Editor’s Note: This story contains spoilers and graphic descriptions of substance use.
Writing off HBO’s new series, Euphoria, as just another teen drama is a mistake… and a potentially harmful one, in my humble opinion.
The first few episodes have left many viewers uncomfortable with their depiction of teen drug use, graphic sex, and self-harm. However, many who have dealt first hand with co-occurring mental illness and substance use disorder, like me, appreciate the brutal candor with which the show portrays how truly difficult it is to navigate the world when you struggle with mental illness and use substances to cope. The show has a unique opportunity to use its platform to raise awareness about the highly stigmatized issues of mental illness and substance use disorder by offering a more accurate portrayal than is usually given in TV and film, showing that anyone can struggle with either or both and, likewise, that anyone can recover.
The show’s protagonist, Rue Bennet, played by Zendaya, has an experience that many people who battle substance use disorder (SUD) can relate to; she has suffered emotional turmoil for as long as she can remember and began using substances to cope at a young age. According to the National Institute of Mental Health estimates that roughly 7.9 million adults have SUD and a co-occurring mental illness and vice versa.
Rue has a long history of mental illness including OCD, anxiety, and possibly even bipolar disorder, and is prescribed a cocktail of medications from a young age to help her manage her symptoms. She started experimenting with opioids when her father falls ill with cancer and she took on the role of his caregiver. Rue has easy access to pharmaceutical drugs and a lot of emotional pain from the trauma of seeing her father get sick and eventually succumb to his illness. The convergence of the two creates the perfect storm in her life resulting in drug misuse, overdose, and rehab.
Rue has a long history of mental illness including OCD, anxiety, and possibly even bipolar disorder, and is prescribed a cocktail of medications from a young age to help her manage her symptoms
Despite going to rehab after overdosing and celebrating 30 days of sobriety, Rue has no plans of staying clean when she leaves the facility. As soon as she gets home, she heads to her dealer, Fezco (Fez), who seems reluctant to sell to her. She pushes and eventually gets what she wants — a steady supply of drugs to alleviate her existential pain, at least temporarily.
During the first episode, we see a flashback of Rue experimenting with drugs and alcohol for the first time. She explains that when the high hits, she feels the air rush out of her lungs and her brain stop. It’s this feeling, her mind halting and pain subsiding, that she will chase at any cost. Anyone who has used substances as a coping mechanism for mental illness understands this desire, to make the discomfort stop, at any cost — it’s often the tipping point that causes casual substance misuse to become a substance use disorder.
The show also frighteningly depicts the lengths that many with SUD will go to in order to get high, risking their safety and even their lives in doing so.
In the second episode, Rue goes to Fez’s apartment to score some drugs but has a run-in with his supplier — a frightening man with face tattoos. Rue explains that she doesn’t have any money but he offers her a dose of Fentanyl off his knife, on the house. Rue stares at the liquid on the knife, seemingly battling with herself over whether or not she should take the risk. Every person with SUD understands this dilemma, even if it isn’t Fentanyl from an intimidating drug dealer and is instead just the glow of the neon signs of the liquor store on the route home. At some point, it isn’t about recreation anymore, it’s about survival. As much resolve as one has to quit using, it can all crumble in seconds with the right trigger.
Anyone who has used substances as a coping mechanism for mental illness understands this desire, to make the discomfort stop, at any cost — it’s often the tipping point that causes casual substance misuse to become a substance abuse disorder.
Rue takes the drugs and is quickly incapacitated by the strong opioid. The supplier goes on to affix Fentanyl patches to her body and grows increasingly physical with her, explaining that she’ll have to find a way to pay him for the drugs. The scene is frightening but also familiar for many in recovery. Many of us have been desperate at one time or another and have done risky things to get our hands on our drug of choice, things that we never would have done had we not lost our agency to the substance at some point. Luckily for Rue, Fez steps in, paying off the supplier and halting whatever nefarious activity was about to take place.
In addition to Rue, another person’s substance use is highlighted in the show. Rue’s childhood friend Lexi’s mother is regularly seen with a full glass of wine, glassy eyes, and an unsteady gait. In an early scene, Rue goes to Lexi’s house to get clean urine from Lexi so she can pass her drug test. Once inside, we see Lexi’s mother and sister at the dinner table, her mother raising a very full glass of wine as a strange toast to Rue’s sobriety, clearly inebriated. Rue’s illicit drug use juxtaposed against the very legal and even mundane scene of a suburban housewife numbing herself with wine at dinner is unsettling, to say the least.
