For many people, drug use disorder is a chronic condition with which they must continue to cope throughout their lives. People like Rue face many obstacles that make it difficult for their condition to improve, or even for them to survive. 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. Rue’s long road aheadĪt the end of the season two finale, Rue says in a narration that she stayed clean for the rest of the school year. ”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. Mirza says the key is to find the treatments-and health care providers-that work for each person. Just as different causes lead people to drug use, different motivations can help individuals recover. 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.” 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. 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. Cognitive behavioral therapy, family therapy, and an approach called motivational interviewing have all been shown to help people with opioid use disorder. Therapy is another option that can be especially effective when paired with medication, Fiellin says. “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.” Taking medication for opioid use disorder “can offer an advantage, an often-needed edge,” says Miranda. 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. “I think that’s a missed opportunity to highlight a treatment like buprenorphine,” says Fiellin. 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. So far, the show has not depicted one of the most successful treatments for opioid-use disorder: medications like buprenorphine. “I’m hoping that at least there’s some acknowledgement that, ‘Hey, there are options there.’” “There’s just an inevitable that we’re going to see Rue die” in future seasons, he says. 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. Fiellin says that relationships like this with “folks who are supporting you and listening,” can be essential for recovery. 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. 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. While these programs can help some people, they’re not for everyone, and come with certain drawbacks, psychiatrists say. 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 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. Something the program does less well is showing the range of options people have to help them recover from substance use disorder. What Euphoria gets wrong: Treatment options aren’t so limited
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