Is the Use of Rehab Being Trivialized? Rehab used to be the linoleum-floored stop of last resort, the rock-bottom from which addiction was fought. Guests examine whether, at least for some celebrities, rehab is now just penance for a public gaffe.
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Is the Use of Rehab Being Trivialized?

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Is the Use of Rehab Being Trivialized?

Is the Use of Rehab Being Trivialized?

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NEAL CONAN, host:

This is TALK OF THE NATION. I'm Neal Conan in Washington.

Think rehab, and you might see white, industrial walls, linoleum floors and hospital food served on plastic trays, but some see a different image -secluded cottages, spa facilities, gourmet cooks - the kind of rehab celebrities check into after passing out from exhaustion at a late-night hot spot or pounding a white SUV with an umbrella after they cut off all their hair.

And whatever problems the glitterati might need help with, it often seems that rehab is penance for a public gaffe, a short stay at a fancy resort beyond the prying lenses of the paparazzi.

In Sunday's Chicago Tribune, Los Angeles Times columnist Dan Neil described his experience in rehab as fluorescent lights, plastic chairs and real people with real problems. While we snicker at the misadventures of the rich and famous there is somebody out there, he wrote, trying desperately to hold on with his or her fingernails and wondering if maybe rehab might really help.

Later in the program, political junkie Ken Rudin; and this week, Congresswoman Lynn Woolsey, co-chair of the Congressional Progressive Caucus. If you have questions about Democratic difficulties on Iraq or other political news, you can send questions now by e-mail: talk@npr.org. Again that's talk@npr.org.

But first, the trivialization of rehab. If you have questions about how it really works, or if you're been there, our number: 800-989-8255, 800-989-TALK. The e-mail address again is talk@npr.org.

And we begin with Dan Neil. He's a columnist for the Los Angeles Times, a Pulitzer Prize-winner. He joins us from member station KUSC in Los Angeles. Nice to have you back on the program.

Mr. DAN NEIL (Columnist, Los Angeles Times; Op-ed Contributor, Chicago Tribune): Hey, Neal, how are you?

CONAN: I'm good. Now you were in rehab 17 years ago, and as I recall, your article - you don't describe a masseur or Pilates classes.

Mr. NEIL: You know, we didn't have that, and we didn't have - we could not pick our own menus, and if you were getting a massage, chances are something had gone horribly wrong with security.

(Soundbite of laughter)

CONAN: Now without telling us what your addiction was, can you tell us what led you to rehab?

Mr. NEIL: Oh, sure, and I have no problem telling you what, you know, my situation was. You know, I was a chronic pothead, and I couldn't stop smoking pot, and what you find out about addiction is it's really just the symptom. I mean, the underlying cause is what has to be treated. And so after a series of, you know, personal crises, I signed up for rehab.

CONAN: And did it work for you?

Mr. NEIL: It did, you know, and the odd thing for me was that - I mean, the first half-hour in rehab, somebody said to me wow, you know, you're - you've been self-medicating your problems. And I was like oh yeah, of course. That makes perfect sense.

CONAN: Ding, ding, ding, ding, yeah.

Mr. NEIL: Man, I was like that makes so much perfect sense, and I'd never heard the phrase before, and after that, you know, a lot of things started to fall into place.

CONAN: And one of the things that you discover in rehab, as I understand it, is you can help other people; they can help you.

Mr. NEIL: Yeah, you know, the modality of recovery is a little bit like the Lancaster method of teaching, where you teach - someone teaches you, and you teach someone else, and along the way, you know, you have the accretion of experience. And so indeed, you know, it doesn't work unless you are with other people on a regular basis to share your experience.

CONAN: It also, it helps to have a staff who knows what they're doing. Indeed, one of the differences between a staff at a rehab center and staying at home is that the people at the rehab center know how to be constructively mean.

(Soundbite of laughter)

Mr. NEIL: That's true. Well you know, you just can't - the thing is, you know, if - people come into rehab, and they've run amok in their own lives, and they're, you know, a very willful and determined bunch, and so - and obviously, that's not working for them. And so one of the things - it's a little bit -it's a tiny like Paris Island. You know, you have to break down the will, and you have to submit.

