First-novelist Miller pulls a minimum of punches in her grueling depiction of a young woman’s heroin-assisted downward spiral. Since her youth in Bensonhurst, Ilyana, the only child of crude, abusive parents, ’sensed heroin as an inevitable destination.— Now a bookish Brown graduate, she lives on the Lower East Side of Manhattan, the same neighborhood her grandparents had worked hard to escape. Ilyana does her best to resist friendships: such attachments seem inevitably to lead to loss. When her beloved roommate commits suicide, Ilyana replaces her with Susie, a big-boned mosaic maker who deflects Ilyana’s reflexive cruelty and wears down her wariness with generosity and bad jokes. Effortlessly domestic, Susie even gets the nihilistic Ilyana to bake a peach pie. Initially, Ilyana is confused by Paul, Susie’s nice-guy boyfriend, but then she gets at what’s behind his lack of focus: that he’s using heroin. He manipulates her into keeping it secret from Susie: and when Susie discovers her deception, she immediately moves out. Bereft, and ruminating on her lost friendship, Ilyana intensifies her own use and takes up with a slick pack of clever addicts—the sort who play parlor games predicting how each will die—but even that insubstantial circle evaporates when a gang member overdoses. Ilyana meticulously chronicles the degrading minutiae of the months that follow: her razor-sharp memory and ready grab-bag of scientific and literary references don—t dissipate, but, rather, enrich her meditations on paralysis, consciously chosen loneliness, masochistic relationships (including a fling with Susie’s Paul), and the decay of her bodily functions. It’s only when Paul dies of AIDS, and Ilyana’s suicidal wishes run rampant, that she opens herself to a redemption of sorts. Though the hopeful transformations feel a bit forced, Ilyana’s voice is authentic in unsparingly illuminating the link between self-protection and self-destruction, revealing a tender inner life that persists despite addiction, depression, and descent into squalor. A bleak, bracing debut.