The Substance: A Mirror to Addiction

When Coralie Fargeat's "The Substance" premiered at Cannes in 2024, audiences weren't prepared for the visceral, unrelenting mirror it would hold up to modern society's obsessions. Now, one year after its September 2024 theatrical release, we're taking a deeper look at this body horror masterpiece—not just for its commentary on ageism and beauty standards, but for its surprisingly accurate portrayal of addiction. Starring Demi Moore as an aging actress who uses a mysterious drug to create a younger, "perfect" version of herself, the film offers one of cinema's most unflinching examinations of dependency and self-destruction.

The parallels between Elisabeth Sparkle's relationship with "the substance" and real-world addiction are impossible to ignore. From the initial promise of a better life to the inevitable spiral of dependency and destruction, the film captures the psychological and physical reality of substance abuse with startling accuracy. For those working in addiction treatment, the movie serves as both an artistic achievement and an educational tool about the nature of dependency.

While most viewers focus on the film's commentary about ageism and beauty standards - and rightfully so - the addiction subtext offers equally important insights. The way Elisabeth becomes increasingly dependent on her weekly transformations, the deterioration of her "real" self, and her inability to stop despite mounting consequences all mirror the classic patterns seen in drug addiction treatment settings across the country.

The film's mirror scenes powerfully represent the self-scrutiny that drives both beauty obsession and addictive behaviors

About "The Substance"

"The Substance" follows Elisabeth Sparkle (Demi Moore), a once-celebrated actress and fitness instructor who loses her television job on her 50th birthday due to ageism in Hollywood. Devastated and struggling with her self-worth, she encounters a mysterious offer: a black-market drug called "the substance" that promises to create a younger, more beautiful version of herself.

The process is seductive in its simplicity. A single injection creates Sue (Margaret Qualley), Elisabeth's perfect younger self. But like all addictive substances, it comes with rules that seem manageable at first: switch bodies every seven days, maintain perfect balance, and never exceed the time limit. As anyone familiar with addiction patterns might predict, these rules become increasingly difficult to follow.

Director Coralie Fargeat has crafted what many critics consider a masterpiece of body horror, but the film's power extends far beyond its shocking visual effects. The psychological journey Elisabeth undergoes, from desperate hope to complete dependency to ultimate destruction, follows the textbook progression of addiction with remarkable precision.

The Addiction Parallels

From the moment Elisabeth first encounters "the substance," the film begins drawing unmistakable parallels to real addiction experiences. The mysterious nurse who introduces her to the drug operates exactly like a dealer, appearing at her moment of greatest vulnerability with promises of a solution to all her problems.

The initial experience mirrors what addiction specialists recognize as the "honeymoon phase" of substance use. Sue emerges perfect, confident, and successful - everything Elisabeth believes she should be. This immediate gratification and the stark contrast between her "using" and "not using" states perfectly capture why people continue using substances despite negative consequences.

Even the physical process of taking the substance resembles intravenous drug use, complete with the ritualistic preparation, the moment of injection, and the immediate transformation. Critics have noted that Elisabeth's bathroom, where she administers the drug, becomes increasingly clinical and sterile, much like the environments where people inject substances in isolation.

The clinical, ritualistic nature of substance administration in the film mirrors real injection drug use patterns

The drug's distribution system also reflects real-world addiction structures. Elisabeth must travel to increasingly sketchy locations to get her supply, interacting with a shadowy network that prioritizes secrecy and continued dependency over user safety. This underground supply chain mirrors how people with prescription drug addiction often graduate to street drugs when legal sources become unavailable.

The Cycle of Dependency

Perhaps no aspect of "The Substance" more accurately reflects real addiction than its depiction of the dependency cycle. Elisabeth's weekly switches between her deteriorating real self and her perfect artificial self mirror the cycles of use, withdrawal, and craving that define substance abuse disorders.

During her weeks as Elisabeth, she experiences what could be described as withdrawal: physical discomfort, emotional distress, and an overwhelming craving to return to being Sue. Meanwhile, as Sue, she experiences the euphoria and confidence that keeps people trapped in addiction cycles. The seven-day rule creates artificial periods of forced sobriety that become increasingly unbearable.

The film brilliantly illustrates tolerance, a key component of addiction. What begins as a perfect solution gradually requires Elisabeth to bend and eventually break the rules to achieve the same satisfaction. She stays as Sue longer, takes extra doses of stabilizer, and makes increasingly dangerous choices—all behaviors that mirror how addiction progresses in real life.

According to the Substance Abuse and Mental Health Services Administration (SAMHSA), this cycle of temporary relief followed by intensified craving is central to understanding substance use disorders. The film captures this pattern with uncomfortable accuracy.

