DISCLAIMER: This blog contains spoilers from the first season of Euphoria. Because this show features many scenes of underage sex, drug use, and violence, parents are strongly advised to watch the series before determining if it is appropriate for their teenagers. Although Women’s Recovery does not treat teens with addictive disorders, Euphoria touches on universal themes that are tragically familiar to any family impacted by substance abuse. 

Can we learn anything from Euphoria, the highly-talked-about teen drama on HBO?

The show focuses on the lives of a group of teenagers as they struggle with substance abuse, sexuality, mental health problems, violence, and trauma. Euphoria has been praised for the realistic way it handles these issues, although it sometimes does so in a very graphic manner.

Although Euphoria boasts an ensemble cast, at its center is Rue Bennett, portrayed by Zendaya, the young actress who up to this point has best been known for her work on the Disney Channel. Rue is a 17-year-old high school junior who has a history of mental health struggles and drug use that has spiraled out of control. Her character also serves as the narrator of the series.

Euphoria explores many themes that are worthwhile topics of discussion between parents and their teenagers. Just as relevant, anyone who has ever battled co-occurring addictive and emotional disorders can easily empathize with Rue.

We are going to take a closer look at how some of the plotlines depicted in Euphoria reflect what is currently happening in the United States. More importantly, we will discuss what we might learn from Rue Bennett and the people around her.

Rue and Overdose: A Lesson Not Learned

It was the end of summer, the week before school started. I had no intention of staying clean.”

~ Rue Bennett

When the story begins, Rue is fresh out of a residential drug rehab program. Her mother, Leslie, had placed her there after Rue overdosed earlier that summer. Adding to the trauma is the fact that Rue’s younger sister, 13-year-old Gia, was the one who had found her unconscious and called 911. Rue only survived because the paramedics got there in time and administer life-saving Narcan to reverse the overdose.

This mirrors the current drug epidemic in America. Last year, there were over 68,000 overdose deaths in this country, and two-thirds of them involved opioids.

While at the hospital, the doctors recommended that Rue should be sent to directly to an inpatient facility for treatment. Since she was still just a 16-year-old minor, they didn’t need her permission, only her mother’s.

However, because she wasn’t emotionally involved in the decision, Rue didn’t seem to fully grasp the lessons learned in early recovery. When she was released from the program, Rue was ready to just pick up where she left off. On the car ride home, she was already planning on using again.

Rue and Relapse

 “What…you think ‘cause I went to rehab, I stayed clean?”

~ Rue

Five days after her return, she met up with her dealer to get more pills. And in this scene, two things become apparent about Rue’s character.

First, it seems as if Rue is such a regular customer that her dealer, Fezco, is willing to let her buy on credit. In fact, their friendly, almost brother-and-sister relationship is so close that it later plays out in unexpected ways.

Fez expresses surprise that Rue has shown up so soon after rehab. But that is the unfortunate reality with a complicated illness like Substance Use Disorder — between 40% and 60% of addicts will relapse at some point.

Second, while Rue’s drug of choice is prescription medication, she is not exactly picky about what kind of pills she takes. When she picks up her regular pills, she also is easily persuaded to try something new, a fast-acting psychedelic.

Rue’s acceptance highlights how drugs change the user’s brain. Because chronic substance abuse affects the pleasure centers of the brain, an addict becomes dependent on this artificial stimulation to function. They compulsively crave it, and when their drug of choice isn’t available or they develop a tolerance to it, they will seek sensation with other, often harder drugs. 

This is why alcohol, cigarettes, and marijuana are considered “gateway” drugs, because they so often lead to other substances.

During the course of the show, Rue and other characters are depicted as using:

  • Alcohol
  • Marijuana
  • Painkillers
  • Tranquilizers
  • MDMA, aka “Molly” or “Ecstasy”
  • Heroin

Rue and Mental Illness: The Roots of Addiction

mental-illness

And then it happens. that moment when your breath starts to slow. And every time you breathe, you breathe out all the oxygen you have. And everything stops: your heart, your lungs, and finally, your brain.”

~ Rue, describing her mental anguish

The series shows how, as a very young child, Rue was diagnosed with a number of mental disorders, each of which could, on its own, negatively affect her ability to cope in a healthy manner. 

Of special relevance, they also increased her risk of comorbid substance abuse:

  • Obsessive-Compulsive Disorder — 25% of people in treatment for OCD also meet the criteria for a SUD diagnosis.
  • Attention Deficit Hyperactivity Disorder — 25% of teenagers who abuse alcohol or drugs have ADHD. 
  • General Anxiety Disorder — 1 out of every people with anxiety also struggle with substance abuse. 
  • Bipolar Disorder — Up to 60% of BPD patients will abuse substances at some point.

