“This show hits really close to home on so many levels”: An analysis of Reddit comments about HBO's Euphoria to understand viewers’ experiences of and reactions to substance use and mental illness

Background: Public health has begun using social media forums such as Reddit to enhance surveillance and modernize interventions for young people. The current study's objective was to examine Reddit posts about the HBO series Euphoria to identify show themes that resonate with adolescent and young adult viewers in order to inform future social media interventions. Methods: Reddit comments in the r/television community from June to August 2019 were downloaded. Following filtering, 725 comments were analyzed and coded using a codebook and ATLAS.ti. Coded comments were analyzed for themes relevant to Redditor substance use, reactions to Euphoria and the main character (Rue), and mental health concerns. Results: During their discussion of the show, Redditors disclosed both personal recreational and prescription drug use, including substance use to cope with mental illness symptoms. There were approximately equal numbers of comments with positive and negative reactions to the show overall and to the main character, Rue. Redditors often found Euphoria's storyline and portrayed events to be relatable and realistic to the experience of young people who use drugs, as well as sometimes triggering. Overall, Redditors thought Rue accurately depicted an individual's struggle with a substance use disorder. Conclusions: This exploratory study highlights how television and social media can contribute to young peoples’ understanding of substance use disorders and mental health. Findings could inform the design of social media interventions for adolescents and young adults on a variety of substance use issues, including stigma and the interconnectedness of substance use and mental health challenges.