SBS’s new documentary Addicted Australia follows 10 Australians signed up to a unique six-month treatment program designed by Australia’s leading national addiction treatment, education and research centre, Turning Point. SBS spoke to Turning Point’s Executive Clinical Director, Dr Dan Lubman, about on-screen depictions of drug use and addiction, why stigma and stereotypes can stop people seeking help and why he hopes the documentary will start a community conversation that promotes hope.
Is there a difference between ‘addiction’ and ‘substance use disorder’?
The term substance use disorder is the official diagnostic term for when a person’s use of alcohol or another substance (drug) leads to health issues or problems at work, school or home. Like other health conditions, a substance use disorder can range from mild, moderate to severe forms of the disorder. Addiction is synonymous with a severe substance use disorder and is characterised by both physiological and psychological dependence.
Do depictions of addiction in movies and TV shows play a significant role in community perceptions of substance use and addiction?
Addiction is the most stigmatised health condition. It is therefore not surprising that most people with a lived experience of addiction are anxious about telling their story in public, even if it is a positive one, for fear of being judged and blamed. Although treatment is highly effective and most people with addiction recover and live fulfilling lives, the community do not hear these real stories of addiction nor the possibility of change and hope.
Unfortunately, we see few positive stories of recovery on TV or film, and when we do, the protagonist is typically depicted as fragile, with a plot line that suggests that they will inevitably relapse. In Australia, we are reluctant to have a real public conversation about addiction, what it is and who it affects, which means that as a community we are reliant on what is typically depicted on screen, even if it continues to reinforce harmful stereotypes and stigmatising attitudes.
And conversely, some that trot out bad stereotypes, or storylines that are damaging or misrepresentative?
What we see in TV and film about addiction are stories that are written primarily to entertain, and as such, rarely reflects how people experience an alcohol, drug or gambling problem in real life. In the fictional world, heavy drinking, gambling or drug use is typically portrayed as cool, funny or flawed. In action films and TV series, addiction is frequently glamorised, with the anti-hero, such as James Bond, Jessica Jones or Jack Sparrow, able to function at the limits, without any obvious impairment. In comedies like Will and Grace or The Hangover, heavy drinking or drug use is portrayed as humorous with any serious harms minimised or ignored.
At the other end of the spectrum are TV shows and movies that depict the person with addiction as either flawed or weak, who has to hit rock bottom and is reluctant to accept any type of help. These extreme views of what addiction looks like means that most people who are struggling with alcohol, drugs or gambling do not identify with these characters, and as such, are confused about what is happening to them (‘I can’t have a serious health problem because I’m not like them’), and don’t realise that treatment is not only available but works.
Could you give some examples of movies or TV series that include realistic portrayals of addiction and recovery?
There are many films and TV series that include a storyline around addiction. Films like Trainspotting, Candy and Requiem for a Dream, while difficult to watch at times, try to portray addiction as realistically as possible, and highlight the considerable pain, isolation and damage that can occur. Movies such as A Star is Born and Leaving Las Vegas, illustrate how destructive the shame and stigma of addiction can be, as well as highlighting that alcohol, drugs and gambling are major contributors to suicide.
Other films such as 28 Days, When a Man Loves a Woman, Traffic and Rocketman provide glimpses of what treatment involves, explore the underlying drivers (such as trauma) that underlie addiction, and highlight the challenge of reaching out for help.
What would you like to see change in the depiction of addiction? Are there common stories that we ought to be seeing, but that aren’t being told?
What we need to see on screen is a change in the narrative to reflect what most people experience. There are parallels here with what we used to commonly see in storylines about mental illness – depictions of violence, madness or weakness. Fortunately, organisations like Beyond Blue have helped to change the narrative around mental health, where the community accepts it as a real health condition, supports and rallies round those affected, promotes help-seeking and celebrates recovery. In contrast, we rarely hear about where to get help for addiction or that change is possible. Instead, prevailing community beliefs are that treatment doesn’t work and the only option is rehab.
