Achieved A Rank

Drank all the whisky

Completed all challenge modes

Smoked every cigarette

Seen all endings

Self-medicated with every substance

Found all items

Found all maps

Read all notes

Took all your medicine

Achieved B Rank

Beat the first speedrun world record holder's time

Achieved C Rank

Achieved D Rank

Achieved F Rank

Played a song on the jukebox

Completed "Matchboxes Only Have 1 Match" Challenge

Participated in the temperance movement

Didn't smoke any cigarettes

Didn't eat any benzos

You pet the cat

Completed "Only Pills Heal" Challenge

Achieved S Rank

Completed "Less than 40 minutes" Challenge