The rigid seven-day cycle in the film represents the structured periods of use and forced abstinence common in addiction patterns

The psychological splitting Elisabeth experiences, literally existing as two different people, also reflects how addiction creates a divide between one's authentic self and their "using" self. Many people in recovery describe feeling like completely different people when using substances, often engaging in behaviors that seem foreign to their true character.

As the film progresses, Elisabeth becomes increasingly unable to exist as herself. The time spent in her original body becomes torture, while the time as Sue becomes the only period she feels truly alive. This mirrors how advanced addiction makes normal life feel impossible without substances, trapping individuals in cycles they desperately want to escape but feel unable to break without professional residential treatment.

Self-Medication and Escapism

At its core, Elisabeth's use of the substance begins as self-medication—a desperate attempt to escape the pain of feeling worthless and discarded by society. This motivation mirrors the vast majority of addiction cases, where substance use initially serves as a coping mechanism for underlying emotional pain, trauma, or mental health conditions.

The film shows how Elisabeth's self-worth has become entirely dependent on external validation and physical appearance. When that validation is withdrawn, she experiences what could be defined as psychological withdrawal, with feelings ranging from depression, anxiety, and a desperate need to reclaim her sense of identity. The substance promises to solve these problems, just as drugs and alcohol promise to solve problems for people struggling with co-occurring disorders.

The temporary nature of the relief provided by the substance is crucial to understanding its addictive potential. Each transformation gives Elisabeth exactly what she craves: youth, beauty, success, and admiration - but only temporarily. This creates a cycle where the solution to feeling terrible is the same thing that ultimately makes her feel terrible, a paradox central to addiction.

The isolation and emotional pain that drive Elisabeth to the substance mirror the underlying issues that often lead to self-medication with drugs or alcohol

Research shows that people who use substances to cope with emotional distress are at higher risk for developing addiction. Elisabeth's story demonstrates this perfectly. What begins as a seemingly rational response to a specific problem (age discrimination) evolves into a compulsive behavior that dominates every aspect of her life.

The film also shows how addiction isolates individuals from genuine human connection. Elisabeth becomes increasingly unable to engage authentically with others, whether as herself (when she feels too ashamed and deteriorated) or as Sue (when she's performing a false identity). This isolation feeds the cycle, making the substance feel like the only reliable source of comfort and identity.

Loss of Control and Consequences

One of "The Substance's" most powerful addiction parallels lies in its portrayal of how Elisabeth gradually loses control over her substance use. What begins as a carefully managed weekly routine slowly deteriorates into chaos as the drug's grip on her life tightens.

The film shows Elisabeth breaking her own rules, like staying as Sue for extra days, taking unauthorized doses of stabilizer, and making increasingly desperate attempts to maintain her high. These behaviors mirror the loss of control that defines addiction, where initial intentions to use substances "responsibly" or "in moderation" become impossible to maintain.

As Elisabeth's real body begins to deteriorate from the substance abuse, she faces the same impossible choice that confronts many people with addiction: acknowledge the damage and seek help, or double down on the behavior causing the damage. The film shows her choosing the latter, engaging in increasingly desperate and dangerous behaviors to maintain her addiction.

The physical deterioration Elisabeth experiences serves as a visceral metaphor for how addiction affects the body. While real substance abuse may not cause the dramatic physical changes shown in the film, the underlying message remains accurate: addiction progressively damages the user's physical and mental health, often in ways that become increasingly difficult to hide or ignore.

The physical manifestations of Elisabeth's addiction mirror how substance abuse takes a progressive toll on the body and mind

The film also accurately depicts how addiction affects decision-making capacity. Elisabeth makes choices that would seem irrational to an outside observer but make perfect sense within the warped logic of addiction. Her ability to recognize consequences becomes increasingly impaired as the substance dominates her thinking, reflecting how chronic substance use changes brain function and judgment.

Perhaps most tragically, the film shows how Elisabeth becomes trapped between two impossible states: unable to live as herself (due to the physical and emotional damage from her addiction) and unable to live as Sue (due to the unsustainable nature of her substance use). This mirrors the experiences of many people with severe addiction who feel caught between an unacceptable present and an impossible future.

Rock Bottom and Destruction

The final act of "The Substance" provides one of cinema's most visceral depictions of addiction's ultimate consequences. Elisabeth's complete loss of control leads to the creation of "Monstro Elisasue," a grotesque fusion that represents the total destruction of both her authentic and artificial selves.

This transformation serves as a powerful metaphor for how addiction ultimately destroys not just the person someone was, but also the person they were trying to become through substance use. The promise of the substance (to create a better version of herself) results in the obliteration of any recognizable version of Elisabeth at all.

The film's depiction of rock bottom is particularly relevant for understanding addiction. Elisabeth reaches a point where she has lost everything that initially mattered to her: her appearance, her career, her health, and ultimately her humanity. Yet even at this point, she cannot stop using the substance, illustrating how addiction can persist even when it no longer provides any meaningful benefit.