You have to be willing to say look, you know, I didn't - my best thinking got me here, so I'm willing to do what you said. The smartest thing anyone ever said to me was stay stupid. And I was like okay. I don't know what I'm doing, so I'll do it the way that it's worked for millions of other people.

CONAN: Now you resent, at least in your article, you resent the Britney Spears and Lindsay Lohans of the world for checking in and out of rehab as it seems to strike their fancy, but isn't this - they may have real problems.

Mr. NEIL: They may indeed have real problems. I wonder if treating them like the exalted stars they are, even in rehab, is a way to address that, because my experience - and I think the truth of the therapeutic environment, is that you have to tell people, you know, they can't have their own way. Their way is exactly what got them where they are.

And also, the revolving-door thing. You know, if you go to rehab, that's an acknowledgement that you can't do it on the outside, right? You know, you need to be inside. But what if you're going to the store, you know, every other day? So I think that's probably, you know, a big problem with it, yeah.

CONAN: And it was not even that so much, it was the reaction that that spawned in the rest of us and, you know, the mere mention of Betty Ford or one of those places, and it makes people giggle.

Mr. NEIL: Yeah, yeah, it really has been made into this kind of what is - it's kind of a ceremonial thing, right? You know, if you have a terrible week in the public eye, you check into rehab. You know, that hash is checked off, and people say well, you know, now it's okay.

We have a great capacity for forgiveness. We - well, you know, it's the 21st century version of the public stocks. You know, people go and, you know, get locked up for a couple of days, and then we forgive them. But the larger point is that these people aren't any better when they get out.

CONAN: And by public stocks, of course, Dan Neil does not mean the Wall Street market but rather those wooden things you stuck your head and arms through and stayed out there for the whole day for people to mock you and say terrible things about you.

Mr. NEIL: That's right, for those of you who weren't raised in New England.

(Soundbite of laughter)

CONAN: Joining us now is Rob Martin. He's a substance abuse counselor with North Carolina Behavioral Health Services. In fact, he was Dan's rehab counselor back in 1989. He joins us from the studios of the North Carolina Agency for Public Telecommunications in Raleigh. Nice to have you on the program today.

Mr. ROB MARTIN (Substance Abuse Counselor, North Carolina Behavioral Health Services): Thank you, Neal, glad to be here. Good to see you, too, Dan.

Mr. NEIL: Hi, Rob.

CONAN: And I have to begin, Rob, by asking: So what kind of a patient was Dan?

Mr. MARTIN: Dan - treating Dan was like flying a kite in a hurricane, basically.

(Soundbite of laughter)

Mr. MARTIN: He is clearly a very intelligent, very energetic and spirited young man, and remains so. I don't think it was me that told him to stay stupid, but it was excellent advice. He was fully capable of coming in the door of thinking himself right out of recovery pursuant to his addictive personality at the time.

But ultimately, he was a model patient. I think he had the happy coincidence of finding himself able to go into treatment and willing to go into treatment at a time when he was at a personal bottom. It all came together.

CONAN: A personal bottom. That's a big part of this, isn't it?

Mr. MARTIN: Huge part of it, huge part. There's a lot of well-intended efforts to get people into treatment as soon as possible, as soon as - excuse me, a problem is identified. Unfortunately, sometimes everybody's ready for the client to go into treatment except the client, and it can cause an aborted or failed treatment experience, expending resources that are no longer available when the client is ready to go in. So that can be a problem. Timing is everything.

CONAN: Timing is everything. And it may prompt cynicism and they won't go when they actually do need it, when the rock bottom actually does hit. By the way, Dan, did Rob remember to send that stay stupid memo to the Pulitzer committee?

(Soundbite of laughter)

Mr. NEIL: I feel like they got it all right. And no, you know, it was Rob who said that, and for the very thing that he said. You know, people who are, let's say - you know, let's say they're college educated, right? They're going to - they're book smart, right? But that doesn't mean they have a clue about how they're actually behaving or how to change their behavior. And so a part of it, and I think a big part for me was just this willing submission to the well-established wisdom that was part of the recovery process when I joined up.

