Euphoria—the The most talked-about television show in the past decade in the U.S.—has thrust teenage drug use into the cultural spotlight. Zendaya plays Rue Bennett (17 years old), a troubled teenager who struggles to overcome a growing drug addiction 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.
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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
It has been controversial because of its portrayal of teenage drug abuse. In January, D.A.R.E.—the Drug Abuse Resistance Education program—The show was criticized 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). This problem is growing; millions of children tried drugs for their first time in 2020. “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 worrying because opioid use can be deadly for young people. Nearly 6,000 teens aged 15-24 died in the United States from opioid-related overdoses in 2020. It is 84% of all deaths from drug overdoses. 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
The program fails to show the variety of treatment options available for people with substance abuse 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.
You can find more information here 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. Rue does find that NA allows her to make a strong connection to Ali Muhammad, her sponsor. Ali pushes Rue to see the world differently. Fiellin says that relationships like this with “folks who are supporting you and listening,” can be essential for recovery. Rue proved that this was true.
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.’”
The series has so far not featured one of most effective treatments for opioid-use disorders: medication 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 drugs, such as methadone and naltrexone) have been proven to lower opioid consumption, lessen the likelihood of an overdose and increase patient retention. 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.”
Fiellin states that therapy can also be a good option, especially when it is combined with medication. People with opioid abuse disorder can benefit from cognitive behavioral therapy, family therapy and motivational interviewing. People who have ambivalence about treatment can benefit from motivational interviewing. It is a counselling approach where a counselor speaks with the patient to discuss their goals and why they should change. 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.”
Different motivations may help people recover, just as drug abuse can be caused by different reasons. 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
Rue recounts in narration at the finale of season 2 that she had stayed clean the entire school year. They are able to see psychiatrists. 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. Rue and others like her face numerous obstacles which make it hard for their situation to improve or to even survive. Drug use disorder, for many, is a long-term condition that they will have to deal with throughout their entire 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. Rue may be seen taking fentanyl in an intentional manner, but she will likely also come across it. Mix it with other drugs without her knowledge, which means that she wouldn’t be able to control her dose. Rhana Hashemi is a researcher that promotes harm reduction education for schools. 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. “Most 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.”
Rue, a teenage girl faces another major problem. 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. It can be hard to be a teenager. It can seem difficult to be a teenager if you add substance abuse disorder.
There is a silver lining to this story: Teens are maturing and still learning, so professionals have the chance to help them early on in drug addiction. Even for someone like Rue, “there’s still so much potential,” Gray says.
