Anna’s guilt complicates her healing process as she unsuccessfully tries to move on from the trauma caused by the car accident, her time outside exposed to the elements, and the resulting deaths of Ed and Olivia. The harsh winter weather, combined with the injuries sustained by the car accident, lead directly to the deaths of Ed and Olivia, and Anna blames herself for everything that has happened due to her decision to have an affair with Dr. Wesley Brill.

To escape her guilt, Anna seeks solace in mind-altering substances; she drinks red wine heavily, and she often begins drinking in the morning. Anna breaks glasses and wine bottles with some frequency, which depicts a loss of physical control, and when people like the Russells and the police detectives enter her home, they immediately notice the empty bottles that litter her coffee table and kitchen counter. Descriptions of her hazy perceptions of the world inside and outside the walls of her home emphasize to the reader that much of what Anna experiences in the novel take place while she is under the influence of alcohol and drugs.

Anna’s reliance on substances, which is a side effect of her guilt, causes Anna even more difficulty as she tries to live with her agoraphobia.