CONAN: Let's get some listeners in on the conversation: 800-989-8255 if you'd like to join us. 800-989-TALK. E-mail is talk@npr.org. Dan Neil, the columnist for Los Angeles Times is with us. Also Rob Martin, a substance abuse counselor. Indeed, many years ago, Dan Neil's substance abuse counselor. And let's see if we can get Meg(ph) on the line. And Meg is calling us from Iowa City.

MEG (Caller): Hi, good afternoon.

CONAN: Afternoon.

MEG: I got out of a rehab facility three months ago after relapsing on narcotic pain medication. And I went totally broke, so I had to go someplace that was state funded. And I went to mental health facility that was actually on a prison grounds. And I have to say, after doing a number of treatments, it was probably the best treatment I ever had because they ran the place almost like it was a prison and I had no choices in anything.

CONAN: So the pacific - view of the Pacific, that was not available in your suite?

MEG: No, no, no. There were no massages and no pedicures. We ate in the cafeteria. The prisoners prepared all the food.

CONAN: And I'm sure they're gourmet chefs.

MEG: Oh absolutely. Absolutely. I was the only one there who was not committed, and I'm sort of wondering - I have a lot of perspective now on whether it's a good idea to actually commit somebody into treatment that doesn't really want to be there. I'd be interested to hear what the substance abuse counselor has to say about that.

CONAN: Well let's get a response from Rob Martin. And also, isn't what Meg is describing more typical of rehab than what we got glimpse through the lenses of Brittany Spears' limousine going by?

Mr. MARTIN: Actually it's not so much typical, but at the other end of the spectrum, the restrictive prison environment. Most people can do well in that therapeutic type setting. The more typical is a blend between the two, a freely admitted; you're not committed. You're allowed to leave when you want. You're there by choice. Facilities similar to the one Dan and I met each other in, they were not plush but it wasn't, you know, a barn either. But I have worked in the prison systems here in North Carolina, however briefly, many years ago, and when you've got somebody in prison, you've got their attention. That's a good thing.

CONAN: Meg, we'll get to your other point about commitment later as soon as we come back from the break, but we're going to let you go. Thanks very much for the call.

MEG: Okay, I want to say, though, that it wasn't a prison. It was on a prison facility and most of the staff (unintelligible). I don't want to give that impression at all but...

CONAN: And before we let you go, we wanted to say good luck to you.

MEG: Thank you so much.

CONAN: All right. We'll be back with Dan Neil and Rob Martin after a short break. I'm Neal Conan. It's the TALK OF THE NATION from NPR News.

(Soundbite of music)

CONAN: This is TALK OF THE NATION. I'm Neal Conan in Washington.

Tomorrow at this time we'll focus on Iran and try to answer some of the many questions surrounding that country's nuclear ambitions, its influence in Iraq, and Tehran's face-off with the United States over nuclear weapons. You can send us your questions in advance by e-mail. The address is talk@npr.org. And we'll get to many of them as we can on the show tomorrow.

Today the focus is on rehab and whether celebrities who check themselves in and out to mitigate every PR disaster are trivializing rehab for the people who really need it. Our guests are Dan Neil, a columnist for Los Angeles Times who wrote an op-ed about this, and Rob Martin, a substance abuse counselor with North Carolina Behavioral Health Services who counseled Dan Neil through rehab in 1989.

And we welcome your calls. If you have questions about how rehab really works, if you've been there: 800-989-8255. E-mail is talk@npr.org. And Rob Martin, I wanted to get to Meg's question about commitment. A lot of people who are in rehab are committed through a court process or they're underage and their parents send them there. Is this a wise step?

Mr. MARTIN: I might not be the best person to ask. In North Carolina, you can't really get committed solely on substance abuse issues. There has to be issues of imminent danger of suicide or homicide. And even then you're stable and when you're no longer a danger. But it's very rare just to get committed just on substance abuse alone in North Carolina.

CONAN: All right. We'll have to try to answer that at another time then. Here's an e-mail question from Eric(ph) in Portland, Oregon. For those who have never been to rehab and have no need to go, pray tell, what is rehab? What exactly goes on there? Dan Neil.

