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The Royal College of Psychiatrists Improving the lives of people with mental illness

Down to the Bone

This is the first in a short series of blogs focusing on various aspects of drug addiction as portrayed in films

down to the bone

Down to the Bone was co-written and directed by Debra Granik and released in 2004. As a film about drug addiction in small town America, the director chose to create a naturalistic portrayal by using real locations and some nonprofessionals in certain supporting roles. In an incredibly powerful central performance, professional actress Vera Farmiga plays Irene, a working class mother of two young sons, living in a stale marriage, who has a cocaine habit. The film won eight awards including two at the Sundance Film Festival in 2004 for the director and for Farmiga’s performance. The story is based closely on the experiences of a real family whom the director met over several years, first producing a short film about them called Snake Feed, which was released in 1997, and later her first full time feature Down to the Bone. In the director’s own comments (available on the Film’s Official website), Granik states her motivation for making the film:

I was drawn to this story because of the questions that it raises. Why do some people keep going and others give up? Why do some people change and how do they do it? Why do some of us run with people who are not good for us? When does a person become dangerous to another? When is it safe to trust? Why are so many people prone to addictive patterns? Why do people relapse?”


The Film

The film opens with Irene returning from work at the supermarket to prepare for a Halloween night of Trick or Treating, in which she tries to encourage her reluctant young sons into dressing up and walking around the neighbourhood. She seems to be a busy caring mother until we watch her dash into the bathroom before they leave home to snort some cocaine while her son knocks on the door asking her a question. Her job at the checkout doesn’t pay enough to feed her drug habit and so she begins to owe increasing amounts to the man who supplies her. He eventually calls a halt to this and refuses to give her any more cocaine without payment. Desperate, Irene tries to offer him her son’s birthday cheque in part payment but the dealer will not accept it. As her physical state of craving becomes more intense, Irene realises that she must get help and so takes a ‘holiday’ to book into a residential drug rehabilitation unit. Unfortunately, despite making good progress, Irene feels she must discharge herself sooner than planned, against the advice of those at the clinic, as she must get back home and to work. Initially, she remains abstinent and starts attending Narcotics Anonymous meetings, where she meets Bob, played by Hugh Dillon, a nurse who Irene saw at the residential clinic, who is an ex-addict and they form a strong attraction for each other.

Unfortunately, without the influence of cocaine, Irene’s performance is slower at the supermarket checkout and she is soon dismissed from her job after revealing the reason for the change in her efficiency. Struggling to survive economically, she begins to do cleaning work with a female friend she met in the rehabilitation clinic and this is initially successful until she starts to have a secret affair with Bob. As he relapses and starts using heroin, Irene is drawn back into her old habits but this time tries heroin with Bob. They are soon caught by police while driving her car, which brings their affair to the attention of Irene’s husband, Steve, and he asks her to leave the family home. She finds a place of her own to live, where her sons can visit and stay, and Bob soon joins her there. But Irene begins to realise that she will be hampered in her attempts to recover from her addiction with Bob in close proximity to her, and so she asks him to leave. The film ends there, without resolution, perhaps reflecting the uncertainty that so many addicts face every day that they strive to stay free of their addiction.


Relevance to the field of Mental Health

Down to the Bone presents a naturalistic portrait of drug addiction that doesn’t shy away from the human effects that it may have on an individual as well as on partners, children and friends. It also gives the example of treatment in a residential drug rehabilitation clinic as well as support in the community through attendance at Narcotics Anonymous. But Down to the Bone is particularly good at demonstrating the vulnerability of someone seeking to recover, taking each day at a time as they strive to stay clean and showing how easy it can be to lapse without a supportive structured environment. In particular this is highlighted by Irene’s ill advised relationship with Bob, himself an ex-addict, which occurs in the context of her unsatisfactory marriage to Steve who also uses drugs. Neither can give her what she truly needs to manage her addiction and we are not given any certainty about her future as the film ends.  Because it was closely based on the experiences of a real person there is an authenticity in the film that provides an excellent opportunity for learning about this complex issue.

Viewing this film accompanied by an exploration of some of the following resources would offer a very good basis for a discussion about the management of drug addictions and the role of various treatment options. An article published in Advances in Psychiatric Treatment in 2003 would make a good starting point. It is titled What works in drug addiction?by Jason Luty (Advances in Psychiatric Treatment (2003) 9: 280-288).

A major addiction charity in the UK, called Action on Addiction, has lots of information about prevention, treatment, research and family support for people with addictions as well as providing lots of useful links to further resources. One of these resources that mental health professionals may find helpful and interesting is the archive of podcasts on addiction posted at the King’s College website of the Institute of Psychiatry, Addictions Department


• More information about Down to the Bone can be found at IMDB and a trailer can be viewed at the Film’s Official website.

Down to the Bone can be purchased from

• Minds on Film is written by Consultant Psychiatrist, Dr Joyce Almeida

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About this blog

Minds on Film is a monthly blog that explores psychiatric conditions and mental health issues as portrayed in a selection of readily available films.

Please note that this blog may contain plot spoilers. Any views expressed are purely my own.

Dr Joyce Almeida

Dr Almeida is a Consultant Psychiatrist working in the private sector in the UK.


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