Is Lindsey Lohan killing the addiction treatment industry or helping it?

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Lindsey Lohan is going back to rehab. And back. And back. And back.

How good can any rehab actually be if they can't get it right with someone who has been in and out of rehabs at a cost of hundreds of thousands of dollars?

This time she was headed to a rehab that turned out to have lost its license and wasn't a legal residential rehab at all. So she went back to Betty Ford instead – a facility that she sued the last time she was there.

"It's no benefit to any rehab to have a client like that," says Don Grant, executive director of Harmony Place, a high end women's facility. "These places think they want the publicity, but what good is it when she comes out and two months later she's relapsed? What does that say about your program to people?"

And that's the question: What do Lindsey Lohan, Charlie Sheen, and all of the other addiction disaster stories say about addiction treatment?

Yes, there's a problem with addiction treatment. In fact, there are several. But perhaps not the ones you think.

Addiction treatment is an industry (and really only recently an industry) with a dark past and a murky present. It's only now emerging from the shadows or trying to. Its history of success is, in a word, dismal.

Yet there are great rehabs and good people who care about quality treatment and the people they help.

The History of Addiction Treatment

Keep in mind there never was any addiction "treatment" before about the late 1940's. In the old days it was considered a moral weakness, not a medical condition, and people with an addiction were committed to a sanitarium. Families and the addicts themselves were ashamed. No doctor studied it, they didn't care about it, it was an embarrassing issue that was dealt with in as much secrecy as possible.

If, for example, Lindsey Lohan was a star in the 20s instead of now, she would likely have been sent to a sanitarium, much the way silent film star Wallace Reid ended his life in one in 1923 from an addiction to morphine at the age of 31. The next year, his widow, Dorothy Davenport, produced and starred in a film about the horrors of drug addiction called "Human Wreckage" and toured the country with the film.

Then came Alcoholics Anonymous, the famous 12-step program established in 1935 by Bill Wilson and Dr. Bob Smith. It was, and is, a heavily spiritual program. But it's a social model of support, not treatment. AA states that its "primary purpose is to stay sober and help other alcoholics achieve sobriety". In 1946 the twelve traditions were introduced and adapted into the AA philosophy. The twelfth of these being, "Anonymity is the spiritual foundation of all our traditions, ever reminding us to place principles before personalities".

Frankly, one of the reasons addiction treatment has such a murky history and reputation is the anonymous aspect of AA, which begat Narcotics Anonymous, and other 12-step programs. All anonymous. That undercover nature of the organization has helped to make some people suspicious of it.

Hazelden, established in 1949 was the first real treatment facility of the type that we are familiar with today. The program was based on the 12-steps established by AA and added a residential component to help people stay sober and get a running start on a life of recovery. Until only a few years ago most facilities were still based on the 12-step methodology. Many still are.

Enter Dual Diagnosis Treatment

In the late 1980's and throughout the 1990's dual diagnosis, or treatment for co-occurring disorders, began to gain traction. This approach recognized that for many addicts, drugs or alchohol were being used to "medicate" underlying problems.

Previously, if a patient had an issue in addition to addiction, he or she needed to get sober prior to being accepted for treatment of the accompanying problem, or had to be in separate programs to treat each issue. This proved to be an unmanageable approach, so facilities that treated both issues concurrently became the new standard of treatment.

This, then, was a clear step toward bringing more psychiatry into addiction treatment along with that good old dose of 12-step spirituality.

Since the turn of the century remarkable things have happened in addiction treatment. Though a pharmaceutical "silver bullet" has long been a sought after remedy, none has been found. But there are drugs that, in controlled doses, are helpful in detox and for relapse prevention. Methadone is not one of them. It is highly addictive itself and addicts who end up in methadone programs are generally considered lost causes.

But today there's plenty of ongoing research into addiction treatment. We now know a lot about how addiction changes the brain, the damage caused by continued drug use, and what needs to happen to return to normalcy.

Neuroscience is playing a critical role and, combined with psychological tools, helps to avoid relapse. Cognitive behavioral therapy and dialectical behavioral therapy can work together to give someone in recovery a fighting chance. Additionally, some medical schools now offer an addiction course of study. Addictionologists are a new breed of specialist. Addiction is now clearly a medical issue.

The Shift Toward 12-Step Alternatives

All of this, along with cultural changes, has begun a shift away from 12-steps and spiritual treatment for addiction.

But many of the people who started treatment facilities, are recovering addicts themselves and are steeped in and devoted to these traditions, including anonymity. Because of its secrecy, and the fact that it is a deeply spiritual program with ardent followers, AA and addiction treatment have developed a cultish reputation.

Perhaps because people have a mental image of addicts as criminals, robbing and stealing to get money for drugs, AA and other such organizations are suffering from a brand image problem which is further exacerbated by the cloak of anonymity. There have also been AA fanatics who have resisted the inclusion of science or anything outside of AA, concluding that the 12-steps are all anybody needs – "the steps work if you work the steps".