Mr. NEIL: Okay. Well, here's my experience. It was in a suburban office park in Durham, North Carolina. Tidy, not plush. You know, the first thing they do is they, you know, check you for contraband because, surprisingly, a lot of people go to rehab thinking, you know, they'll just keep a little taste for hair of the dog or whatever. And typically that's, you know, all part of the process. And then you check in and you have sort of an admission assessment. And then what I remember is the room, my first room. It was a couple of low built-in beds and - oh, there's no - I also remember there was no caffeinated coffee because people will abuse anything, and caffeinated coffee is one of them.

So there was decaf coffee. That was a huge step down for me. And that was it. And when they closed the sort of hospital-like door I was like oh yeah, I'm really in rehab, whoa.

CONAN: You're waiting for a big nurse to come through the door?

Mr. NEIL: Yeah, absolutely. Actually, the nurse I remember was actually a very tiny person, but powerful.

CONAN: And what do you do during the day? Is it constant therapy sessions? Art therapy? What do you do?

Mr. NEIL: Well that's an interesting question because, you know, I was reading about these luxury rehab centers, where they have yoga and Pilates and, you know, and me time. But in my experience, you know, we spent most of the day in group or individual counseling, or assessments or some kind of process because, you know, when people walk through the door their brains are pretty scrambled and they need a lot of intensive therapy. And so you do - mostly you do that. But Rob knows more about that than I do.

CONAN: Rob?

Mr. MARTIN: Well, generally a person who has got in trouble with alcohol or drugs has been trying to control or cease use on their own with good, solid honest efforts, but they just didn't know what would and what would not work. So a large component in the beginning component is getting people educated that willpower alone is not going to work. If willpower worked, there wouldn't be any treatment centers. So we do a lot of educational type groups with lectures, a lot of chalkboard work, films and videos, thinks like that. I even use several "Simpsons" episodes as instruction aids. There are also - well, I highlight Barney, the town drunk (unintelligible) drunks are hilarious in American society. But take Barney's booze away and make him a crack addict and he ceases to be funny real quick. But that outlines some of the American attitudes about alcohol.

But we also do small group. Each counselor in the center we were in was assigned six to eight clients and those were your primary clients, although you could talk to any counselor, of course.

CONAN: Sure.

Mr. MARTIN: And we would have small groups where just those six or eight and I and a nurse partner I had named Debbie(ph) - Debbie Crosier(ph) - would work with the clients and do more personal individual, apply the education to the individual's situation - process group.

CONAN: All right, let's see if we can get some more - and the typical stay at a rehab center is?

Mr. MARTIN: At that time it was 30 days because that's what the insurance package was. That has changed now and it can be anywhere from two, three, four, five-day detox to a six weeks stay, twelve weeks stay.

CONAN: Depending on what kind of insurance you've got, again.

Mr. MARTIN: Exactly.

CONAN: Let's see if we can get some more callers on the line. This is Jason(ph). Jason's calling us from Florida.

JASON: Hello. Hi. When I was in middle school I was put into a rehab clinic for juveniles. I was about 15 years old. And it was because I was smoking a lot of pot with my friends all the time and got into some trouble in school. And when I went to rehab, I learned about a lot more harder drugs from all the people there that I wouldn't normally have been exposed to in middle school, like ecstasy and all sorts of drugs. And, you know, my concern is that kids being put in there to get over their problems are being exposed to harder stuff, and potentially if they relapse they could be in more trouble.

CONAN: Are you saying Jason, just to be clear, you found out about these drugs and talked about them. They weren't available to you, were they?

JASON: No, no, they were not.

CONAN: But you got curious about them.

JASON: Excuse me?

CONAN: But you got curious about them?

JASON: Right.

CONAN: Right. Rob Martin?

Mr. MARTIN: In that situation where you're in treatment - adolescent abusing one drug learns of all the others, if they leave treatment and they had a good treatment experience and do well, they're going to have the tools they need to avoid any drug or alcohol. If they're going to return to use and back to the party scene, they're going to get exposed to those things sooner or later anyway. We can't have individual treatment centers for each individual drug and keep them all separated.

JASON: I'm sorry to interrupt you, but I wanted to emphasize the point of relapse happening, because I know of quite a few people who have had relapses from traumatic experiences in their lives, like death in their family and stuff like that, where, you know, they kind of feel completely helpless again.

