I went to see this movie without any prior expectations (I hadn't seen the trailer).
After a slow start the plot progressed steadily and managed to hold my attention despite Milo Ventimiglia's "smell the fart" acting. The copious amounts of gore seem excessive in the beginning, but generally add to the overall "shock factor" of the movie. Along with some in your face, sometimes slightly disturbing, sex scenes, this film is definitely NOT FOR THE LIGHTHEARTED.
Without giving too much away, this movie relies upon a classic mentor/apprentice rivalry. Despite being involved in sick extra curricular activities, main character Ted Grey manages to hold the viewer's empathy. The climatic ending of the film leaves you feeling satisfied yet a little sick in the stomach.