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Research shows more than half of teens try alcohol, but repeated use can rewire reward pathways.

About 1 in 15 adolescents develop substance use disorder, reflecting a major public health concern.

Prevention works best with open dialogue, early intervention, and access to youth-focused treatment resources.

If you've been watching this season of "Euphoria" like me, we have been on a ride.

When Rue’s Jeep teetered on top of a makeshift ramp ascending the U.S.-Mexico border wall during the Euphoria Season 3 opener, I held my breath and grabbed the blanket. The scene very literally made viewers wonder which way she would go: toward her home, filled with trauma, newfound hope, and familiar patterns, or a new beginning, one with unknown opportunities, potential dangers, and desires that still lingered in her mind and body?

Rue ultimately chose her own path—recognizing that challenges exist on both sides of her journey—and left the vehicle moving her quickly toward either direction. (Which, of course, added to the massive debt she owed her drug dealer. Oh, Rue.)

As a clinical psychologist working with teens and their families, I see how this scene brought to life the very real experience of adolescent drug use and its aftermath.

Zendaya’s character, Rue, a biracial teen who develops severe trauma and grief due to the loss of her father at 13, uses substances to feel free, intense, and alive, to feel something bigger, to feel anything.

But with more than 150 million viewers of the trailer, not to mention the real-life overdose of a beloved character on the show, we have to talk about what this looks like off-screen.

Let’s start by distinguishing between use and abuse. Most teens who use substances report using small doses to relax, have fun, or cope with stress—maybe like Rue at the beginning of her mental health journey. Normal adolescent behavior supports this, with more than half of 12th graders reporting alcohol use, while one in six adolescents has used drugs.

Over time, though, young people’s brains may get used to that rush of dopamine—the feel-good chemical—that starts to tell their body: “That felt good; do it again.”

And that’s when we go from using to abusing. Indeed, substance use disorder occurs when using a drug, alcohol, or other substance starts to take over how one’s brain makes decisions.

And with more than 1 in 15 adolescents currently experiencing a substance use disorder, it is critical to understand the reality of this use. This opener did just that.

There’s serious pain and danger involved in such heavy substance use for teenagers. The opener certainly showed the relational, financial, and physical dangers in graphic detail. It’s critical, then, to have some safeguards in place for young viewers of the show to understand what they can do if they find themselves wanting to use illicit substances more heavily.

Regular talks about substance use. Because the use of alcohol and drugs is relatively common for young people, it’s important to understand the likelihood that young people may experiment with substances. Having regular opportunities to check in, then, should be a part of our routine with teens in our lives. Let’s discuss both immediate and long-term consequences of use and abuse, such as impaired driving, irrational decision-making, and health impacts, so they have the full picture of their behaviors.

Understand the root of the problem. Like Rue on "Euphoria," we must recognize if substance use is the problem itself or is being used to solve the problem. Young people may use substances to cope with other pressing concerns, including co-occurring mental health disorders. There may also be extreme peer pressure, normalization, or glamorizing, so an understanding of friend influences and social media intake is critical.

Making resources available to get help. While attending to regular use within the home may be feasible, such as locking up alcohol and substances, figuring out ways to support teens who are heavier users is important. Community- and hospital-based rehabilitation clinics remain a significant resource for substance-dependent youth, with hotlines and apps supplementing youth and families in their knowledge and decision-making for treatment.

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"Euphoria"’s depiction of the fallout of Rue’s addiction is a prime example of the lengths young people struggling to cope with mental health disorders will go to self-medicate.

It is crucial to champion better mental health treatment to meet the needs of teens engaging in dangerous coping strategies like substance abuse. But it’s insufficient to end the story there.

At the end of the episode, Rue finds herself in yet another difficult and life-threatening situation. She says of her substance abuse that “I have been paying for that single f*cking mistake ever since.” In a world with severe consequences for relying heavily on substances, particularly when some are becoming more dangerous, it’s important to understand all sides of the journey.

The use, abuse, tolerance, dependence, addiction, and relapse cycle that often make up the substance abuse journey feels a lot like Rue's Jeep making its way up and onto the ramp. Safety can be within reach, but it is not an easy path that gets us there. Let’s be sure we equip our young people with the right tools for the journey.

Dr. Riana Elyse Anderson is a licensed clinical and community psychologist, associate professor at Columbia University's School of Social Work, and affiliate with Harvard’s Hutchins Center for African & African American Research and FXB Center for Health and Human Rights. She is a Public Voices Fellow of The OpEd Project in Partnership with National Black Child Development Institute.

Ayana Williams is a junior at Barnard College majoring in Women and Gender Studies and an intern with Dr. Anderson through a YouTube THE-IQ Mental Health Fellowship.

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