The Pursuit of Youth and the Price of Addiction Make Up ‘The Substance’

For my 42nd birthday, I decided to surround myself not with the children and adolescents I normally do as a pediatric psychiatrist but as a chaperone for one of my daughter’s field trips to a local farm that every year hosts a massive fall festival. After hours of chasing multiple 7-year-old girls through a corn maze, hauling pumpkins and packages of popcorn, and climbing up to and bumping down gigantic slides, I collapsed for a quick 30-minute nap.

Four hours later, my wife woke me for my birthday dinner. Oof. I joked with her that I needed a younger version of myself to fill in for me, because I was still exhausted and sore all over.

This common experience is the crux of French director Coralie Fargeat’s recent movie “The Substance,” which is carried by a career-best performance from Demi Moore as Elisabeth Sparkle and a breakout role by Margaret Qualley as Sue. After getting fired from her long-running Jane Fonda–esque aerobics TV show when she turns 50, Elisabeth is approached with an offer for the Substance, a black-market serum that promises to provide a younger, more beautiful, more perfect version of oneself. The mysterious concoction is supplied via a weekly pickup from a safety deposit box in packaging that would make Apple envious.

Elisabeth starts the process, with Sue literally emerging from her and Elisabeth falling into an induced seven-day coma, after which Sue will need to switch spots with Elisabeth—or else. As the disembodied voice on the Substance’s helpline repeatedly says: “You are one.” Sue tries out for and immediately gets Elisabeth’s role, leading a new, young, sexy aerobics show, becoming the face of the network, and even being invited to host a New Year’s Eve show. Meanwhile, those seven days come and go fast, and when Sue starts to borrow days from Elisabeth, disaster strikes.

“The Substance” can be viewed through the lens of the DSM as a metaphor for substance use disorders and the ways that we—as a society and as a profession—talk about addiction. How often do we tell patients “a glass or two of alcohol won’t hurt,” knowing full well how easily it can become more than that? Turn on the TV, and you’ll see beer ads woven into sports and celebrations, or wine commercials promising relaxation and sophistication. Bring a bottle to a party—it’s expected. With the legalization of cannabis in more states, the normalization of substance use has become increasingly pervasive, as long as you follow the “rules”: only in moderation, only on weekends, only at home.

But what happens when the rules are broken? In “The Substance,” Elisabeth learns the answer in the form of a disconnected phone call—a chilling reminder of what happens when control slips away.

While “The Substance” critiques substance addiction, it also highlights another, subtler dependence: nostalgia and youth. Our society glorifies the past, as our nation’s election to Make America Great Again recently showed, while also equating youth with vitality and value. Photo and video filters on Instagram, Snapchat, and Photoshop erase years from our faces and bodies with a swipe. The anti-aging industry is worth billions, as we try product after product in hopes of finding the fountain of youth. Many of my male friends and family members have made the international trip to an all-inclusive Turkish hair-transplant clinic.

But the pursuit of youth, much like any addiction, comes at a cost. For Elisabeth, that cost is her identity, her autonomy, and eventually, her very existence. In “The Substance,” Sue isn’t just a younger version of Elisabeth—she’s a symbol of the relentless societal pressure to remain relevant, perfect, and ageless. And as Sue begins to take over, Elisabeth becomes a shadow of herself, consumed by the very thing she sought to control.

This mirrors what many people experience in their pursuit of youth: a loss of authenticity, self-worth tied to external validation, and the creeping realization that no filter, serum, or surgery can truly turn back the clock. Just as Elisabeth’s relationship with Sue becomes unsustainable, so too does our collective addiction to nostalgia and the illusion of eternal youth. The real question isn’t just what we’re willing to sacrifice for these fleeting ideals—it’s whether chasing them is worth losing who we truly are. ■