Experts explain the treatment process at rehab clinics--for celebrities and for regular folks.
By Richard Sine
Reviewed By Louise Chang, MD
Actor Michael Douglas, radio commentator Rush Limbaugh, and former congressman Mark Foley might seem to have little in common, but there's one experience they do share: rehab.
Hardly a week goes by that we don't hear of some new high-profile actor, singer, or politician checking into a center to treat a drug or alcohol problem. And when a celebrity goes to rehab, it's often to an exclusive facility with marble baths, ocean views, and a full spa.
It's enough to give addiction treatment a bad name. A 30-day stay in a rehab clinic used to be a common treatment for addicts. But today it's rarely covered by insurance, and thus too costly for most Americans. Does that mean that effective treatment is only for the rich and famous?
Fortunately, the answer is no. Outpatient treatment has proven to be equally effective for many addicts, experts say. Either way, not even the fanciest program can guarantee successful treatment. Success also requires a lifelong effort by the patient to stay clean.
How Rehab Works
Whether you're a celebrity or just a regular person, addiction treatment typically involves a similar series of steps:
- Detoxification. About half of the addicts who come to Butler Hospital in Providence, R.I., must check in as an inpatient for three to five days of "acute stabilization," Alan Gordon, MD, Butler's chief of addiction rehabilitation, tells WebMD. Some must cope with symptoms of withdrawal such as tremors, paranoia, and depression. Others must deal with the crises that brought them in to treatment, such as legal or domestic problems. (In outpatient programs like those at Butler Hospital, "detox" is the only inpatient component.)
- Diagnosis. Many addicts also suffer from psychiatric problems--such as sleep disorders, bipolar disorder, depression, and anxiety--or have faced traumatic life experiences such as rape or incest. While the exact relation between these problems and substance abuse may not be clear, many addiction treatment programs link up patients with psychiatrists or therapy groups.
- Cognitive therapy. This therapy helps addicts realize which life situations are most likely to trigger substance abuse, says Newt Galusha, MD, of Harris Methodist Springwood Hospital in Bedford, Texas. Then the addicts develop alternative plans. For example, if an addict usually drinks after arguing with a spouse, he might learn to end those fights by counting to 10 or going to an Alcoholics Anonymous meeting instead of going to a bar. Addicts also learn "assertive skills" that help them learn how to say no to drugs or alcohol, Gordon says.
- Family therapy. Many programs bring family members into the program to heal damaged relationships and shore up the addict's support network. Support from family members is key to helping addicts stay clean over the long run, Garrett O'Connor, MD, chief psychiatrist at the Betty Ford Center, tells WebMD.
- Medication. An FDA-approved medication, Campral, helps people with alcohol dependence who have quit stay alcohol-free. Another FDA-approved drug, Suboxone, treats addiction to opiates (including heroin and some prescription painkillers); it reduces withdrawal symptoms and cravings. Suboxone has a similar effect as methadone but is less prone to abuse, Gordon says.
- Introduction to 12-step programs. The Scripps McDonald treatment center in La Jolla, Calif., recommends "90 meetings in 90 days" for all of its patients, says Fred Berger, MD, center medical director. Many centers encourage patients to attend Alcoholics Anonymous or other forms of group therapy for a year or more after treatment.
How Addiction Works
It's the same old story: Celebrities check in. They check out with stories of a miraculous turnaround. And then, sometimes, they check right back in again. Is it poor self-control, or poor treatment?
Rehab experts say treatment can be very effective. But to understand how to gauge effectiveness, it's good to know a bit about how addiction works.
Experts now agree that addiction is a brain disease with a genetic component, Gordon says. But it's also affected by behavior. This behavioral component makes addiction comparable to other chronic illnesses such as diabetes and high cholesterol. Medicine has not found a way to "cure" these diseases with a pill or an operation. Instead, they require a lifetime of treatment, coupled with lifetime behavioral changes.
While most addiction treatment programs set abstinence as a goal, a relapse isn't a reason to give up on a patient as hopeless--just as you wouldn't give up on a diabetes patient who goes on a sugar binge, says Michael Scott, MD of the Sierra Tucson treatment clinic in Tucson, Ariz. "Addicts have their ups and downs, but you can take that information and work with it to see how to do better," Scott tells WebMD.
