There isn’t much to do in Langford, Virginia. A bowling alley. A lake. A soft-serve stand. It’s the sort of place to which people either escape or succumb. Those with a choice in the matter usually decide between the ages of 18 and 21; wait any longer and the door quickly closes. Every few years, someone might return to document the state of things through the lens of their now-larger world. How quaint it was, how mundane, how quietly decayed.

The United States is now decades into the economic degradation of once-prosperous rural communities and an epidemic of opioid abuse that has taken hold of them. Langford (a fictional composite of other Virginian cities) is no exception. Writer-director Jamie Sisley based Stay Awake, his feature-length adaptation of his 2015 short film, on his own upbringing in a similar city and his own struggle with familial drug abuse while living in a place that didn’t offer much hope that things would ever improve. Although it sometimes relies on the recognizable formula of drug abuse and recovery stories, Sisley’s film is a nonetheless effective entry in the genre thanks to excellent lead performances and a script that does not cut corners in its emotional honesty.

Derek (Fin Argus) and his brother, Ethan (Wyatt Oleff), have grown up in Langford with their single mother, Michelle (Chrissy Metz). Michelle is addicted to Xanax, which she procures thanks to a doctor who knows about her dependency but doesn’t seem to care. Whenever she overdoses, the brothers rush her to the hospital, quizzing her on showtunes and popular music to keep her awake and relatively cognizant. Michelle knows it’s a disease. She wants to get better. Each time she awakens in the hospital, she takes her exhausted sons out to breakfast and insists this time is the last time she’ll put them through such an ordeal. It never is.

The boys love their mother, of course, and the strength of Stay Awake comes from the conflicts between them and within them. Can they keep doing this for her? What is it costing them? What are the limits of their love for her — or the limits of their ability to help her? Derek graduated high school and works at the bowling alley. He still dates high-school seniors (who else would he date?), but his latest girlfriend, Melanie (Cree Cicchino), is heading off to college and doesn’t seem interested in returning home every weekend just to hang out with her barely employed boyfriend. That’s not to say Derek lacks dreams. He aspires to a career in acting and occasionally picks up side work in local advertisements. However, there’s no way he could leave Langford for larger opportunities in, say, Richmond — not when every day brings the possibility of an energy trip to the hospital.

Ethan, on the other hand, is 18 and desperate to leave for greener pastures. It’s not an easy future to plan, though. His relationship with Ashley (Quinn McColgan) ends when he reveals to her that he intends on attending Brown University rather than their agreed-upon future at the University of Virginia. Outside of her, he doesn’t have much of a social life besides Derek and their mother. Unlike Derek, who seems happy to stay in Langford and willing to pull Michelle through her cycle of relapse and recovery, Ethan just wants it to end. The weight of his mother’s disease weighs much more heavily on him. Every day that passes feels like another step away from a life he has a choice in leading.

Derek’s positive demeanor and Ethan’s troubled, open emotionality can only exist in tandem, and it’s a struggle for both of them as they try to figure out how to move forward without one another. They support and hinder one another while doing their best to decide what the next move is for Michelle.

Michelle isn’t just a plot device, of course. Metz is excellent as a woman whose tragic past (the boys’ father left at some point) has created a lot of trauma she has difficulty dealing with, which feeds her habit. She wants to get better but isn’t sure how to do it. She’s trapped, and her situation impacts everyone around her. By focusing primarily on the brothers, Sisley’s script allows the film to do justice to Michelle’s story without making it all about addiction itself, which is sometimes too often the focus in movies about relapse and recovery. Large issues, like misprescribed drugs and the extreme cost of recovery care, are seen through the eyes of the characters. It’s dramatic rather than didactic.

The opioid crisis has been ongoing for so long that there are many, many independent dramas that depict the way it has ravaged the American social fabric, particularly in underserved communities, particularly Appalachia. Sisley’s camera does justice by the beauty of the region in contrast to the tragedy he’s chronicling. His script avoids a lot of common pratfalls with addiction stories and never lays the blame on any one person or thing. The focus on character, particularly the brothers, and the way they face life together as they’re about to become separate, makes this a notable entry in films about the subject. Stay Awake isn’t the first melancholic movie to watch private worlds fall apart in the silence of forgotten America, but it’s one to remember.