Euphoria—the most tweeted-about TV present of the last decade within the U.S.—has thrust teenage drug use into the cultural highlight. The HBO present follows 17-year-old Rue Bennett, a candy however troubled teen performed by Zendaya, as she navigates a deepening drug use dysfunction. It’s not fairly. Rue takes the highly effective opioid fentanyl, injects morphine, and drags round a suitcase crammed with 1000’s of {dollars} price of medicine (a stash she will be able to’t resist dipping into). In the meantime, she rips aside her life: tearing by her home, ransacking strangers’ houses, and screaming on the folks she loves essentially the most.
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But the present’s season two finale, which aired on Feb. 27, ends on a hopeful be aware for Rue’s restoration. Right here’s what habit consultants who watch the present say that Euphoria will get proper about teen drug use and therapy—and the place it misses the mark.
What Euphoria will get proper: Drug use isn’t uncommon amongst teenagers
The present has sparked controversy over the way it portrays teen drug use. In January, D.A.R.E.—the Drug Abuse Resistance Training program—criticized the present for “glorify[ing]” highschool drug use and making it appear “widespread and widespread in at this time’s world.” However drug use just isn’t unusual amongst highschool college students at this time. Within the U.S., about 1.6 million children ages 12 to 17—6.3% of the adolescent inhabitants—had substance use dysfunction in 2020, in response to the Substance Abuse and Psychological Well being Providers Administration (SAMHSA). “That’s an enormous drawback,” says Dr. Lynn Fiellin, professor of drugs on the Yale College of Medication and Little one Research Heart, who’s skilled in habit medication and behavioral well being (and who’s a fan of the present). The issue appears to be rising, too; in 2020, hundreds of thousands extra children tried medication for the primary time. “Euphoria depicts precisely what’s going on,” she says.
Rue takes many several types of medication all through the present—from marijuana to Xanax—however she mostly makes use of opioids. This can be a main concern, as a result of opioid use is commonly lethal in younger folks: in 2020, almost 6,000 youth ages 15 to 24 died of an overdose involving opioids within the U.S, amounting to 84% of all drug overdose deaths in that age group, in response to Nationwide Heart for Well being Statistics knowledge.
The present excels at portraying the “chaos” that may occur when a youngster’s substance abuse will get uncontrolled, as Rue’s does, says Fiellin. Within the first episode, Rue’s little sister discovers her overdosing in a puddle of her personal vomit; the 2 seasons comply with Rue as her drug use continues to wreck her closest relationships.
What Euphoria will get unsuitable: Remedy choices aren’t so restricted
One thing this system does much less effectively is displaying the vary of choices folks have to assist them get well from substance use dysfunction. Whereas psychiatrists and consultants agree that Rue—or somebody like her—faces a troublesome restoration, she hasn’t explored all of her choices, and even the very best ones.
On Euphoria, Rue has participated in two predominant remedies: inpatient rehab in season one and Narcotics Nameless (NA)—which, like Alcoholics Nameless, is a 12-step-model emphasizing spirituality and abstinence from substances. Whereas these applications may also help some folks, they’re not for everybody, and include sure drawbacks, psychiatrists say. Rehab applications can differ in high quality and be very costly, whereas NA can typically alienate people who find themselves much less non secular—like Rue, who declares she doesn’t imagine in God. Nevertheless, NA does allow Rue to develop a strong connection together with her sponsor, Ali Muhammad, who pushes her to alter the way in which she seems on the world. Fiellin says that relationships like this with “of us who’re supporting you and listening,” may be important for restoration. That proved to be true for Rue.
Dr. Sulman Aziz Mirza, a psychiatrist who makes a speciality of grownup, baby and adolescent, and habit psychiatry (and who watches the present), says he needs Rue’s storyline would present her attempting totally different choices that would assist her get well. “There’s simply an inevitable [sense] that we’re going to see Rue die” in future seasons, he says. “I’m hoping that not less than there’s some acknowledgement that, ‘Hey, there are alternatives there.’”
Up to now, the present has not depicted one of the profitable remedies for opioid-use dysfunction: medicines like buprenorphine. Based on Robert Miranda, professor of psychiatry and human conduct at Brown College (who is aware of concerning the present’s emphasis on drug use however doesn’t watch it), buprenorphine reduces cravings and withdrawal signs by activating the identical elements of the mind as opioids, however doesn’t set off the identical “excessive” or negative effects. “I feel that’s a missed alternative to spotlight a therapy like buprenorphine,” says Fiellin. Buprenorphine and different related medicines, together with naltrexone and methadone, have been discovered to scale back opioid use, lower the chance of overdose, and improve the chances {that a} affected person will keep in therapy, in response to the Nationwide Institute on Drug Abuse.
