Is Dr. Drew Too Risky for Prime Time?
(page 2)In a statement a spokesperson for the National Institute on Drug Abuse (NIDA) disagreed, saying, “Different treatment approaches are needed for different people, since not everyone afflicted with addiction responds to the same intervention.”
Indeed, it’s not clear why a methadone patient like Starr should have been encouraged to stop that medication at all. Studies have shown conclusively that methadone reduces opioid use, cuts death rates and lowers crime: it is at least as effective as abstinence-based treatment on these measures, and in some cases, more so.
While some methadone patients can achieve lasting abstinence, the risk of relapse and resulting death by overdose is extremely high. As a result, expert advice is generally to support attempts at abstinence but not to disparage maintenance or oppose a return to it if the patient isn’t doing well.
In fact, a 2007 consensus statement convened by a panel of experts by the Betty Ford Center—not exactly a hotbed of support for non-abstinence treatments—recognized that people on stable maintenance should be seen as being in recovery, just like those in 12-step programs. The experts wrote, “formerly opioid-dependent individuals who take…methadone as prescribed and are abstinent from alcohol and all other nonprescribed drugs would meet this consensus definition of sobriety.”
This is apparently news to Dr. Drew, who tells patients that “methadone takes your soul away,” which can’t mean that he thinks methadone is consistent with sobriety. When questioned about this statement, he told VH-1, “If you get enough for it to work, you’re just on the couch. You can’t do anything.”
“That’s completely false,” O’Brien says. “We’ve had people on methadone going back to school, practicing law. There's hard evidence that methadone saves lives and probably a lot of souls, too.”
Pinsky discourages not only methadone but also maintenance with buprenorphine (Suboxone, Subutex), which is also consistent with sobriety if used as prescribed, according to the Betty Ford consensus. Indeed, Hazelden itself—the originator of the 28-day abstinence-based model on which Dr. Drew’s program is based—has recently begun offering buprenorphine maintenance. It had found that too many people were dying of overdose following treatment, so it changed its practices based on the data. Three of the five deaths following Celebrity Rehab have involved opioid relapses that might have been prevented by maintenance.
But Dr. Drew insists—again contrary to NIDA guidelines—that buprenorphine “is supposed to be a medication for outpatient detox,” not a maintenance drug. NIDA says, “Buprenorphine has been approved to treat opiate addiction, reducing withdrawal symptoms and preventing relapse without producing euphoria or sedation.”
Still, on an episode of Sober House 2, a counselor can be seen taking buprenorphine away from Starr, calling it “the root of all evil.” While Starr had been using crack and other substances as well as his maintenance drugs, experts say that he could have been detoxed from them while on methadone or buprenorphine.
“Where I get really annoyed is when people say that they ‘don’t believe in’ medication or that it’s ‘against my philosophy,’” O’Brien says. “That’s not scientific. Maintenance has saved thousands of lives. People who have this prejudice are engaging in unethical behavior.”
“I wish I could claim more responsibility for [Mindy McCready's suicide]," Dr. Drew said.
And sadly, the deviations from recommended treatment on Celebrity Rehab don’t stop there. In episode two of season three, McCready and fellow patient Dennis Rodman were taken for brain scans, purportedly to show them how much their addictions have damaged their brains and the harm that will result if they relapse.
“We do a lot of research with brain scans but we don’t claim this has any role in treatment at the present time,” O’Brien says. There’s no way currently of knowing what the scans really mean for recovery. However, on Celebrity Rehab, patients are told that their brains are damaged. The intention is apparently to use fear of the negative consequences to strengthen their resistance to relapse. But this exposure to their own brain damage could make them hopeless about their ability to avoid relapse instead.
If someone were providing care on national TV for years that was as far away from what experts recommend for any other condition, it wouldn’t take a journalist to bring the misleading claims to the experts for debunking, especially after someone dies. But addiction still isn’t really seen as a disease where research evidence should determine the best treatment. Instead, it’s a matter of “philosophy” and faith. You can say, “Methadone steals your soul,” and still get a national TV show and be quoted every time a celebrity relapses—and no one even reports until after a death that all of the major bodies on addiction medicine disagree.
While the choices that McCready, Starr and others made after leaving treatment are clearly their own and cannot simply be blamed on any treatment provider, insistence that a return to any form of maintenance treatment is a failure and that there are no alternatives to the 12-step program of abstinence certainly does not offer hope to patients. If they begin to find the pain unbearable and do not find the steps useful, they may believe they have nowhere else to turn but back to drugs.
And giving people punitive treatment—the way Dr. Drew does in detox—may be part of why they drop out or fear seeking additional help. McCready, for example, was apparently seriously reluctant to get psychiatric help for depression following the recent death of her son’s father, even when Dr. Drew urged her to hospitalize herself. And apparently she left that treatment early, against medical advice. In several decades of research, not one study has supported the confrontational approach over a more empathetic style.
Dr. Drew responded to McCready’s death and the criticism of the show in a call-in appearance on The View last week. He said, “In a weird way I wish I could claim more responsibility for this. The reality is, though, I haven’t seen Mindy, say, in years. I’ve talked to her occasionally, and we've been friendly, but I've not been her doctor in years. I wish some of [the Celebrity Rehab clients] would stay with us. Some of them do, and some of them are sober, but some go on their own way and cut their own path. And I wish I could be more responsible for them."
He could start by practicing more responsible addiction medicine.
Maia Szalavitz is a columnist at The Fix. She is also a health reporter at Time magazine online, and co-author, with Bruce Perry, of Born for Love: Why Empathy Is Essential—and Endangered (Morrow, 2010), and author of Help at Any Cost: How the Troubled-Teen Industry Cons Parents and Hurts Kids (Riverhead, 2006).
- 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