I saw this because I enjoyed the intense experience of Debra Granik's more recent film, "Winter's Bone". This film, similarly titled "Down to the Bone", covers somewhat the same emotional range. It is a very bleak story, but not entirely the most accomplished one. The problem with attempting an unpredictable story of addiction is in following the predictable life of an addict. This film is neither complex enough or well executed enough to really give us a new way of seeing things. Better cinematography could have helped. Using very cheap digital equipment (though probably more high tech as of 2004), Granik and cinematographer Michael McDonough take "Down to the Bone" in a more vérité-style direction. But the production values are low and poor even by normal documentary standards. This is a style that would only have great merit if this truly was a documentary, and not a dramatic film. The use of a soundtrack and other cinematic devices detracts from any possible grittiness that could have added to the feel.
The truth and power lies in the acting, as understated as it is here. It's refreshing to see human lives without a lot of exaggeration or demonstrative emoting. Vera Farmiga is the best thing going here, and I found her style compelling. The other performances are all good, and never feel any less than real. In the end, something about this film feels unfinished. Debra Granik has gone on to do a much better picture with "Winter's Bone". This is in interesting starting place, but it just isn't enough more than that.