What’s true — and false — about teen drug use and addiction

Happiness-the Most tweeted about TV show of the decade in the United States — has pushed teen drug use into the cultural spotlight. The HBO show follows 17-year-old Rue Bennett, a sweet but troubled teenager played by Zendaya, as she receives treatment for a severe drug use disorder. It is not beautiful. Rue take powerful opioid fentanyl, injecting morphine, and dragging a suitcase full of drugs worth thousands of dollars (an item she couldn’t resist getting her hands on). Meanwhile, she tore her own life apart: tearing her home apart, ransacking strangers’ homes, and screaming at the people she loved most.
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However, the show’s second season finale, which aired on February 27, ended with Rue’s hopes of recovery. Here’s what the show addiction experts say Happiness right understanding of teen drug use and treatment — and where it leaves its mark.

What Euphoria is right: Drug use is not uncommon among adolescents

The show has caused controversy over how it portrays drug use among teenagers. In January, DARE — Drug Abuse Resistance Education program—Criticize the program for “honor”[ing]”Drug use in high school and making it seem ‘common and widespread in today’s world'”. But drug use is not uncommon among high school students today. In the United States, approximately 1.6 million children aged 12 to 17 years – 6.3% of the adolescent population – have a substance use disorder in 2020, according to Substance Abuse and Mental Health Services Administration (SAMHSA). “It’s a big deal,” says Dr. Lynn Fiellin, a professor of medicine at Yale Medical School and the Center for Children’s Research, who is trained in addiction medicine and behavioral health (and is a fan of it). of the program) said. The problem also seems to be growing; In 2020, millions more children will try drugs for the first time. “Happiness describe exactly what is going on,” she said.

Rue uses a variety of drugs throughout the show — from marijuana to Xanax — but she uses opioids most often. This is of great concern, because opioid use often causes death among young people: in 2020, nearly 6,000 young adults aged 15 to 24 years old will die of opioid overdoses in the US, accounting for 84% of the total. number of drug overdose deaths in that age group, based on Data from the National Center for Health Statistics.

Programme Fiellin says it’s brilliant at portraying the “chaos” that can happen when a young person’s substance abuse spirals out of control, as Rue did. In the first episode, Rue’s sister discovers she overdosed in a puddle of her own vomit; two sequels to Rue as her drug use continues to destroy her closest relationships.

What Euphoria Is: Treatment Options Aren’t So Limited

Something the program underperforms is offering a variety of options people have to help them recover from a substance use disorder. While psychiatrists and experts agree that Rue – or someone like her – faces a difficult recovery, she has yet to explore all of her options, or right away. all the best options.

Above Happiness, Rue participated in two main treatments: inpatient rehabilitation in season one and Narcotics (NA)—which, like Alcoholics Anonymous, is a 12-step model that emphasizes on spirituality and abstinence from addictive substances. While these programs may help some people, they are not for everyone and come with certain downsides, psychiatrists say. Rehabilitation programs can vary in quality and very expensive, while NA can sometimes alienate the less religious – like Rue, who claims she doesn’t believe in God. However, NA allowed Rue to develop a strong relationship with her sponsor, Ali Muhammad, who pushed her to change the way she saw the world. Fiellin says relationships like these with “people who are always supportive of you and listening” can be essential to recovery. That proved to be true for Rue.

Dr. Sulman Aziz Mirza, a psychiatrist who specializes in adult, child and adolescent psychiatry and addiction (and viewer of the show), said that he wishes Rue’s storyline would give her a try. Various options can help her recover. “Only one thing is inevitable [sense] that we will see Rue die” in future seasons, he said. “I hope that at least there’s some recognition that, ‘Hey, there are options out there.'”

To date, the program has not described one of the most successful treatments for opiate use disorders: drugs such as buprenorphine. According to Robert Miranda, professor of psychiatry and human behavior at Brown University (who knew about the show’s emphasis on drug use but didn’t watch it), buprenorphine reduces cravings and symptoms. withdrawal by activating the same parts of the brain as opioids, but without the same “high” or side effects. “I think it’s a missed opportunity to highlight a treatment like buprenorphine,” says Fiellin. Buprenorphine and other similar drugs, including naltrexone and methadone, have been found to reduce opioid use, reduce the risk of overdose, and increase the likelihood that patients will stay on treatment. according to the National Institute on Drug Abuse.