This last one is extremely important, because at a point during the season, Rue is shown to be fully in the grip of both the manic and depressive phases of her illness.

People with these kinds of mental illnesses often attempt to “self-medicate” with alcohol and drugs, to alleviate their symptoms and to deal with the emotional pain resulting from trying to live with their condition.

Rue said her disorders kept her constantly on edge, “Until every second of every day you find yourself trying to outrun your anxiety.”

Rue and Prescription Misuse and Trauma: Dad’s Pain Pills

“The first time I tried OxyContin, I was 13.”

~ Rue

As shown in flashbacks, Rue’s father was diagnosed with cancer a few years before the current time setting. Because he was largely bedridden, Rue would often sit with him and help him. As he got worse, he was prescribed strong opioid medications to help ease his discomfort.  Rue noticed how he would drift off and disconnected from his pain, whenever the drugs took effect.

One day, on little more than a whim, Rue took one of her father’s pain pills. And that, as they say, was that. Soon, it was a regular thing – she started stealing his pain pills almost daily. She would even curl up next to him, completely high, and watch TV, but because her father was too out of it due to his own medications, he never noticed.

Again, this is very typical among teenagers who misuse medications. In fact, among new substance abusers age 12 and older, prescription drugs are abused more often than any other illegal drug. And just like Rue Bennett, 2 out of every 3 teenagers who misuse pain medications say they got them from friends and family — including from their medicine cabinet at home.

This is why the Partnership for Drug-Free Kids advises all parents to properly store and monitor all prescription drugs in their home, and to properly discard any unused or unwanted medications.

Rue and Her First Time: An Introduction to Valium

And when it hit me, I thought… This is it.This is the feeling I have been searching for my entire life, for as long as I can remember. Because suddenly, the world went quiet. And I felt safe, in my own head.”

~ Rue, talking about her first experience with Valium

Although Rue didn’t start stealing Oxycontin until she was 13, her relationship with powerful mind-altering medications had started years earlier.

Rue’s mental health issues first manifested when she was a very young child. During one particularly bad anxiety episode, she was briefly hospitalized. While she was there, they gave her liquid Valium to calm her down.

For better or worse, this was a life changing experience. As Rue said in the voiceover, it was the first time she had ever “felt safe in her own head”, a feeling she had been searching for her whole life.

Valium is a tranquilizing anti-anxiety drug in the benzodiazepine class. Other popular tranquilizers of abuse include Xanax, Klonopin, Ativan, and Librium. These are extremely powerful and habit-forming drugs. Among regular users, “benzo” dependence can develop in as little as two weeks, and it can be so severe that abrupt withdrawal can prove fatal. In fact, recent research has shown that even simply taking the drug “as needed” can promote non-medical misuse.

How bad is the problem of benzodiazepine abuse in the United States? Per a recent study published in the American Journal of Public Health:

  • Since 1996, fatal benzo overdoses have more than quadrupled.
  • Annually, approximately 1 in 20 Americans fill a tranquilizer prescription.
  • This is a 67% spike since 1996.
  • During that time, the average prescription quantity has more than doubled.
  • The overdose death rates among Hispanics, African-Americans, and seniors continues to increase.
  • There are almost 200,000 first-time benzo abusers every year.

Specific to Rue’s situation and overdose history, mixing opioids and benzos is extremely dangerous. Both are central nervous system depressants that slow heart rate, lower blood pressure, and especially, suppress breathing. 75% of overdoses involve multiple substances.

Again especially relevant to Rue’s story, people who abuse both opioids and benzodiazepines are at triple the risk for psychiatric hospitalizations.

Rue and Loss: The Death of Her Father

death

I just showed up one day without a map or a compass or to be honest anyone capable of giving one iota of good f****** advice.

~ Rue

Like a lot of people who struggle with emotional disorders, Rue has trouble relating to people. And when her father died of cancer, she lost one of the people she felt closest to. Poignantly, it is revealed that the hoodie she wears everywhere is the one he wore while he was sick.

Trauma and addiction have a complicated relationship, with each increasing the possibility of the other. For example, more than 70% of patients in rehab have personal histories of trauma. 

But Rue’s youth at the time of her father’s death is also extremely significant because of the influence it would have on her eventual problem with drugs.

A 2012 study found that traumatic experiences during childhood strongly increases the likelihood of developing SUD as an adult. Adverse Childhood Events impact the regions of the brain linked with emotional regulation and impulse control.

