By: Jessica Gold
Addiction experts will tell you that media portrayals of drug use are not helping their patients. Drug use is often glorified and harms are typically minimized. In fact, one study of the top grossing films of 1999, 2000, and 2001 found that substance users on film were unlikely to suffer any consequences of use, in the short or long term, and rarely were shown refusing offers to use or regretting their use. These kinds of portrayals are particularly an issue for teen viewers. Michael Wenzinger, MD, a Psychiatrist specializing in Addiction and Child & Adolescent Mental Health at Washington University in St. Louis explained, “The absolutely mind boggling dissonance between how celebrated drug use can be in pop culture versus how debasing and dehumanizing it is in reality is probably one of the most confusing signals being sent to our youth.”
Enter MTV’s new docuseries 16 and Recovering, which airs its fourth and final episode this week. The series follows students at Northshore Recovery High School in Beverly, Massachusetts, a Boston suburb hit hard by the opioid epidemic. It aims to showcase the realities of addiction, but also the hope of recovery, by focusing on the students and the principal, Michelle Lipinski, and their stories. It also educates viewers, as a companion website for the series was developed in parallel with the National Institute on Drug Abuse to provide resources for those who may be struggling with substance use and their loved ones watching at home.
“I was blown away,” explained Anna Lembke, MD, Associate Professor of Psychiatry and Addiction Medicine at Stanford University. “I’ve seen so many shows about addiction that don’t get it right. This was probably among the most thoughtful, accurate, heart-wrenching depictions of addiction I’ve seen in film or print.”
Her enthusiasm was echoed by other interviewed experts, who felt this was a unique and important series portraying the power of addiction. In particular, there are key concepts that emerge in the episodes that the experts felt were typically incorrectly shown or not even mentioned at all in other media. 16 and Recovery is different and by being different can potentially help shift the narrative of addiction in our culture, especially for and about teens.
Teenagers That Use Drugs Are Not Simply ‘Bad Kids’
Despite the fact that substance use is common in the United States and 1 in 13 people above age 12 need treatment for addiction, Brian Fuehrlein, MD PhD, Associate Professor of Psychiatry at the Yale School of Medicine who specializes in addiction, believes most teenagers feel invincible and most parents feel that “nothing like this would ever happen to their child.” Because this show focuses much more on the experience of addiction and recovery and showcases that it can happen to anyone, Dr. Fuehrlein feels it helps to reframe the narrative. This is not simply about bad children or a choice, but instead a disease that requires treatment.
Dr. Lembke adds that she liked that the show not only portrayed the vulnerability of teens, but also how hard the world is now, even if you do have a support system filled with loving parents, grandparents, teachers, and counselors. She says, “drugs are everywhere, and it takes a lot of effort and resilience and luck to avoid them at all.” In other words, the world is filled with a lot of risk. No one knows whether it will take one use or multiple to become addicted. We do know, however, that addiction is a brain disease and it is not something one can just “stop.” According to Dr. Fuehrlein, this line of thinking and the promises that come with it, really just delay treatment in the long run one and are stigmatizing. The show emphasizes just how difficult sobriety is even if a student wants to stay sober. In showcasing these very real challenges, as Dr. Fuehrlein says, the show “allows viewers to have a much deeper understanding of what is actually going on in the brains of these children.”
The Self Stigma of Addiction Delays Care
Given that identity and self confidence are developing in the teenage years, Dr. Wenzinger feels stigma, especially internalized stigma, can really affect teenagers much more than many other groups. He says, “The disdain and biases of others is a toxin to this growth that can be just as poisonous and deadly as the drug itself — conditioning teenagers that they are bad people who do not deserve help.” As a result, they delay care or stop medication and this happens so regularly that it has even become, Dr. Wenzinger adds, “an expected part of the disease in that it can be anticipated to be one of the challenges to treatment.”
Again, the show helps to change that narrative. Jessica Hulsey, Founder of Addiction Policy Forum explains, “Putting a real face on addiction serves as an important reminder that this disease can happen to anyone. Raising awareness [also] helps to reduce stigma and makes it safer for people to talk about addiction.” She notes that substance use disorders remain the most stigmatized health condition in the world by the media, the healthcare and criminal justice systems, and in the community. By not only showing teens struggling and failing, but also showing that substance use disorders can be treated and recovery can be maintained, the show helps to change the image of addiction and recovery in society. It also helps decrease the shame associated with it.