Taking medication for an opioid use disorder “could offer an advantage, a necessary advantage,” says Miranda. “It can help alleviate intense cravings and adverse drug withdrawal symptoms that people face – many teenagers included – while struggling to reduce their drug use. .”

Fiellin says therapy is another option that can be especially effective when combined with medication. Cognitive-behavioral therapy, family therapy, and an approach known as motivational interviewing have all been shown to help people with opiate use disorders. Motivational interviewing, a counseling method in which a counselor talks to patients about why they need to change and their reasons for doing so, is designed to help people with attitudes around seeking treatment. This strategy could make sense for someone like Rue, who walks out of rehab during the series premiere and declares, “I have no intention of keeping myself clean.” Behavior change can be a “hard sell” especially for a teenager like Rue, said Dr Kevin Gray, professor of psychiatry and behavioral sciences at the Medical University of South Carolina. : rather than waiting for them to be motivated”.

Just as there are different causes of drug use, different motivations can help individuals recover. Mirza says the key is finding treatments — and healthcare providers — that are right for each person. “I may be educated at Harvard and have degrees and publications and books and all that,” says Mirza, “but if I can’t connect with the kid in front of me, that doesn’t mean anything. what reason.

The long road ahead of Rue

At the end of the second season finale, Rue said in a narration that she kept clean for the rest of the school year. But psychiatrists see Happiness agrees that Rue’s longer road to recovery won’t be easy — nor easy if she’s a teenager in the real world. People like Rue face many obstacles that make their condition difficult to improve, even difficult to survive. For many people, drug use disorder is a chronic condition that they must continue to deal with throughout their lives. “There are some young people who have really serious trouble with substance use who have the ability to recover quickly and maintain lifelong sobriety, but others struggle with addiction,” says Gray. forever. “Just like if someone has high blood pressure or diabetes, we don’t expect them to enter treatment, then stop treatment and be cured forever.”

Fiellin points out that one of the reasons for Rue’s substance use problems is her struggle with anxiety, panic attacks and other mental health issues. Mental illness and drug use can create a “vicious cycle”: mental illness can push people to use drugs, which in turn can make the condition worse, she said. That means it’s especially important to find a way to treat both problems. “Mental health and addiction are so closely linked, and there’s so much overlap, that you can’t really solve the problem in a vacuum.”

Nor did the program uncover another major risk for Rue and drug users of all ages in the United States: the danger of drug supplies contaminated with the powerful, related opioid fentanyl to an increase in opioid overdose deaths in the U.S. While Rue has been shown to intentionally use fentanyl, she is also likely to experience it mixed with another drug without her knowledge, which means she won’t be able to control her dosage. Rhana Hashemi, a researcher promoting harm reduction education in schools, criticizes Happiness because drug supply seems so simple: Rue and the other characters don’t question what they’re taking or selling and don’t seem to care much about whether the drugs are mislabeled or adulterated. . Although they are not explored in the show, harm reduction methodsas Narcan and fentanyl test strips, which can help make drug use safer. “Most substances have fentanyl, and fentanyl quantification is really difficult,” says Hashemi. “That’s why it’s so important to never use it alone, test your drugs, and have Narcan on hand.”

Another big challenge for Rue is that she’s a teenager. Accessing high-quality treatment can be a big problem for teens — especially if, like Rue, they live outside of a city and their families aren’t wealthy. It’s a combination of all the other typical teen challenges: dealing with a growing brain, limited impulse control, and the drive to figure out an identity. For anyone, being a teen can be difficult. Classification of substance use disorders can make that seem impossible.

However, it is worth noting that adolescents are still growing and maturing, and their youth provides an opportunity for professionals to intervene early in their drug use. Even for someone like Rue, “there’s still a lot of potential,” Gray said.

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