show’s emphasis on drug use but does not watch it), buprenorphine reduces cravings and withdrawal symptoms by activating the same parts of the brain as opioids, but doesn’t trigger the same “high” or side effects. “I think that’s a missed opportunity to highlight a treatment like buprenorphine,” says Fiellin. Buprenorphine and other similar medications, including naltrexone and methadone, have been found to reduce opioid use, decrease the risk of overdose, and increase the odds that a patient will stay in treatment, according to the National Institute on Drug Abuse.
Taking medication for opioid use disorder “can offer an advantage, an often-needed edge,” says Miranda. “It can offer reprieve from the intense cravings and adverse drug withdrawal symptoms that people face—including many teens—while struggling to reduce their drug use.”
Therapy is another option that can be especially effective when paired with medication, Fiellin says. Cognitive behavioral therapy, family therapy, and an approach called motivational interviewing have all been shown to help people with opioid use disorder. Motivational interviewing, a counseling approach in which a counselor talks with a patient about the reasons why they need to change and their reasons for doing so, is designed to help people who are ambivalent about seeking treatment. This strategy might make sense for someone like Rue, who walks out of rehab in the series premiere and declares, “I had no intention of staying clean.” Changing behavior can be an especially “hard sell” for a teenager like Rue, says Dr. Kevin Gray, a professor of psychiatry and behavioral sciences at the Medical University of South Carolina, so motivational interviewing programs can help by “driving them toward motivation, rather than waiting for them to be motivated.”
Just as different causes lead people to drug use, different motivations can help individuals recover. Mirza says the key is to find the treatments—and health care providers—that work for each person. ”I could be Harvard trained, and I could have degrees and publications and books and everything like that, but if I can’t connect with the kid that’s in front of me, it doesn’t mean anything,” says Mirza.
Rue’s long road ahead
At the end of the season two finale, Rue says in a narration that she stayed clean for the rest of the school year. But psychiatrists who watch Euphoria agree that Rue’s longer path to recovery will not be easy—nor would it be if she were a teen in the real world. People like Rue face many obstacles that make it difficult for their condition to improve, or even for them to survive. For many people, drug use disorder is a chronic condition with which they must continue to cope throughout their lives. “There are some young people who get into really serious trouble with substance use who are able to recover quickly and maintain lifelong sobriety,” says Gray, but others struggle with lifelong addiction. “Just like if somebody had hypertension or diabetes, we don’t expect them to enter a treatment, and then stop the treatment and forever be cured.”
One of Rue’s triggers for substance use issues is her struggle with anxiety, panic attacks, and other mental health issues, Fiellin points out. Mental illness and drug use can create a “vicious cycle,” she says: mental illness can push people to use drugs, which in turn can make the condition worse. That means it’s especially important to find ways to treat both issues. “Mental health and addiction are so tightly linked, and there’s so much overlap, that you really cannot address one in a vacuum.”
The show also hasn’t explored another major risk for Rue and drug users of all ages in the U.S.: the danger of a drug supply that is contaminated by the highly potent opioid fentanyl, which has been linked to a surge in opioid overdose deaths in the U.S. While Rue is shown taking fentanyl intentionally, she is likely to also encounter it mixed in with another drug without her knowledge, which means that she wouldn’t be able to control her dose. Rhana Hashemi, a researcher who promotes harm reduction education in schools, is critical of Euphoria for making the drug supply seem so simple: Rue and other characters don’t question what they’re taking or selling, and there doesn’t seem to be much concern for whether drugs are mislabeled or adulterated. Though they’re not explored in the show, harm-reduction methods, like Narcan and fentanyl test strips, can help make drug use safer. “[Many illicit] substances have fentanyl, and dosing the fentanyl is really difficult,” says Hashemi. “That’s why it’s so important to never use alone, to test your drugs, and to have Narcan on hand.”
One other major challenge for Rue is that she is a teenager. Access to high-quality treatment can be a major problem for adolescents—especially if, like Rue, they live outside of a city and their family isn’t wealthy. That’s compounded by all the other typical challenges of being a teen: dealing with a developing brain, limited impulse control, and the drive to figure out identity. For anyone, being a teen can be difficult. Layering on substance use disorder can make it seem impossible.
However, the silver lining is that teens are still growing and maturing, and their youth gives professionals an opportunity to intervene early in their drug use. Even for someone like Rue, “there’s still so much potential,” Gray says.
Correction, March 2
The original version of this story implied that most illicit drugs contain fentanyl. For a number of reasons, it’s difficult to determine if in fact that is the case; what is relatively certain is that many illicit drugs contain fentanyl.
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