Rue’s illicit drug use juxtaposed against the very legal and even mundane scene of a suburban housewife plying herself with wine at dinner is unsettling, to say the least.
In the third episode, Rue makes what seems like a genuine attempt at staying clean, after her best friend, Jules, threatened to end their friendship if she didn’t stop using drugs. Rue stays clean for two weeks but is unable to resist a bottle of pills she finds in Jules’ kitchen. It is an emotionally-fraught decision. Rue knows that taking the drugs could endanger her friendship with Jules, not to mention her familial relationships, which are already on thin ice. Still, her cravings have hijacked her brain and she will go to any length to get high, even if it means losing everything she loves.
This portrayal of craving and eventual relapse is shockingly accurate.
After taking the pills, Rue goes to a Narcotics Anonymous meeting and lies about being 60 days clean, even sharing with the group what she’s done to maintain her sobriety. After the meeting, a man who had watched her speak intently begins asking about her family, her sister in particular. He asks her if she knows how she has undoubtedly emotionally-scarred her younger sister, who had to find her unconscious after an overdose. Rue doesn’t understand the random guilt trip and turns to leave but the man tells her he knows she is high. He says that he knows the tricks she is playing because he’s done it all for himself. He gives her his number and tells her to reach out when she’s done trying to kill herself.
This merciless reality check is what every substance misuser fears most, but probably needs and maybe even hopes for. I have seen people who struggle with SUD lie to themselves and others about their substance use, believing that if they can just convince everyone that it’s not a problem, then it won’t be. We delude ourselves into thinking that we are the world’s greatest liar when, in reality, many can see through our façade. Being called out on the dishonesty, especially by someone who has been in our shoes, feels simultaneously like our house of cards is falling and a welcome sense of relief. It’s a sense that we no longer have to participate in the ruse we’ve created. Rue tucks his number away and rides her bike into the night.
I have seen people who struggle with SUD lie to themselves and others about their substance use, believing that if they can just convince everyone that it’s not a problem, then it won’t be.
Back into using and, after experiencing a particularly bad panic attack, Rue bikes to Fez’ apartment, explaining that she just needs a few pills to get by. Fez tells her he can’t deal to her anymore and closes the door. Rue quickly goes from agitated to inconsolable, begging Fez to open the door, even screaming that he did this to her — he sold her the drugs that she started using, and then cut her off. After denigrating Fez for not giving her the pills, she walks away in a tearful rage.
We can see that she is at the end of her rope. This isn’t someone who is in control of her behavior anymore. Her drug use has taken a serious toll on all of her relationships and has endangered her life a number of times. She doesn’t want to use but she is compelled to and doesn’t know how to cope with life’s struggles and her own mental illness without chemical assistance. Rue pulls a card out of her pocket — it’s the number of the man she met at NA. She calls him and asks if they can meet and the episode closes.
Euphoria provides a frighteningly realistic glimpse into what it is like to struggle with mental illness and how using substances to cope can quickly grow into abusing those same substances.
It isn’t pretty, but it feels accurate to many who have faced struggles similar to Rue’s. The show could have taken the usual route that most media does, portraying the person with mental illness and substance abuse as a malevolent individual who is a danger to everyone around them. In reality, mental illness and SUD often look far more mundane.
Rue is, by all accounts, a normal middle-class kid who has experienced trauma and has learned to cope by using substances. She isn’t a bad person; she is simply in a lot of pain that she hasn’t learned to deal with in a healthy way.
In that way, she is like so many of us who struggle with our mental health and substance use. Euphoria has an important opportunity to decrease stigma around the issues of mental illness and SUD by using its platform to more realistically depict these two illnesses and show that those who struggle with either or both are not weak or immoral; they are often just doing their best to minimize pain without adequate resources to do so. With the show being renewed for a second season on HBO, I hope that Euphoria continues to shine a light on the at times disturbing but also very common occurrence of SUD and mental illness because we need a more truthful portrayal of both if we are going to adequately treat and provide resources to anyone who struggles with either.