Taking treatment for opioid use dysfunction “can provide a bonus, an often-needed edge,” says Miranda. “It will probably provide reprieve from the extraordinary cravings and antagonistic drug withdrawal signs that individuals face—together with many teenagers—whereas struggling to scale back their drug use.”
Remedy is another choice that may be particularly efficient when paired with treatment, Fiellin says. Cognitive behavioral remedy, household remedy, and an strategy referred to as motivational interviewing have all been proven to assist folks with opioid use dysfunction. Motivational interviewing, a counseling strategy during which a counselor talks with a affected person concerning the the reason why they should change and their causes for doing so, is designed to assist people who find themselves ambivalent about in search of therapy. This technique would possibly make sense for somebody like Rue, who walks out of rehab within the collection premiere and declares, “I had no intention of staying clear.” Altering conduct may be an particularly “arduous promote” for an adolescent like Rue, says Dr. Kevin Grey, a professor of psychiatry and behavioral sciences on the Medical College of South Carolina, so motivational interviewing applications may also help by “driving them towards motivation, somewhat than ready for them to be motivated.”
Simply as totally different causes lead folks to drug use, totally different motivations may also help people get well. Mirza says the secret is to seek out the remedies—and well being care suppliers—that work for every individual. ”I may very well be Harvard skilled, and I may have levels and publications and books and all the pieces like that, but when I can’t join with the child that’s in entrance of me, it doesn’t imply something,” says Mirza.
Rue’s lengthy highway forward
On the finish of the season two finale, Rue says in a narration that she stayed clear for the remainder of the college yr. However psychiatrists who watch Euphoria agree that Rue’s longer path to restoration is not going to be simple—nor would it not be if she had been a teen in the actual world. Individuals like Rue face many obstacles that make it troublesome for his or her situation to enhance, and even for them to outlive. For many individuals, drug use dysfunction is a persistent situation with which they need to proceed to manage all through their lives. “There are some younger individuals who get into actually critical hassle with substance use who’re in a position to get well rapidly and keep lifelong sobriety,” says Grey, however others wrestle with lifelong habit. “Identical to if any person had hypertension or diabetes, we don’t count on them to enter a therapy, after which cease the therapy and endlessly be cured.”
One in all Rue’s triggers for substance use points is her wrestle with anxiousness, panic assaults, and different psychological well being points, Fiellin factors out. Psychological sickness and drug use can create a “vicious cycle,” she says: psychological sickness can push folks to make use of medication, which in flip could make the situation worse. Meaning it’s particularly vital to seek out methods to deal with each points. “Psychological well being and habit are so tightly linked, and there’s a lot overlap, that you just actually can’t deal with one in a vacuum.”
The present additionally hasn’t explored one other main threat for Rue and drug customers of all ages within the U.S.: the hazard of a drug provide that’s contaminated by the extremely potent opioid fentanyl, which has been linked to a surge in opioid overdose deaths within the U.S. Whereas Rue is proven taking fentanyl deliberately, she is more likely to additionally encounter it blended in with one other drug with out her data, which signifies that she wouldn’t be capable to management her dose. Rhana Hashemi, a researcher who promotes hurt discount training in colleges, is crucial of Euphoria for making the drug provide appear so easy: Rue and different characters don’t query what they’re taking or promoting, and there doesn’t appear to be a lot concern for whether or not medication are mislabeled or adulterated. Although they’re not explored within the present, harm-reduction strategies, like Narcan and fentanyl check strips, may also help make drug use safer. “Most [illicit] substances have fentanyl, and dosing the fentanyl is de facto troublesome,” says Hashemi. “That’s why it’s so vital to by no means use alone, to check your medication, and to have Narcan readily available.”
One different main problem for Rue is that she is an adolescent. Entry to high-quality therapy could be a main drawback for adolescents—particularly if, like Rue, they dwell outdoors of a metropolis and their household isn’t rich. That’s compounded by all the opposite typical challenges of being a teen: coping with a creating mind, restricted impulse management, and the drive to determine id. For anybody, being a teen may be troublesome. Layering on substance use dysfunction could make it appear unattainable.
Nevertheless, the silver lining is that teenagers are nonetheless rising and maturing, and their youth offers professionals a chance to intervene early of their drug use. Even for somebody like Rue, “there’s nonetheless a lot potential,” Grey says.
