Rehab Reality Check

There is an ongoing debate in the field between the hermetic model of places like Sierra Tucson, which bans cell phones and magazines as distractions from therapy, and the secular approach that attempts to integrate sober behavior into clients' ordinary lives. Wonderland Center, which has undertaken the Sisyphean challenge of treating Lindsay Lohan, sends its patients out into the world of temptation--it's located in West Hollywood, so they don't have to travel far for it--with a "Sober Companion" to utter for them the life-giving phrase, "mineral water with a twist." Individuals respond better to one program or another, but overall, the most important variable is simple motivation. Schwarzlose, whose facility has treated 76,000 people over the years, some more than once, points out that licensed health-care professionals and commercial pilots who go through rehab at Betty Ford usually stay clean afterward, because they know they'll be out of work for life if they fail another drug test. If movie studios treated actors the same way, he muses, gossip columns would have a lot less to write about.

But the real breakthrough, the paradigm shift, will come when safe, reliable drug treatments are available for addiction. Although they are no more likely to end addiction forever than Prozac ended depression, such drugs could make a big difference in the lives of people struggling with addiction. Their eventual likelihood got a big boost when researchers made the astonishing claim last month that people with injuries to a specific region of the brain instantly lost the desire to smoke. "There are probably 10 new drugs in development for alcoholism," says Willenbring, "and some are very exciting." Of course, people were very excited in the 1990s about using antidepressants to treat addiction, but that approach hasn't lived up to its promise. (Another disappointment was Antabuse, which reacts with alcohol to make you throw up; naltrexone, a more sophisticated drug, blocks the brain's opiate receptors--you can still drink, but it won't make you feel good. It can reduce relapse rates in the three months after treatment by 20 to 40 percent.)

But as researchers learn more about how addiction works, even more ingenious and effective drugs are possible. One, Topamax, an existing epilepsy drug (which means it has a leg up on safety testing), affects the balance between two brain chemicals, glutamate and GABA. Addicts have an excess of glutamate, which enhances the desire for drugs or alcohol; GABA inhibits it, so restoring the balance reduces cravings. You could call it willpower in a pill. A second class of drugs, nearing clinical trials, dampens the stress response, which researchers believe is crucial to preventing relapses after treatment. Willenbring cautions, though, that even the most effective drugs will undoubtedly have to be combined with some form of behavioral support.

But the paradigm shift goes deeper, because research will almost certainly also show that, under the $500 haircuts, celebrity brains are a lot like everyone else's. The advent of these drugs may also portend an end to that peculiar medical specialty, celebrity addiction, with its ego-soothing trappings and Pacific sunsets. One authority on this is William Moyers, 47, the son of TV journalist Bill Moyers, and himself a recovering alcoholic and crack addict. After four rounds of treatment he finally achieved sobriety in 1994. He is now vice president of external affairs of the Hazelden Foundation, which runs the highly respected treatment center in Minnesota. Hazelden, like Betty Ford, takes celebrities, but also many ordinary people struggling with addiction. "The best way to recover," he says, "is to level the playing field, so that people understand they're not alone. Whether they're actresses or waitresses."

With Anne Underwood, Raina Kelley, Karen Springen and Karen Breslau

© 2007