Mental Illness And Addiction Coexist And Interact With Each Other
Just like many of the students in the show, studies suggest that about half of the people who have a mental illness will also have a substance use disorder at some point in their lives, and vice versa. Dr. Lembke felt that 16 and Recovering did a particularly good job showcasing the interaction between mental illness and addiction as complex and driving each other in a bidirectional way. She feels the media typically portrays dual diagnosis over simplistically as the following: People who use drugs have depression or anxiety and if their depression or anxiety were treated, they would stop using drugs. Dr. Lembke notes, however, that “the truth is so much more complicated. Sometimes people relapse because they’re depressed, and sometimes they relapse because they’re feeling good. Addiction alone breeds relapse, not just ‘self-medication.’” The show does a much better job with this nuance.
Addiction Permeates Families
16 and Recovering also emphasizes the effect of addiction on families and families on addiction, which is something you often don’t see portrayed on television. Dr. Fuehrlein explains that parents not only worry about addiction killing their children, they also worry about it ruining their relationships with them. He says, “Imagine if cancer not only killed people, but in the process of killing people it made everyone around them angry at them first and ruined all relationships with their loved ones. Addiction not only kills people, but they often die alone after having ruined all their relationships in the process.”
By focusing on the relationships, the show can also help teach good communication styles and decrease the overreliance on punishment. Jessica Nickel adds that the show “models how we should respond as a country, as school systems, [and] as parents.” In particular, there are moments that the principal interacts with students in a loving and respectful way and Nickel believes that these can serve as “a very powerful reminder of how we all can treat those struggling with addiction.” Given this, Dr. Fuerhlein feels that though MTV itself typically targets younger audiences, it would help to try to get parents of teenagers to watch the show, too. He says, “This would provide some insight to the parents of what is happening in the brain of their child who is addicted to drugs or alcohol and would hopefully encourage the parents to have empathy for their struggling child instead of feeling anger (which is so common when a loved one is addicted).” It could be one way to improve communication all around.
The show (Spoiler Alert) also chose to showcase the overdose death of one of the central characters, Shawn, in Episode 3. Beth Linas, PhD, MHS, an infectious disease epidemiologist who researches the social determinants of health of opioid and heroin use, says while it was really hard to watch, death from overdose is an outcome that happens and showing the impact it can have on a school, peers, loved ones, and a community is not something we typically see or understand. She adds, “it’s even more rare to see or learn about in youth.” But, showing it helps to start conversations.
Overdose is also a likely outcome of addiction and, according to Dr. Wenzinger, it needs to be shown. He feels, “Cold and emotionless statistics seldomly move people. [However,] seeing this immediately likeable teenager go from 114 days sober to dead in a span of the 40 minutes leaves a clear impression of just how swift, lethal, and unpredictable addiction can be.” He especially appreciated the parallels between Shawn and Sam and how Shawn felt much less doomed until his final minutes. He adds, “The randomness of who makes it through, and who doesn’t is one of the cruelest aspects of the disease.” Dr. Fuehrlein emphasizes, “it really can happen to anyone.” This only further normalizes addiction and helps remove the “not me” or “not my kid” label from it.
Underlying the conversation about loss is also one of a broken system. Dr. Lembke felt some of the benefits of the show to the viewer are that it showcases how hard it is for kids to get into recovery, even when they want to, and how broken the system is, especially in an emergency. Seeing is believing, and perhaps that can incite systemic change. One potential missed opportunity in the show highlighted by the experts, however, is the lack of mention of what detox or rehab is like or what options exist for medication for recovery such as suboxone. Dr. Wenzinger notes excluding that “could even leave the impression that medical treatment has nothing to offer.”
Ultimately, 16 and Recovering avoids the tropes of addiction storylines by shifting the narrative to recovery and changing the nature of how addiction in teenagers is shown on television. It is raw and realistic and even painful at times. But, by showing recovery, though challenging, is possible, Dr. Lembke believes these students’ stories can “give other kids hope that they’re not alone and they can get better.” That is a truly good use of television.
The author of this piece has ongoing consulting work with ViacomCBS but does not work directly with the show or any of the people mentioned in this piece.
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