CONAN: And - go ahead, I'm sorry.

Mr. MARTIN: Every life is full of bad things. Bad things happen to good people all the time. Family members and loved ones die. All sorts of bad things happen. It is part of the human condition and it's part of recovery to learn how to handle those things without resorting to drugs and alcohol.

CONAN: Jason, how did it work out in your case?

JASON: In my case, I just kind of grew up and I went to college and, you know, I relapsed a couple of times. I mean, you don't know, but I pretty much got my head back on the right track by myself. And my friends who don't do that stuff and stay away from it as far as possible I kind of just surrounded my environment with people who, you know, steer clear of that stuff.

CONAN: Sounds like you learned some lessons.

JASON: Absolutely.

CONAN: All right.

Mr. MARTIN: Good for you, Jason.

CONAN: Jason, thanks very much for the call. Appreciate it.

JASON: No problem.

CONAN: And stay in there. All right. Let's go to - this is Ann(ph). Ann's with us from Chicago.

ANN: Hi. I'm an addiction counselor in Chicago and I've been working almost 20 years in the field. My impression regarding, you know, this current wave of celebrities is that this is a field where we see a lot of relapse and a lot of people leaving treatment and returning to treatment. And yes, it can be an abuse, but most people don't have a posse of cameras following them and photographing their every move. And I think that has to be tempered with certain treatment facilities who allow media to have access to people while they're in treatment. But typically a lot of people do drop out of treatment after a day, or after three days, or after a week, and they return a week later.

CONAN: And may do something crazy but not have their picture in the front page of every newspaper in the country the next morning.

ANN: Exactly.

CONAN: Yeah. She's got a point, Dan Neil.

Mr. NEIL: Perhaps, but I think what we're talking about with these celebrities is just people who have become so accustomed to privilege that, you know, they have been - their privilege inoculates them from really the therapeutic dynamic of going to rehab, which is to say okay, I give up. I can't do this. I need somebody's help. As I said in my column, you know, it's very hard to tell somebody that their life is unmanageable when they've hired a personal manager. And, you know, it's hard to tell them that they're powerless when they've got, you know, $20 million in the bank.

I mean it is true that their private lives are public. But it's also true that the nature of celebrities sort of makes them harder to treat.

ANN: I agree but I also think that I have seen - I think there are certain treatment centers that are complicit with this. When they allow celebrities to leave to do a film or to do a concert or do an interview, then they're feeding into the whole celebrity and they're not treating the illness.

CONAN: At that point, it's more a resort than a rehab center.

ANN: Exactly.

Mr. MARTIN: If I may, there's a…

CONAN: Go ahead, Rob Martin.

Mr. MARTIN: Well, there's a dynamic any treatment center, any clinician wants to avoid and that's where the patient begins dictating treatment. There's nothing on - like the caller, I've been in the business about 20 years, a little less than 20 years.

I've had dozens and dozens of people leave treatment, outpatient or inpatient, and come back. But the reason they want to come back makes a big difference. Some say I freaked out, I missed my girlfriend, my wife. I went out, I relapsed, I made a big mistake. You guys were right. Can I please come back in?

That's an appropriate readmission. I don't know, but I suspect a lot of these Hollywood folks are checking in and out because they're dictating that they be allowed to do so and bring the cameras, because they want it on the news cycle on cable TV.

But that - you run into deep ethical problems when you let a patient, when you knowingly let a patient dictate treatment, what they will and will not do. How long they'll stay, how long they will not. From the 12-step modality, we have that familiar phrase that addiction is self-will run riot. That's part of the thing we're trying to turn around, of course.

And you're not going to do that if the patient's dictating what's going to happen.

CONAN: Ann, thanks very much for the call.

ANN: Thank you.

CONAN: Appreciate it, Ann.

Just wanted to quickly, Rob Martin, when we've been talking to addiction to alcohol and other drugs. Is it fundamentally different? I think the media sometimes tends to use rehab perhaps in situations where it might not apply. Anger management therapy. There are kinds of eating disorder programs that are not dissimilar to addiction treatment. Again, eating disorders are not dissimilar to addictions. But we're strictly talking here about addiction programs, correct?

