What It Means That ‘Euphoria’ Looked At Rue’s Substance Use & Mental Health At The Same Time

After last night's season finale, which left viewers with many questions about the fate of beloved characters, fans of HBO’s new series Euphoria are sad to see the end of the season. But the first season of Euphoria sparked a much-needed conversation about the intersection between mental illness, trauma, and substance misuse. Euphoria has been lauded for not pathologizing or criminalizing Rue, which helps viewers with similar experiences — particular those in Gen Z — identify with her. And for me, as a person who has struggled with mental illness for years, Rue is a treasure of a character, because I'm able to empathize with her experiences — and I see how others do, too. Spoilers ahead for the Euphoria Season 1 finale.

In the first episode of the series, through flashbacks to Rue’s childhood, viewers learn that Rue was diagnosed with obsessive-compulsive disorder (OCD), attention deficit disorder (ADD), general anxiety disorder, and possibly bipolar disorder. In the same episode, Rue narrates her journey through mental health issues and substance use. When she tells viewers how and why she began to self-medicate, she says that drugs make her feel like, "Everything stops. Your heart, your lungs, and finally your brain. And everything you feel and wish and want to forget, it all just sinks. ... Over time, it's all I wanted, those two seconds of nothingness." Right at the start, this gives viewers a framework through which to see Rue as a complex person, with complex motivations.

Later in the series, viewers start to see Rue exhibit more symptoms of bipolar disorder, a condition that is often portrayed onscreen with stigmatizing stereotypes. In the series’ penultimate episode, viewers see Rue having a possible manic episode, where she is obsessively coming up with various theories to explain her girlfriend/best friend Jules’ depression. Although those around her seem convinced that Rue is bipolar and going through a manic phase, Rue herself doesn’t seem so sure, at one point going online to ask, “Can a bipolar person tell that they’re bipolar?”

New York-based psychiatrist Dr. Angela Coombs says that this confusion is something many patients with bipolar disorder experience. “It might not be so obvious that these are mood symptoms. I think with particularly for young folks, who are trying to find out what their 'normal' even is, it can be hard…to recognize that, ‘Oh, maybe there's something else going on,” Coombs tells Bustle.

Rue also experiences a depressive episode, where she struggles with getting up from bed to go to the bathroom, leading her to be hospitalized for a kidney infection. After the incident, Rue’s mom strokes her hair while Rue tells her “I think I need to go back on medication.” This is a crucial decision Rue makes for her own health, one that may aid her recovery in impactful ways.

It's especially important to discuss how Rue's mental health conditions can overlap and some — particularly bipolar disorder — are also linked to substance use, because of the kind of self -medication Rue describes. A study published in The American Journal of Psychiatry demonstrated that there is “considerable overlap and interaction” between substance misuse and bipolar disorder. And according to a study published in Biological Psychiatry, for people with bipolar disorder, the risk of struggling with substance misuse is even higher when bipolar disorder is developed early in life, like it was for Rue.

Dr. Rajy Abulhosn, medical director of drug-testing company Confirm BioSciences, tells Bustle that people with bipolar disorder that's poorly treated are more likely to develop substance use disorder, too. According to Abulhosn the symptoms of both conditions — which can be very similar — can interact with each other, creating a harmful cycle. "During times of either mania or depression, people with bipolar disorder [may] turn to drugs or other substances to help deal with the associated symptoms,” Abulhosn tells Bustle. “In the depressive phase, people may turn to alcohol or other substances to help ease depression, sadness, loneliness, and/or associated anxiety. For those in the manic phase, their hyperactivity may lower inhibitions and impair judgment, leading them to use or abuse substances when they normally wouldn't.”

In the series finale, Rue experiences a relapse after deciding not to run away with her girlfriend/best friend Jules, because she realizes that it would be dangerous for her to be without her medication, and that her family would worry about her well-being. She’s devastated to be without the person she loves, and this sends her back to a dark place. However, there’s still a glimmer of hope for Rue, even in the midst of her relapse, because her initial decision to prioritize her health and family shows that Rue is becoming more cognizant of her own needs and that of others around her. Her relapse may be upsetting to watch, but healing is not linear, and neither is Rue’s story.

The creator of Euphoria, Sam Levinson, also struggled with substance use, he told Entertainment Weekly in May 2019. Because of this, he wanted to make sure that the show was realistic without glamorizing Rue's substance use. "If we're pulling our punches and we're not showing the relief that drugs can bring, it starts to lose its impact," Levinson said. "Because drugs can — drugs are not the solution, but they can feel like it at times, and that's what makes them so destructive," Levinson said at the show's premiere at the ATX Television Festival in June 2019.

Dr. Abulhosn says that better portrayals of bipolar disorder and substance use are needed. “The media will sometimes play a role by promoting this idea that people who suffer from bipolar disorder and substance abuse belong on the fringes of society,” or erasing the fact that many people with bipolar disorder may be predisposed to develop it because of their genes. Additionally, "oftentimes, there is a severe trauma or life event that increases the likelihood of developing bipolar disorder or substance abuse (or in fact triggers the bipolar disorder or substance abuse),” Dr. Abulhosn says. Euphoria’s decision to delve into how Rue losing her father to cancer at a young age impacted her substance use is crucial in that context.

For some viewers who experience substance misuse and/or mental illness, the complex, realistic nature of Rue’s story may resonate deeply with them. On the show, Rue is allowed to be more than just her substance misuse or her bipolar disorder. We see her as a loyal friend, as a girl falling in love, and as a fun-loving daughter and sister. Rue contains multitudes that Black women substance users are often denied. So for Rue, a Black teenager struggling with substance misuse, to simply be shown as a kid who needs help is pretty revolutionary. And it means a lot to many viewers.

Nicholas, 27, tells Bustle that Rue's “mentality fits mine like a glove.” Nicholas says that as a neurodivergent person, they understand why not using drugs "feels impossible" for Rue. "Other people don’t realize the war zone going on in our minds; you get to the point you’d literally sell your soul for some inner quiet and your brain is on full lockdown with flashing lights and sirens." Nicholas also tells Bustle that, like Rue, they’ve lost a parent to cancer, who they took care of as they were dying. Because of this, Nicholas sees themself in Rue’s struggle to recover from the trauma of losing her dad. And as a queer, Black person, Nicholas identifies with Rue’s “sexual/romantic fluidity that defies any particular label," as well as her racial identity.

This is why stories like Rue's are deeply important, because they push back on the demonization of people with these conditions, especially people who experience multiple marginalizations as a result of their race, gender identity, mental illness, or other factors. And it informs the public about the intersection of bipolar disorder and substance use, in way that's both artful and seemingly accurate.

I love that Euphoria paints a complex, rounded, compassionate picture of what it's like to experience mental illness and recover from substance use. Other TV shows can often depict these issues in harmful and inaccurate lights. But the truth is almost never that harsh, and it's never that binary. Euphoria's first season acknowledged this critical fact — and shows promise for a new era of television that treats these issues with empathy and grace.

If you or someone you know is seeking help for substance use, call the SAMHSA National Helpline at 1-800-662-HELP(4357). If you or someone you know is seeking help for mental health concerns, visit the National Alliance on Mental Health (NAMI) website, or call 1-800-950-NAMI(6264). For confidential treatment referrals, visit the Substance Abuse and Mental Health Services Administration (SAMHSA) website, or call the National Helpline at 1-800-662-HELP(4357). In an emergency, contact the National Suicide Prevention Lifeline at 1-800-273-TALK(8255) or call 911.