The National Child Traumatic Stress Network has estimated that 1 in 4 American children experiences one or more ACEs, and for each ACE experienced or witnessed, the risk of initiating substance use climbs up to 400%.  So a child with 5 ACEs can be up to 2000% more at-risk to abuse substances than a child with no history of trauma.

Rue and Fezco: Advice from an Unlikely Source

“I’m serious, Rue. I’ve seen a lot of people die. None like you. I don’t know what type of f***ed-up sh** you got going inside your head. I don’t know how to help, but I could tell you one thing: this drug sh**, it’s not the answer.”

~ Fezco

When Rue resumes her drug use after rehab, she takes elaborate measures to fool her mother Leslie. For example, when her mother starts to suspect that she is using again, Rue employs the tools used by all drug addicts — denial, deflection, dishonesty, and deception. Not only does Rue flat-out tell Leslie that she’s clean, she even dares her mother to drug test her. To Leslie’s surprise and relief, Rue passes the drug test.

But what Leslie didn’t know was that Rue had substituted the urine of a friend who didn’t use drugs. By successfully fooling her mother, Rue bought space and time to use drugs.

In a similar way, Rue brings her dishonesty the 12-Step Narcotics Anonymous meetings she’s required to attend. For example, she accepts a special chip awarded for achieving 60 days of sobriety, even though she’s using regularly.

At one point, she even blackmails a meeting Chairperson, forcing him to falsify her attendance sheet to make it look like she hadn’t skipped any meetings. 

All of this deception allowed Rue’s drug use to worsen, and with the exception of her mother, her friends were aware and concerned. In one of the most surprising scenes of the season, Fezco runs into Rue at a party and actually advises her to stop using drugs.

In another episode, Rue is at Fezco’s house when his upline supplier, a scary and dangerous face-tattooed thug named Mouse, shows up. In a terrifying scene, Mouse forces Rue to snort fentanyl. When she promptly passes out, Mouse insinuates that he is now going to sexually assault her as payment for the drugs he just made her take.

Similar attacks happen all-too-frequently in the United States. Some estimates say that up to 79% of sexual assault victims were impaired by drugs or alcohol at the time of the assault.

Only Fezco’s quick intervention saves Rue. He pays off Mouse out of his own pocket, then takes care of her while she is unconscious. He even instructs his little brother to get the  Narcan “just in case”.

Fezco makes up his mind to save Rue from herself, that he has to stop selling her drugs. In yet another emotionally-charged moment, Rue shows up to buy drugs and he turns her away. He won’t even let her in his home. The scene ends with a desperate Rue banging on Fezco’s door, plaintively wailing, “You did this to me!”

Rue and Ali: One Addict to Another

Let me know when you want to stop trying to kill yourself and eat some pancakes.”

~ Ali

One of the most positive relationships that Rue forms is with Ali, an older recovering addict she encounters at Narcotics Anonymous meeting. After she shares to the group and misrepresents her sobriety, Ali catches up with her outside and tells her that she just got up “in front of a whole group of people who are struggling with the same issues”  and lied about being clean. He gives her his card in case she ever wants to talk.

When she is turned away from Fezco, she does exactly that, and this is important. Ali is the only adult that Rue confides in honestly. As she moves forward, having someone she can trust could play a major part in her eventual recovery.

Helping Rue is actually part of Ali’s sober journey.  The 12th Step of Recovery says:

Having had a spiritual awakening as a result of these Steps, we tried to carry this message to other addicts, and to practice these principles in all our affairs.”

This Step means that for the sake of his own personal recovery, Ali must do what he can to help other addicts who are still stuck where he once was – Rue, for example.

Rue and Leslie: A Parent’s Heartbreak

heartbroken

Here’s the toughest part, no matter what you say, or do, or wish, the decision will be all hers. And all you can do is hope she gives herself the chance that she deserves.”

~ Leslie Bennett

Rue’s struggles with mental health and substance abuse have understandably strained her relationship with her mother. They have loud arguments that sometimes turn physical. Leslie is unable to completely trust Rue, but that’s actually justifiable because Rue has learned how to fool her mother.

In some ways, Leslie is more on top of things than many parents of substance-abusing teenagers. She does a lot of the right things:

  • She doesn’t abuse drugs or alcohol herself.
  • She has had Rue evaluated for mental illness.
  • When Rue overdoses, she immediately checks her into a rehab program.
  • She drug-tests Rue regularly
  • She requires Rue to attend Narcotics Anonymous
  • She informs doctors of Rue’s history of substance abuse

The biggest possible criticism of Leslie is that Rue doesn’t seem to be on any medications, neither for her psychological disorders nor for her substance abuse. After a serious bipolar cycle, Rue herself has to ask her mother to be put back on medication.