Mr. MARTIN: I am, yes.

CONAN: Okay, all right.

Mr. NEIL: And I just want to say, Neal, that, you know, Isaiah Washington, the actor from "Grey's Anatomy," checked into rehab because he had used a homophobic word. And Ted Haggard, the reverend, checked into rehab because he had acted out on his homosexual impulses, and then came from, quote-unquote, "rehab" cured. Well, unless they gave him a head transplant, he's not cured from rehab like that.

Mr. MARTIN: And there's Foley and Mike Richards as well.

Mr. NEIL: Oh yeah, right. Foley.

CONAN: Congressman Mark Foley. Anyway, we're talking with Dan Neil of the Los Angeles Times and with substance abuse counselor Rob Martin. You're listening to TALK OF THE NATION from NPR News.

And let's get Kelly on the line. Kelly calling us from Miami.

KELLY (Caller): Hi. I have a question regarding - because I heard you mention the 12-step program. I actually spent six months in an outpatient rehab facility where I felt that I had very little choice in terms of the approach that, you know, I went through recovery. I understand that patients are necessarily going to be given, you know, the choice, how long they stay and, you know, the quarters in which they stay, which is totally understandable.

But I felt almost that I was forced into complying to this 12-step program that I didn't necessarily believe in. And I've been sober for 18 months now outside of, you know, the 12-step program. And I just found that it was a little compromising, and I wanted to know what you thought about that and the choices that patients are given.

CONAN: Dan, your piece seems to suggest you used the 12-step program, too.

Mr. NEIL: Yes, and my feeling is - this is just my feeling - I believe everybody should be in some sort of 12-step program. Because basically it, you know, it teaches humility and it asks people to check themselves, make sure they're not being arrogant, or stupid, or misleading, and that is a life, is a way to live. It's also a way to stay sober.

I know that there's a big controversy, an ongoing controversy, about addiction treatment, whether the 12-step programs are the only way or should it be treated more as a medical condition that can be managed.

My sense is - and this is just my sense alone - I mean 12-step programs have worked for millions and millions of people, whereas the track record for medicine is a little less definite. So one other thing is 12-step programs are free. You know, hospitals and rehab are very, very expensive. And so you have the whole axis of insurance compensation that comes into play here.

KELLY: But I think what I found, I suppose, like the most troubling about the 12-step program was this sort of air of it being sort of very dogmatic and you having to submit and say, you know, I really have no control over these circumstances when, in fact, I believe that it is my will that keeps me sober. And it is, you know, my ability to control myself and to check myself on my own without, you know, submitting or sort of following the exact text of a book.

You know, I do understand that it works for many people but, you know, I thought it was sort of unfair. It got to the point where I, you know, I got to my tenth step and I just really just said, you know, I'm lying. This is kind of not what I agree with. So I just wanted to say that I really think that patients should be given more leniency in how they want to approach their recovery. And it has worked for so many people I know but…

CONAN: I don't mean to interrupt but I wanted to give Rob Martin at least 30 seconds to respond to what you were saying, Kelly.

Mr. MARTIN: With all due respect to the caller, anybody at all familiar with the AA and NA programs understands that their own literature states, and this is repeated at the formal parts of the beginning and ends of the meetings themselves, state very specifically the 12 steps are not commanded. They're just suggested as something the founders had tried and found to work.

It is true that there's a certain path everybody has to take from active, out of control youths down to the other hopeful extreme of clear, sober living with peace, in that everybody that goes from there, from that point to the other, follows a certain trajectory and the 12 steps help organize that. But they're not commanded.

CONAN: Kelly, good luck and stay with it.

KELLY: Great, thank you.

CONAN: Appreciate the phone call. Dan Neil, thank you so much for your time today. Always good talking to you.

Mr. NEIL: Thank you, Neil. Talk to you later, Rob.

Mr. MARTIN: You too, buddy.

CONAN: Dan Neil is a columnist for the Los Angeles Times. He's been talking to us from KUSC studios in downtown Los Angeles. Also with us today, Rob Martin, a substance abuse counselor with North Carolina Behavioral Health Services.

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