I’m a TV writer. Sometimes for shows you’ve probably heard of (like Sweet Tooth on Netflix) and sometimes for shows you probably haven’t (like Hap & Leonard on Sundance/AMC). But I also work at Boulder Care, helping develop content like, well, this very blog. So I’ve been straddling two worlds lately that seem totally different on the surface. But there is one area where they overlap, and I’ve been struck repeatedly by how often it surfaces.
In both Hollywood and Healthcare, people seem to believe the myth that there aren’t any stories to tell about addiction that don’t end in sadness and heartache.
Working at Boulder Care, I’ve quickly come to learn that that simply isn’t true.
Hollywood loves a tragic story, where a seemingly good protagonist is sucked into a world of temptation, gets in way over his or her head, and winds up consumed by corruption and destruction. Think Wolf of Wall Street or Joker or even Macbeth. In many genres, this storyline works just fine.
But when depicting stories of SUD patients, following this trope and denying that happy endings are possible has some very real and damaging consequences.
The Hollywood Classic
We’ve all seen the movie – many times – where an a-list actress is struggling to make ends meet and barely making it. She might have a bad boyfriend, or a wild best friend, or just bad luck, but one way or another, she’s introduced to the most evil of temptations: drugs.
And once she starts to use, she’s hooked. She’s powerless against this corrupting force – and she starts to destroy her life to use more and more.
She refuses to listen to anyone that she has a problem. Until she hits that favorite Hollywood moment, ROCK BOTTOM. What that means in real life is rather unclear, but in the movies it includes some combination of losing her job, or her children, or her home, or all three, because of drug use. And of course, there will be lots of tears and suffering. Finally, her family can show her tough love and threaten to cut her off. (Seriously? Why? Has a lack of empathy ever helped anyone tackle a difficult obstacle?)
She’s out on the street. She might get arrested. But for sure, she tries to stop using drugs. Alone, without help. And of course, this means she has to go through tortuous withdrawal. She has to sweat and cry and shake. To face her demons (and earn her oscar nomination), she must go through the gauntlet, and come out on the other side… for a moment. Because even when she makes it through withdrawal, something will derail her again. Perhaps her friend kills herself. Or her boyfriend is killed in a drug deal gone wrong (because all drug users must face violence). She’s out of money, out of options, and out of support. And she has nowhere to turn. Except back to drugs.
Her family won’t help her again now that she has touched a drug again. They’re convinced that’s the only way she can be handled. And as she uses again, she makes a beautiful speech confessing that she thinks her drug use is a moral failure – and she has to pay the price for it.
And finally, she overdoses.
She leaves her family behind to regret that she couldn’t beat the impossible odds, but never question that there might have been a better way. That’s simply the ONLY WAY a story with someone who has SUD can end.
To be honest, I believed that narrative for years. I think we all have.
It has won so many A-listers their Oscars, it has to be true. Requiem For a Dream. A Star is Born. Hillbilly Elegy. Trainspotting. Traffic. The Oscar nominations list goes on…
But it’s not a real story of recovery. Or at the very least, it’s not the ONLY story of recovery. It's just the way most of the world is introduced to addiction treatment. And coming to Boulder, I have been thrilled to hear a different story. An inspiring one.
A Different Recovery Story
That’s when I met Erica. Okay, met is a strong phrase, since she’s not a real person, but her story is based on the real patient experiences that happen every day in treatment at Boulder. Erica started taking prescription painkillers about a year ago after hurting her back at work. After a while, stress in her life (maybe from a difficult divorce, challenges of being a single parent, problems at work, or something similar), she started to feel dependent on the opioids to get through her day. Her health started to suffer and people in her life start to notice.
Erica wants help. And she wants to stop feeling dependent on opioids. But she’s worried what will happen if other people find out. Will she lose her job? Will people think she’s a bad parent, or worse, try to take away custody? And on top of that, she can’t afford in-patient rehab – she can’t even afford to take three weeks off of work.
But instead of turning to despair, or continuing to suffer, Erica discovers a different treatment option: telehealth.
She can have visits when and where she needs. And she can start treatment immediately, without disrupting her life, or having to tell everyone at work. Within a day, Erica has met a clinician and filled her prescription for MAT – probably Suboxone – and she’s feeling better. The medication works. Having access to a care team 24/7 gives her a sense of security that she can get help and advice when she needs. Her life continues. Her chronic disease is being treated. Her family is able to support her as she goes through treatment. And her life starts to get better again.
It’s such a joy to learn about patients like Erica. They’re working with clinical teams to get treatment. They’re improving their lives, achieving goals like going back to school, getting better jobs, and having happy, successful relationships with their children. And their odds at doing so aren’t impossible – they’re rather common. In fact, at Boulder, 80% of the people who enter care are still in treatment, i.e. active recovery, after 12 months.
This isn’t to say that recovery is easy, by any means, even at Boulder and with medications. There’s very hard work to do in every recovery journey.
But hard doesn’t mean tragic. And hard can have a happy ending. That’s the story we need to tell.
Withdrawal isn’t the only option. Cold turkey and abstinence aren’t the only options. Going through a tough-love intervention isn’t the only option. Suffering isn’t the only option. Saying that every SUD story has to include these tragic details not only tells people who don’t know about substance use disorder a lie, it also convinces people who do have SUDs that they can only come to a similar end. They are only worthy of sadness. They’re not sick, they have a moral failing. And that discourages countless people from seeking the treatment they need.
Can you win an Oscar portraying SUD treatment as it really happens, when it’s based in science and medicine? I don’t know. But I think, for the sake of the many considering seeking SUD treatment, we need to try.