Is Dr. Drew Too Risky for Prime Time?
Drew Pinsky practices old-school, tough-love 12-step recovery. After Mindy McCready's suicide—the fifth fatality among Celebrity Rehab alumni—our columnist asks if he should either get with 21st century treatment or get off the air.
With the news last week of country star Mindy McCready’s suicide by gun, the death toll among Dr. Drew’s Celebrity Rehab patients now stands at five, giving the show an unusually high mortality rate of nearly 13%. But what’s even more disturbing is that most of those deaths—possibly even McCready’s—might have been prevented if the program had utilized treatment practices proven to be most effective.
Although Dr. Drew appears to truly believe in what he does, addiction experts say that the treatment philosophy and policies demonstrated in his show and public statements often do not reflect the best evidence-based practices. His rejection of maintenance treatments, use of punitive detox practices and humiliating therapy and insistence that people cannot truly recover without complete abstinence through 12-step programs reflect the conventional wisdom of the 1980s, not the data of the 21st century. Indeed, Celebrity Rehab’s treatment—leaving aside the massive confidentiality violation of being televised—diverges dramatically from the National Institute on Drug Abuse’s (NIDA) Principles of Drug Treatment, a guide that lays out standards for the best addiction care.
Take the harsh way McCready was treated during her detox on season three of Pinksy's show, which premiered in 2010. As the cameras rolled, the country star began shaking and making involuntary movements. Her roommate, Mackenzie Phillips, simply laughed at her, apparently buying into the stereotype that addicts who seem ill must be faking it. But as Phillips belatedly realized that the seizure was all too real, the cameras continued to roll. She raced around, screaming and searching for a nurse; nearly a minute goes by with no one stopping the production to help. Instead, the cameraperson actually zoomed in as McCready shuddered and shook.
Prior to treatment, McCready admitted to drinking and taking benzodiazepines (anti-anxiety drugs like Valium and Xanax)—both of which can cause withdrawal seizures if patients aren’t adequately medicated during detox. Indeed, withdrawal from benzodiazepines and alcohol—unlike methadone or heroin withdrawal—can be fatal because these seizures can progress into a condition called status epilepticus.
Charles O’Brien, MD, PhD, is the director of the University of Pennsylvania’s Center for Studies in Addiction. He has developed drugs to treat dependence to alcohol, opioid and cocaine, done pioneering research into the clinical aspects of addiction and the neurobiology of relapse, been a longtime advisor to the government on drug policy and is widely seen as one of the top treatment experts in the world. He says that the death rate from such seizures can be as high as 10%. “If you properly medicate, you can usually prevent seizures,” O’Brien tells me. (To be fair, McCready had also suffered a previous head injury, which could also have caused the seizures.)
Seizures and other behavioral consequences of Pinsky's tough-love, no-medication, abstinence-only approach make for high drama, which is why some detractors have argued that Celebrity Rehab may put entertainment ahead of the most effective treatment—and even safety. For his part, Pinsky argues that drama is the only way to attract viewers. He told The New York Times in response to criticism of such practices by other addiction specialists that “the problem with my peers is they don’t understand television…you have to work within the confines of what executives will allow you to put on TV.”
Dr. Drew's treatment "philosophy" diverges dramatically from government standards for the best addiction care.
Sadly, that’s not the only way in which the show fails to provide evidence-based treatment. Consider what happened to former Alice in Chains bassist Mike Starr, who, under the current standard of care, probably should not have been detoxed at all, let alone as rapidly as was done on the show. In 2011, he died of an overdose of unspecified prescription opioids.
In the first episode of season three in 2010, Dr. Drew notes that withdrawal symptoms vary but that Starr is “in for a painful and even dangerous journey.” Starr was withdrawing from methadone, which he had been taking for 10 years to treat heroin addiction, a not insubstantial period of time.
Most experts say that methadone detox, done slowly, even after decades of use, needn’t be either extremely painful or dangerous, merely unpleasant and at times seriously uncomfortable. But Starr was withdrawn quickly, producing pain—and drama. He vomits voluminously at one point, leaving the puke to fester overnight when no one comes to clean it up. Sanitation issues are not the main problem, however.
O’Brien says that allowing people to suffer by abruptly stopping methadone is unethical. “It's a moral thing, and it doesn’t have anything to do with recovery,” he says. “Why should we be sadistic and want people to suffer just because they’ve become addicted? There’s not a shred of evidence that it’s good. This has absolutely no benefit.”
On day two of Starr’s detox, Pinsky describes his withdrawal as “so bad that he’s becoming confused, paranoid and rageful.” However, the doctor apparently does not slow the detox process to ease these symptoms. Indeed, as Starr kicks things, curses at the staff, makes obscene gestures and demands the cameras be turned off, the production continues, ignoring what appears to be a removal of consent to tape.
By day four, Starr has broken a lamp and refuses to get out of bed. Dr. Drew considers sending him to a lockdown psychiatric center, describing the musician as “overtly psychotic, a complication of his methadone withdrawal.”
However, psychosis is not considered a symptom of methadone withdrawal, according to O’Brien. “If someone becomes psychotic during withdrawal, it might be underlying schizophrenia,” he says, explaining that many people with addictions also suffer other psychiatric conditions. “We have seen people who are doing well on methadone go to pieces when they are taken off abruptly,” he says. “That’s why you take them off slowly. The best way is long-term detox over months as an outpatient.” That is, not 21 days’ inpatient like Dr. Drew’s program—and probably not at all if the patient does poorly without the drug.
Celebrity Rehab also reinforces negative stereotypes and myths about addiction—primarily the idea that abstinence through the 12 Steps is the only hope for recovery. That idea may have been deadly for Starr and some of the other patients, like bodybuilder and actor Joey Kovar, who overdosed on opioids last year, and actor Jeff Conaway, who died of pneumonia that was probably sparked by an opioid overdose in 2011.
For one, Pinsky’s repeated insistence that abstinence through 12-step programs is the only way to recover is a fundamental deviation from evidence-based best practices. In a voiceover on the show, Pinsky says, “12-step meetings are the cornerstone of recovery. Therefore, attendance is mandatory.” He also states, “Without 12-step, in my experience, there is no possibility of recovery."
- Mindy McCready
- Dr. Drew
- Celebrity Rehab
- National Institute on Drug Abuse
- Mackenzie Philips
- Charles O’Brien
- University of Pennsylvania’s Center for Studies in Addiction
- Alice in Chains
- Mike Starr
- Drew Pinsky
- Joey Kovar
- Jeff Conaway
- Betty Ford Center
- Sober House 2
- Dennis Rodman
- maintenance treatment
- evidence-based treatment
- Maia Szalavitz