What HBO's 'The Pitt' gets right—and wrong—about treating alcohol use disorder

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HBO’s The Pitt gets a lot right about emergency medicine. But its most accurate detail may also be its most troubling: what isn’t treated in the ER.

That’s especially true in its portrayal of patients’ alcohol use in Season 2.

My own alcohol misuse led to two emergency room visits, and eventually, to founding a virtual care clinic for alcohol use disorder. Watching this season, I was struck not just by what the show gets right, but by how often the healthcare system treats symptoms without addressing the underlying condition.

In one respect, The Pitt is unmistakably accurate: alcohol use shows up in the emergency department every day. We see multiple patients affected by alcohol misuse in the single shift chronicled in Season 2: Jackie, a young woman with a deep wound to her tongue from a bar crawl mishap; Jude, a boy with a firework hand injury and alcohol on his breath; and most poignantly, the death of Louie, a kind man overtaken by years of chronic drinking.

Alcohol misuse causes more than 5 million emergency department visits each year, more than opioids or marijuana. And that doesn’t even count the falls, car crashes, or other injuries where alcohol plays a role.

The full impact of alcohol use disorder extends far beyond the ED. It costs the U.S. around $250 billion annually when you factor in all healthcare costs, lost productivity and the other ways alcohol misuse shows up across the healthcare system and in workplaces and families.

The show also reflects a hard truth: alcohol use disorder is a chronic disease, and it takes a heavy toll over time. We meet Louie in Season 1 and see him return to the ER repeatedly— dealing with intoxication, withdrawal, and everything in between.

Louie is likable. He jokes with the staff and asks about their lives, but it’s clear they are worried about him — warning that his liver will eventually fail if he keeps drinking. Their concern is well founded. Roughly 178,000 people die from excessive alcohol use each year in the United States, most from chronic conditions that develop over time. In Season 2, Louie becomes one of them.

The show also reflects how difficult it can be to engage people in treatment— and how uneven recovery often is. The doctors treat Louie’s acute symptoms but struggle to engage him in ongoing care. They suggest quitting and offer to connect him with a social worker, but he deflects. This is common: most people with alcohol use disorder do not get treatment, even though effective options exist.

We later learn that Louie had put together a few months of sobriety between visits. It’s a small detail, but it matters. Recovery rarely moves in a straight line — but it does happen.

The show also hints at how complicated this can be. Jude, a 12-year-old who gets injured in a firework accident, had been drinking with older kids while dealing with instability at home. Alcohol use doesn’t come from one place. It’s usually some mix of mental health, environment, life circumstances, and, for some people, genetics.

More hopefully, that same complexity means treatment can be multi-faceted. Peer support, therapy, addressing underlying mental health conditions, and greater stability day to day can all help.

Where The Pitt feels most true to life is where it reveals a systemic failure.

Take Jackie, who comes into the ER after a drunken accident. The doctors treat her injury and ask about her drinking—she’s drinking daily and bingeing on weekends— But that’s where it stops. We see her discharged with detailed wound care instructions but no clear next steps to reduce or quit drinking.

This is realistic. It’s also the system failing in plain sight.

These moments are missed across the healthcare system every day, despite representing clear opportunities to intervene. Patients are stabilized and discharged without being offered the full range of evidence-based options that could help them drink less or stop altogether, driving repeat visits, higher costs and worse long-term outcomes.

Medications like naltrexone can reduce heavy drinking and cravings, and research shows that starting treatment in the emergency department can improve quality of life. Yet these interventions remain underused, even though they have the potential to reduce repeat ER visits and improve outcomes at scale.

What’s true in the emergency department is true across the healthcare system: we treat the consequences of alcohol use, not the condition itself — a costly cycle for patients, providers and employers alike.

There is one final thing The Pitt gets right: the dignity of people living with alcohol use disorder. After Louie’s death, the staff gather to remember him — his humor, his kindness, his life beyond the hospital.

That portrayal carries real wisdom. No one is defined solely by their illness.

But if we recognize that humanity, our response should reflect it.

The problem isn’t that people with alcohol use disorder show up in emergency rooms. It’s that we keep sending them back out the same way — and paying the price for it.

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