This lack of medication is a major misstep on Leslie’s part. Uncontrolled mental illness greatly increases the likelihood of self-medicating with alcohol and drugs, as is evidenced by Rue’s behaviors. And the combination of anti-addiction medication and counseling is considered to be the “gold standard” of addiction treatment.   

Rue and Gia: Like Sister, Like Sister?

But man, now you just got me thinking about what that does to a 13-year-old, a 13-year-old kid, who finds her big sister overdosed. What that moment must do to somebody – how it affects the rest of their lives…”

~ Ali

When Rue’s father died, her mother had to take a second job to pay the outstanding medical bills. That meant that when Rue overdosed, it was Gia, her younger sister, who found her and called 911. This must have been especially hard, because the two girls are shown to have a very close bond.

But because Gia obviously looks up to her big sister, she is also in danger of following her bad example. On at least two occasions, Gia hangs out with older boys and smokes marijuana. In a strange twist of fate, Rue has to be the responsible one and protect her little sister.

Euphoria does a good job at showing how children can be affected by substance abuse within the family. In fact, genetics is the largest causal factor, accounting for up to 60% of the risk for SUD.

Rue and Jules: A Personal Intervention

“I’m not kidding, Rue. I’m not trying to become best friends with someone who’s gonna  f****** kill themself…I don’t wanna be around you if you don’t stop using drugs.”

~ Jules

When she comes home from rehab, Rue meets Jules, a transgender girl who is new in town. They are instantly best friends, and possibly more. Rue is smitten with Jules, and their bond becomes the most important relationship in Rue’s life. This is both a good and a bad thing.

It’s a good thing, because although Jules has some pretty serious and possibly dangerous issues, substance abuse is not one of them. In fact, she gives Rue an ultimatum – drugs or her. Rue chooses her and decides to try and stay clean.

And she’s mostly successful. She starts truthfully attending NA meetings and even has a starkly-honest moment of sharing with the group, saying, “Hey everyone. I’m…I’m Rue and I’m an addict…I’ve been clean for 13 days. It’s been okay. I’ve actually been really happy.” By the time of the Winter Formal dance, Rue has managed to stay clean for three months.

But she still struggles. She steals pills from Jules’ house and in another scene, she is so tempted at Fezco’s house that she imagines the prescription bottles are talking to her. When she has to go to the hospital for a kidney infection, she tries to fool her nurse into giving her strong opioid painkillers. Only her mother’s note to her doctor about Rue’s history of substance abuse thwarts her attempt.

It’s a bad thing, because Rue may be too emotionally attached to Jules, at a time when she is still struggling with her still-fragile sobriety. Even Ali tries to gently warn her that high-school romances never last forever.

And he was right.

In the season finale, Rue and Jules decide to run away together. But just as they are stepping onto the train, Rue pulls back, realizing at the last moment that she can’t abandon her mother and her sister after everything she has already put them through. 

Rue and Relapse: The Struggle Continues

“If I could be a different person, I promised you I would. Not because I wanted, but because they do. And therein lies the catch.”

~ Rue

The breakup with Jules sets up the dramatic final scene.

Rue leaves the train station, sobbing as she walks home. When she arrives, she relapses by snorting the pills that she stole. She collapses back onto the bed, and viewers share her rush as the drug hits her — there’s a dazzling and surreal musical number meant to represent what creator Sam Levinson calls “the cycle and the madness of addiction — how you’re thrown back into it and thrown out of it and it’s dizzying and at times beautiful but also really f***ing terrifying.”

It’s one of the most-talked about television season finales in recent memory, but despite what Internet theorists have to say, Levinson confirms that Rue doesn’t die in that final scene. Her journey will continue in Season 2.

Rue and the Future: What’s Next?

…I think Rue has a big journey ahead of her, and a tough one. It’s not something I want to cut short, because of who Rue means to me as someone who has battled with addiction and come out the other side, and because I think there’s a lot more to delve into and unpack in terms of the effects of addiction on Rue and on her family and those around her.”

~ Sam Levinson

It’s fitting that the first season of Euphoria didn’t have a saccharine, fairy-tale ending. By having Rue relapse again, the show mirrors the real-life struggles of people with substance abuse problems. Addiction is an incurable disease, and it takes a lifetime of effort, one day at a time, to learn how to best manage the symptoms and live a sober and serene life. 

For most people with SUD, including Rue, there will always be a risk of a slip or a relapse. The important things are learning how to make the lifestyle changes that minimize that risk and learning how to appropriately respond if a slip or relapse does occur.

But as Mr. Levinson says, it is possible to battle addiction and come out the other side, both for Rue Bennett, and anyone who personally identifies with her story.