Euphoria— the most-tweeted US TV show of the decade — has put teenage drug use in the cultural spotlight. The HBO show follows 17-year-old Rue Bennett, a sweet but troubled teenager played by Zendaya, as she navigates a deepening drug addiction. It’s not pretty. Rue takes the potent opioid fentanyl, injects morphine, and drags around a briefcase with thousands of dollars worth of drugs (a stash she can’t resist diving into). Meanwhile, she tears her life apart: tearing through her house, looting the homes of strangers and yelling at the people she loves most.
Still, the season two finale, which aired on February 27, ends on a note of hope for Rue’s recovery. Here’s what addiction experts watching the show say: Euphoria gets right about teen drug use and treatment — and where it’s wrong.
What Euphoria Does Right: Drug Abuse Is Not Rare Among Teens
The show has sparked controversy over how teenage drug use is portrayed. In January, DARE – the Drug Abuse Resistance Education program – criticized the show for “glorifying”[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 US, in 2020, according to the Substance Abuse and Mental Health Services Administration (SAMHSA), approximately 1.6 million children ages 12 to 17 – 6.3% of the adolescent population – had substance use disorders. “That’s a huge problem,” says Dr. Lynn Fiellin, a 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 also seems to be growing; in 2020, millions more children tried drugs for the first time. †Euphoria reflects exactly what is going on,” she says.
Rue uses many different types of drugs during the show, from marijuana to Xanax, but she mostly uses opioids. This is a major concern as opioid use often kills young people: In 2020, nearly 6,000 young people aged 15 to 24 died from opioid overdoses in the US, representing 84% of all drug overdose deaths in that age group, according to data from the National Center for Health Statistics.
The show excels at portraying the “chaos” that can arise when a young person’s drug use spirals out of control, as Rue’s does, says Fiellin. In the first episode, Rue’s sister discovers her overdose in a pool of her own vomit; the two seasons follow Rue as her drug use continues to ruin her close relationships.
What Euphoria Is Doing Wrong: Treatment Options Are Not So Limited
One thing the program doesn’t do as well is showing the options people have to help them recover from substance use disorder. While psychiatrists and experts agree that Rue — or anyone like her — is facing a difficult recovery, she hasn’t explored all of her options, or even the best ones.
on EuphoriaRue has participated in two main treatments: Inpatient Rehabilitation in Season One and Narcotics Anonymous (NA) — which, like Alcoholics Anonymous, is a 12-step model that emphasizes spirituality and substance abstinence. While these programs may help some people, they’re not for everyone and have certain drawbacks, psychiatrists say. Rehabilitation programs can vary in quality and be very expensive, while NA can sometimes alienate people who are less religious, such as Rue, who says she doesn’t believe in God. However, NA allows Rue to develop a strong bond with her sponsor, Ali Muhammad, which pushes her to change the way she sees the world. Fiellin says such relationships with “people who support and listen” can be essential to recovery. That turned out to be true for Rue.
dr. Sulman Aziz Mirza, a psychiatrist specializing in adult, child, and adolescent psychiatry (and who watches the show), says he wishes Rue’s storyline would show her she was trying different options that might help her. to recover. “There’s just an inevitable [sense] that we will see Rue die in the coming seasons,” he says. “I hope there’s at least some recognition that, ‘Hey, there are options out there.'”
So far, the show hasn’t depicted any of the most successful treatments for opioid use disorders: drugs like buprenorphine. According to Robert Miranda, a professor of psychiatry and human behavior at Brown University (who knows about the show’s emphasis on drug use but doesn’t watch it), buprenorphine reduces cravings and withdrawal symptoms by activating the same parts of the brain as opioids, but don’t cause the same “high” or side effects. “I think that’s a missed opportunity to spotlight a treatment like buprenorphine,” says Fiellin. According to the National Institute on Drug Abuse, buprenorphine and other similar drugs, including naltrexone and methadone, have been shown to reduce opioid use, decrease the risk of overdose and increase the likelihood that a patient will remain in treatment.
Taking medication for opioid use disorders “may provide a benefit, an often necessary edge,” Miranda says. “It may provide respite from the intense cravings and adverse withdrawal symptoms people face — many of them teens — as they struggle to reduce their drug use.”
Therapy is another option that can be especially effective when combined with medication, Fiellin says. Cognitive behavioral therapy, family therapy, and an approach called motivational interviewing have been shown to help people with opioid disorder. Motivational interviewing, a counseling approach where a counselor talks to a patient about the reasons they need to change and the reasons for it, aims to help people who are ambivalent about seeking treatment. This strategy may make sense for someone like Rue, who leaves rehab during the series premiere and declares, “I wasn’t about to stay clean.” Behavioral change can be a particularly hard sell for a teen like Rue, says Dr. Kevin Gray, a professor of psychiatry and behavioral sciences at the Medical University of South Carolina. instead of 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 caregivers — that work for each person. “I could have a Harvard degree, and I could have degrees and publications and books and stuff, but if I can’t connect with the kid in front of me, it means nothing,” Mirza says.
Rue’s long road ahead
At the end of the season two finale, Rue says in a story that she stayed clean for the rest of the school year. But psychiatrists who watch Euphoria agree that Rue’s longer path to recovery isn’t going to be an easy one — nor would it be if she were a teenager 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 that they must deal with throughout their lives. “Some young people who have really serious problems with substance use, who are able to recover quickly and stay sober for a lifetime,” Gray says, but others struggle with a lifelong addiction. “Just like if someone had hypertension or diabetes, we don’t expect them to go on treatment, and then stop treatment and be cured forever.”
One of Rue’s triggers for substance use problems is her struggles 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 problems. “Mental health and addiction are so closely linked, and there’s so much overlap, that you really can’t tackle one in a vacuum.”
The show also didn’t explore another major risk to Rue and drug users of all ages in the US: the danger of a drug supply tainted by the highly potent opioid fentanyl, which has been linked to an increase in opioid deaths in the US. While Rue can be seen using fentanyl intentionally, she’s also likely to encounter it in combination with another drug without her knowledge, meaning she wouldn’t be able to control her dose. Rhana Hashemi, a researcher who promotes harm reduction education in schools, is critical of Euphoria to make the drug stash seem so simple: Rue and other characters have no doubts about what they’re taking or selling, and there doesn’t seem to be much concern about whether drugs are mislabeled or counterfeited. Although not explored on the show, harm-reduction methods, such as narcan and fentanyl test strips, can help make drug use safer. “Most [illicit] fabrics have fentanyl, and dosing fentanyl is really difficult,” says Hashemi. “That’s why it’s so important to never use alone, test your drugs, and have Narcan on hand.”
Another big challenge for Rue is that she is a teenager. Access to quality treatment can be a major problem for adolescents, especially if, like Rue, they live outside a city and their families are not wealthy. That’s compounded by all the other typical teen challenges: coping with a developing brain, limited impulse control, and the urge to figure out identity. Being a teenager can be difficult for anyone. Layering on a substance use disorder can make it impossible.
The silver lining, however, is that teens are still growing and maturing, and their youth gives professionals the opportunity to intervene early in their drug use. Even for someone like Rue, “there’s still so much potential,” Gray says.
This post What Euphoria does right and wrong about teenage drug use and addiction?
was original published at “https://time.com/6152502/euphoria-hbo-teenage-drug-use/”