The public nature of Elisabeth's final breakdown - occurring during a live television broadcast - mirrors how addiction often eventually becomes impossible to hide. Despite tremendous efforts to maintain appearances, the reality of substance abuse typically becomes visible to others, often at the most important or public moments.

The destruction of Elisabeth's identity reflects how addiction ultimately destroys both who someone was and who they hoped to become

The film's unflinching portrayal of this destruction serves an important purpose: it shows audiences the reality of where untreated addiction leads. While not every person with addiction experiences such dramatic consequences, the underlying trajectory where there's a progressive loss of control leading to destruction of identity and quality of life remains accurate.

Critics have noted that the film's extreme imagery makes it difficult to watch, which serves its purpose. Addiction is not glamorous or romantic; it is a devastating disease that destroys lives. The film's horror elements force viewers to confront this reality in a way that more sanitized portrayals might not achieve.

Lessons for Recovery

While "The Substance" depicts the darkest possible outcome of untreated addiction, it also offers important lessons for understanding recovery. The film demonstrates why early intervention is so crucial. Elisabeth's addiction progresses rapidly from seeming manageability to complete chaos, illustrating how quickly substance use disorders can escalate without proper treatment.

The movie also highlights the importance of addressing underlying issues that drive addictive behaviors. Elisabeth's substance use is fundamentally about trying to escape feelings of worthlessness and invisibility. Without addressing these core psychological issues, any attempt to stop using the substance would likely fail, just as recovery efforts often fail when they focus solely on stopping substance use without addressing underlying mental health concerns.

The film's portrayal of isolation in addiction underscores why social support is crucial in recovery. Elisabeth has no meaningful relationships to anchor her to reality or provide alternative sources of validation and worth. Recovery programs emphasize building healthy relationships precisely because connection to others provides alternatives to the artificial relationships people develop with substances.

The movie also illustrates why complete abstinence is often necessary for recovery from severe addiction. Elisabeth's attempts to moderate her use of the substance. Following the rules and maintaining balance both ultimately fail because the substance itself has changed her brain chemistry and thought patterns. This reflects research showing that for many people with severe addiction, controlled use is not a viable option.

Despite the film's dark trajectory, real recovery offers hope for rebuilding authentic identity and meaningful relationships

Perhaps most importantly, the film demonstrates why addiction treatment must address the whole person, not just the addictive behavior. Elisabeth's obsession with youth and beauty, her lack of meaningful relationships, her career disappointments, and her fundamental sense of worthlessness all contribute to her vulnerability to addiction. Effective treatment programs address these underlying issues alongside the addiction itself.

For families and friends of people struggling with addiction, the film offers a stark reminder of how the disease progresses and why intervention cannot wait. Elisabeth's story shows how quickly someone can move from seeming to manage their substance use to complete loss of control, emphasizing the importance of seeking help early rather than waiting for rock bottom.

A Powerful Artistic Mirror

"The Substance" succeeds as both a feminist horror film and an addiction narrative because it understands that both issues stem from the same source: a society that devalues people based on surface characteristics while offering false solutions that ultimately cause more harm than the original problems.

The film's power lies not just in its shocking imagery but in its emotional honesty about the desperation that drives people to seek chemical solutions to psychological pain. Elisabeth's story, while extreme, reflects the experiences of millions of people who turn to substances in an attempt to become someone they're not or escape someone they don't want to be.

For viewers who have experienced addiction personally or through loved ones, the film may be particularly difficult to watch because it captures so accurately the internal experience of addiction - the desperate hope, the temporary relief, the mounting consequences, and the ultimate destruction of identity that occurs when substances become more important than authentic life.

Yet the film's unflinching portrayal serves an important purpose: it removes any glamour from addiction and shows clearly where the disease leads without intervention. In a media landscape that often romanticizes substance use, "The Substance" provides a necessary counterweight that emphasizes addiction's true costs.

The movie also serves as a valuable educational tool for understanding how addiction develops and progresses. Its depiction of the psychological factors that drive initial substance use, the way tolerance develops, the loss of control that defines addiction, and the ultimate consequences of untreated disease provides insights that could help viewers recognize these patterns in themselves or others.

Ultimately, "The Substance" stands as a powerful artistic achievement that uses the conventions of body horror to explore the very real horror of addiction. While its imagery may be fantastical, its insights into the nature of dependency, the progression of addictive disease, and the destruction that follows untreated addiction are grounded in observable reality.

For those struggling with addiction or concerned about someone who is, the film offers a crucial message: this disease requires professional intervention, comprehensive treatment, and ongoing support. As Elisabeth's story makes horrifyingly clear, the alternative— is the progressive destruction of everything that makes life meaningful.