What we need to see in TV and on film is that addiction can affect anyone, from any background, at any age. We also need to acknowledge that most people with addiction are actually high functioning and working, and are keeping their condition secret for fear of judgement or because they don’t believe help is available. There needs to be more nuanced and humane portrayals of addiction that reflect the complexity of people’s journeys and the underlying stories that typically include trauma, mental ill-health and isolation.
This 2018 study says that “A common, yet to date untested, assumption about stigma is that it keeps individuals with SUDs from seeking treatment.” From your knowledge of research and what you’ve seen happening here in Australia, how much do on-screen depictions of addiction affect people’s willingness to seek help?
We know that stigma is a major barrier to help-seeking, and it is therefore no surprise that there can be up to a near two-decade delay before people with addiction seek treatment. But we know that community perceptions can change – they have for cancer, depression and HIV – and that is mirrored by stories of hope and recovery on screen.
There is great empathy and compassion for the character undergoing cancer or mental health treatment, and their recovery is celebrated. There is also a greater focus on their journey and recognition that their loved ones are also struggling. This changing narrative supports community calls for increasing early intervention and prevention efforts and investments in treatment and research, as well as the importance of hearing from people with lived experience and greater support for carers.
If we start telling the real stories of addiction, it is likely that we will also see a change in how the community perceives addiction, which over time, will hopefully reduce stigma and promote earlier help-seeking.
Do you think there are important differences in on-screen depictions of differing types of addiction or substance use?
There are major differences in how legal and illicit drugs are portrayed on screen. Alcohol and heavy drinking are more likely to be normalised – on reality TV shows such as The Bachelor or Love Island, or in comedies such as Cheers or The Simpsons. Drinking heavily is frequently portrayed as fun or as a coping strategy, with a storyline that intimates that alcohol is relatively harmless. While drugs such as cannabis also typically appear in comedies, such as Pineapple Express and Ted, drugs such as methamphetamine and heroin are more likely to appear in crime series or dramas such as Breaking Bad and Law and Order.
The recurring storyline that is frequently promoted between drug use and crime, and the link to images of violence, poverty, depravity and exploitation, reinforce the stigma associated with taking these drugs and the public perception that people with addiction are dangerous and untrustworthy. In turn, these media portrayals of addiction perpetuate stigma and discrimination, and prevent people and their families reaching out for help when they need it most.
This paper on stigma and discrimination says “It would be worthwhile to better understand how portraying addiction or mental illness as treatable might lower stigma among the general public, which has grown accustomed to seeing media portrayals of untreated individuals with mental illness or drug addiction as dishevelled, often homeless, and potentially dangerous.” That was a US study. Would you say the same applies here?
There is little TV or movie content that showcases how successful treatment for addiction can be, and what works. We rarely see examples of people seeking help early, but instead witness the character needing to hit rock bottom before they can get better, and their family at a loss with nowhere to go for support. Yet we know from research in other areas of health that increasing public awareness that a health condition can be effectively treated reduces stigma and discrimination. Unfortunately in Australia, this is not the story that we hear through media, and there is limited government funding to widely promote helplines, treatment services and stories of recovery. This lack of hope contributes to prevailing stigma, the long delay we see in help-seeking and the growing number of untimely deaths. What would help change this narrative are TV shows and films that present more realistic stories of addiction, and the reality that treatment not only works, but recovery is to be expected.
Is there anything else you’d like to say about the depiction of addiction on screen?
We are only on the start of this journey, but I am hoping that Addicted Australia will create a community conversation about addiction that helps to promote hope, encourages help-seeking and begins to change the narrative that we see on our screens every day.
Turning Point, in consultation and collaboration with the sector, has launched a public information and advocacy campaign that asks Australians to Rethink Addiction. Visit the Rethink Addiction website to find out more about addiction.