There is a healthy debate today whether the anonymity aspect of AA is actually out of step with the times and whether it would be more beneficial to have those who chose to "come out of the closet" and reveal that decent, normal, everyday people have addiction trouble and are in recovery.

It was a shock to many people when Roger Ebert finally decided to reveal that he was an alcoholic who had remained sober for three decades with the help of AA. Roger Ebert dealt with his alcoholism quietly, before it became a public event. If he had been arrested for DUIs on a regular basis, it may have been covered by the press. More importantly, there is a question as to whether the anonymity continues the attachment of shame to addiction, which is now classified as a disease.

The fact is, there are a lot of celebrities who deal with their alcoholism or addiction quietly. Some get press coverage, like Mathew Perry and Cory Monteith. But everyday, successful people also suffer from addiction and addiction comes in many forms today.

There is a rising tide of people who become addicted to medications that have been prescribed to them. It's one of the fastest growing problems. So, now more than ever anyone can become an addict.

There are also different degrees of alcoholism and addiction. There is a difference between having a drinking problem and being an alcoholic. For the former, simply going to a rehab and "drying out" for 30 days could easily be enough to get back on track. But there are also those on whom addiction has an unrelenting stranglehold, who will struggle with this affliction every waking moment of every day for the rest of their lives. A thirty-day stint in a rehab is only the beginning of treatment for these people.

The fact is, after thirty days in a treatment facility, any treatment facility, only between 10% to 20% manage to stay sober. The rest relapse within a year, usually within weeks. Research has shown that, for these cases, the longer the treatment the better the chance of recovery, with the best results being seen at a year in treatment, residential followed by outpatient.

A Poorly Regulated Industry

One of the problems with addiction treatment is the number of bad facilities out there. It is a very loosely regulated industry and facilities have found all kinds of ways to skirt licensing requirements and other regulatory issues. The facility that Lindsey Lohan was headed to originally – she showed up at their door but never went in – had no license for residential treatment. But they were, and are, still providing treatment by housing people in "sober living" homes and sending them to an outpatient office for treatment.

It's much easier to get a license for an outpatient office than a residential facility. In fact, if there's a therapist who is licensed, there is no requirement to have the office licensed. What constitutes a licensed facility is murky territory for addiction treatment.

"People have no idea what's happening out there," says Michael Sigal, CEO of BookYourCare.com. Mr. Sigal, a successful tech pioneer out of Monster.com, set out to find addiction treatment for a loved one a few years ago. "The internet was full of false information, websites with photos of places that weren't really of those places, claims you couldn't trust… most often people don't find out until they show up at the facility and have already paid."

After a lot of research, Sigal booked his loved one into a facility he thought seemed trustworthy. It went out of business while his loved one was there. "I couldn't believe it," he says. Sigal got together with the director of that facility, who also didn't know the facility was in trouble, and they created BookYourCare.com, a website where people can find facilities that have been fully vetted by the company through on-site visits and background checks performed by retired Treasury agents.

"We've found facilities with owners that had so many lawsuits they filed a bankruptcy, closed down the business and just reopened somewhere else only weeks later." Sigal said. "It's unbelievable what's going on out there. But the good facilities have embraced us, they know this industry needs this."

Another clear sign the business of addiction treatment is changing is the amount of private equity money moving into the field. Bain Capital bought CRC Health recently, one of the largest providers of addiction treatment. Other private equity firms are funding similar networks of treatment centers."

Jeff Schwartz, CEO of Avalon Malibu, a luxury rehab, says, "I really worry about what that's going to mean to the quality of care with so much focus on the bottom line."

A CRC Health source that prefers to remain anonymous revealed that, "anything that doesn't help drive profits is under serious scrutiny, if it hasn't already been cut."

The Road Ahead

So, there are clearly challenges ahead for addiction treatment. But the shroud of anonymity is clearing away. It's an industry that now truly needs more transparency. Cases like Lindsey Lohan help to emphasize that point. As for Lindsey, time will tell if she smartens up. Others have made it – Robert Downey, Jr., Drew Barrymore. Being sent to treatment by a court isn't always the best way to go. It sometimes means you're not as interested in recovery as staying out of jail.

Here is one thing to remember about addiction: it is the only other thing that the brain will ultimately accept as something necessary to live. In other words, the brain will assign it the same importance as air, water, food and sex. Because of that the brain will also do anything to get it. This is why real addicts burn through whatever money they have and then start to steal, or prostitute themselves, or worse.

But the fact of the matter remains that unless someone wants to get sober and stay that way, is willing to do the work to stay that way, has learned that life is better enjoyed that way, there is no keeping them sober. Lindsey Lohan, so far, has proven to be one of those people.

Dean Clement Kraemer has been a writer and marketing expert for three decades with a special focus on healthcare and addiction treatment.

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