People often blame the victim when treatment fails

Remember all the brouhaha about Charlie Sheen and his drug troubles a while back? Who can forget?!  After trying numerous times to deal with his drug troubles the rehab way, Sheen was unfairly criticized for his decision to have “in-home” rehab. This attack was illustrative of the narrow thinking in celebrity rehab and in the addiction treatment industry alike about what treatment should look like and what it takes to “get recovery” and stay recovered. Following are examples of this thinking.

Exhibit A. When it was announced that Sheen would not be getting help in a group setting, Drew Pinsky of “Celebrity Rehab with Dr. Drew” fame (and now a regular on several other shows), was quoted as saying, “Treatment of addiction is a group process when done properly—not an individual thing at all.” As I’ve suggested previously in this column, although group therapy has been and remains the primary mode of counseling in rehab, not only is there no evidence that group treatment is the best way to treat addiction in general, I found that it wasn’t helpful for many individuals I interviewed for Inside Rehab. Dr. Thomas McLellan, CEO and co-founder of the Treatment Research Institute in Philadelphia is well known for saying this about group treatment: “If you go to just about any addiction program in this country, the major treatment activity is ‘group.’ If that doesn’t work, then they’ll try...‘group.’ And when all else fails they’ll suggest . . . ‘group!’” He has long argued that scientific studies support the value of having more individual counseling than is customary in addiction treatment programs.  At the low end for group time at 12-step residential programs I visited, staff at an exclusive celebrity rehab said that their residential program still consisted of about 60 percent group and 40 percent individual counseling. I was told that clients in primary care (the first stage of treatment) attended 21 groups per week. Although less than at many programs, I’d still say that’s a lot of “group”.

Exhibit B. Pinsky has been known to say that the 12 steps are “mandatory,” “the cornerstone of sobriety,” and that you can’t stay sober without them. Similar messages came from other high-end rehabs I visited. However, not informing clients about alternatives to AA can actually harm people when they’re led to believe that if they don’t connect with the established approach and (therefore) don’t do well in treatment, it’s because of some personal failing. Pinsky illustrated this blame-the-victim mentality in a CNN interview shortly after the death of Amy Winehouse when he said, “People look at these stories and go, ‘Oh, addiction treatment doesn’t work.’ The crazy thing about addiction is, part of the disease is a disturbance of thinking where the addict themselves convinces themself [sic] they don’t need to listen to or do what they’re being told to do and if they simply do the recovery process on a daily basis, just simply do it, they will be fine, just the way a diabetic is fine if they take their insulin three times a day.” If only Dr. Drew would get it that, sometimes—dare I say, oftentimes—it is the treatment and “what they’re being told to do” that fails the addict and alcoholic.

Exhibit C. An administrator at one high-end residential rehab told me of their treatment for opioid addiction, “No one leaves on Suboxone because that’s a recipe for disaster.” This rehab wasn’t alone in this practice, which more than one leading expert I interviewed described as “unconscionable”. Why? Because research suggests that most people addicted to opioids – including the prescription painkillers OxyContin and Vicodin – or heroin are very like to relapse if they are not discharged on “maintenance” doses of Suboxone or methadone. These medications also lower the death rate associated with opioid use. A recent analysis of Dr. Drew's "Celebrity Rehab" published in the journal, Substance Use and Misuse found that "although many patients had histories of opioid use, there were no positive messages" about Suboxone or methadone. On the contrary, these medications were portrayed as unacceptable, further stigmatizing methadone and Suboxone use and hindering many opportunities to provide science-based information.

I do believe that the intentions of Dr. Drew and most others who treat celebrities and other clients are well and good. They just need to get with the science, recognizing that more people would be helped if they were to step away from treatment-as-usual – be it in celebrity rehab or your neighborhood drug and alcohol treatment program.

Some of this material was adapted from INSIDE REHAB: The Surprising Truth About Addiction Treatment-and How to Get Help That Works by Anne M. Fletcher.  Used by permission of Viking Penguin, a division of Penguin Group (USA) Inc.

Follow me on Twitter @annemfletcher for daily updates on addiction, weight control, psychology, and health

Copyright Anne M. Fletcher

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