About 50% of patients at Butler Hospital's programs remain clean and sober for a year after treatment, Gordon says. But many of those who relapse "don't go into a black hole," he says. Instead they return to treatment to build on the behavioral skills they learned the first time.
Studies show a connection between treatment success and the "length and intensity of treatment," says Galusha. That usually means at least three weeks of treatment lasting several hours a day (whether as an inpatient or outpatient), followed by frequent attendance at AA or other group therapy for about a year.
Who Benefits from Inpatient Care?
A 30-day stay in a clinic used to be the standard treatment for addicts. But with the rise of managed care in the 1980s, insurers balked at the costs, Gordon says. Many clinics shut down, and for years it was very difficult to get an insurer to cover any inpatient treatment. Now some insurance plans will cover inpatient stays at relatively inexpensive facilities, Galusha says.
Experts say inpatient treatment is most needed by addicts coming from a chaotic environment or who suffer from a severe psychiatric illness. For example, if family members are substance abusers, "an inpatient program will get them out of that environment so some intensive work can be done," Berger says. By contrast, outpatient treatment may be fine for a patient who is married and has a steady job.
A homeless single mom in a drug-infested neighborhood might well qualify for inpatient treatment, experts say; so would a hard-partying celebrity who is constantly traveling between movie sets or concert stages. The difference, of course, is that celebrities can spend a thousand dollars a day or more on treatment, while the homeless mom is at the mercy of the public health system.
High Cost of Treatment
Treatment at Sierra Tucson--which has treated Ringo Starr, Michael Douglas, and Mark Foley--costs about $1,200 a day. There's a pool, spa, gym, climbing wall, and even equestrian stables. But Sierra Tucson isn't just a retreat, says Scott; patients spend most of their waking hours in "emotionally draining" recovery activities. "We treat them intensively, and they do well."
Other, simpler inpatient facilities charge lower rates. The RightStep chain, based in Houston, charges $8,500 for a one-month inpatient stay, and says it has "preferred agreements" with many major insurers. (Intensive outpatient treatment costs $3,000.)
How to find a good clinic? Ask your doctor or friends, suggests Berger. Look for a clinic that is staffed with addiction-certified counselors and medical staff, says Galusha. And look for a clinic with medical staff that can treat the psychiatric problems that so often accompany substance abuse, says Gordon. That usually means access to psychiatrists as well as counselors, he says.
Treating the High-Profile Ego
Maybe celebrities and others in the public spotlight can afford fancy clinics. But they also face special challenges when it comes to getting clean and sober, say the experts who treat them regularly.
Celebrities and other high-profile people are surrounded by "groups of people who have a vested interest in their success," says Scott. A lot is at stake, whether it's a political campaign, a concert tour, or a movie production. So not everyone in the entourage may be so accepting when an addict needs to take time out for group therapy or to stay away from events where liquor is served.
Successful people with large egos are especially difficult to treat, Scott says. "They have accomplished so much in their lives, so they cannot believe they can't [kick the habit] themselves," Scott says.
O'Connor treats a lot of high-flying professionals in addition to the occasional celebrity. Doctors, pilots, and the like are expected to be high achievers, O'Connor says, and addicts in these professions have developed a matching ability to deny and rationalize their abuse. So it is especially difficult for these people to admit that they have let people down because of their addiction. "An enormous cistern of grief accompanies them into the center," O'Connor says. "What we really treat is the shame of it all."
Published Nov. 27, 2006.
SOURCES: Alan Gordon, MD, chief of clinical addiction rehabilitation, Butler Hospital, Providence, R.I. Newt Galusha, MD, medical director of addiction treatment, Harris Methodist Springwood Hospital, Bedford, Texas. Fred Berger, MD, medical director, Scripps McDonald Center, La Jolla, Calif. Garrett O'Connor, MD, chief psychiatrist, Betty Ford Center, Rancho Mirage, Calif. Michael Scott, MD, medical director, Sierra Tucson, Tucson, Ariz. Tucson Citizen: "Sierra Tucson will add 44 beds to treatment facility," Nov. 10, 2006. Promises Residential Treatment Center web site. Sierra Tucson web site. FDA web site.
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