I guess this posting on TMZ illustrates on many levels what's wrong with addiction treatment in this country in the 21st century. And our society in general, if you really want to be honest. Seems Lindsay Lohan got into an altercation with a staff member at Betty Ford Center, where she's in for her - uh, nth round of rehab, resulting in a police report, an alleged sprained wrist, the firing of the staff member for talking about it publicly (how do you make a public police report without talking about it?) and a juicy story for TMZ and others to run with.
First, my disclaimers. I don't really know anything about Lindsay Lohan, except what I read and see on TV. So this is just, like, my opinion. My knowledge of the Betty Ford Center is a bit fuller, since I actually looked at the Better Business Bureau's rating of them as a charity (they reportedly fail to meet the minimum standards for a reputable charity, including making data available on the effectiveness of their services). But I also know a lot about treatment programs (or "rehab" programs, as they are popularly called) from my ten years of case managing mental health and substance abuse treatment and my longer history of referring people to programs and rubbing elbows with their marketing people at conferences and meetings. So I know more about what I'm talking about on that score. Although I usually keep any criticisms to myself, out of professional courtesy.
And on the subject of mental health and substance abuse treatment, its relationship to the legal system, and patient compliance and noncompliance, I'm pretty much an expert, having done dozens of substance abuse assessments on people who violated drug and alcohol laws and policies and needed to fulfill the requirements imposed on them. So on to this story.
First, there's Lindsay Lohan. She certainly appears from what we read and see to be a train wreck of a human being. She was interesting (though a little hard to watch, which I assumed was part of her acting) in "A Prairie Home Companion;" but everything I've seen about her since that time has been painful. Take an apparently insecure human being with seemingly poor role models for parents, expose her to the celebrity machine and make her part of the national freak show for a few years, throw in some well-meaning attempts by the legal system to impose some constructive consequences on her, and wait for the mixture to ferment into a sour mash of what passes for "entertainment" these days. We probably expect her to self-destruct like Anna Nicole Smith, (whose tragic life has been replayed over and over by "Entertainment Tonight," in a particularly creepy carnival display). But at least she's still with us and in apparently decent health.
Then there's the judge and court system that tried to impose some sensible consequences for her drunk driving offense. They tried various forms of probation and education, and when those didn't work, finally sentenced her to "treatment." Which is dubious enough in the case of your average Joe who sits through a few classes and dozes through "Clean and Sober" a couple times. But for a celebrity, it's even worse. No hope of getting the offender to face the issues honestly and realistically, because of the constant pressures of public exposure, second-guessing, and celebrity narcissism that are sure to be involved.
Then there's the "treatment" itself. The pervasive approach that has come to be used in the treatment industry in this country is a bizarre amalgamation of support and shame. They've taken AA, which was the only game in town for many years, and twisted it to fit an industry that too often serves itself more than the client's needs There are good treatment programs out there (often based at hospitals or psychiatric facilties), but "rehab" tends to mean the free-standing residential programs that believe in 28 days (or more) of indoctrination rather than individualized therapy and an actual treatment plan.
This AA-based style of treatment (which many AA members consider a perversion of their program, by the way) seems to take some of the unhealthier 12-step lore and adds unhealthier treatment approaches to it. They focus on how they have to "break through denial" to get the substance-abusing person to realize that he or she is a lower form of life, which isn't exactly the AA approach (they always say that they are a program of attraction rather than compulsion).
There's already a pretty strong dose of Christian sin-and-salvation fundamentalism involved, with the AA program being a direct descendant of the Oxford and Moral Re-armament Movements of the early Twentieth Century, codified by a reportedly narcissistic insurance salesman and his male drinking buddies in the 1930's and followed like an actual religion ever since. That's okay when it takes place in church basements and draws a core fellowship of like-minded people, but then you have the forced treatment component, which frankly makes poor use of whatever benefit there is in AA. And then, you toss in the celebrity aspect that's morphed into a marketing machine over the years. When Tiger Woods checked into a "sex addiction" program, the treatment facilities went wild, throwing all their energies into promoting that dubious "disease" and their treatment programs as the only solution for it.
Finally, there's the Betty Ford Center. Our former First Lady is still revered as a brave pioneer who brought addiction treatment into the national conversation and helped create a prestigious and respected professional program that offers hope to the afflicted. But unfortunately, it's also become a stop on the celebrity rehab tour that offers a freak show of celebrity nuttiness for the paparazzi and the likes of TMZ to mine for our prurient interest. There's limited hope of privacy or confidentiality, and apparently very little in the way of medical care, but there's a whole lot of gratitude and wonderfulness among its supporters and alumni.
There's also a lot of cash flowing in ($25,223,002 in patient revenues, and $5,079,517 in donations, according to the figures they provided the BBB). As the BBB pointed out, there's little in the way of effectiveness data for BFC, but that's not unusual: no treatment program likes to reveal how many of the people it treats actually manage to stay drug- and alcohol-free for a year or more and achieve what the American Psychiatric Association calls "sustained complete remission."
The thing is, few of these "rehab" (residential) programs actively help patients to understand how addiction really works in the body and mind, how to manage cravings and urges, how to manage lifestyle changes, or what to do if they relapse. Instead, they get the standard-issue disease-and-denial talk, advice to "keep coming back," and gratefulness directed at the program (which can mean Betty Ford or AA in general), with the standard assertion that it has"saved so many lives." The participants get a lot of spiritual and serenity talk, disease education, one-day-at-a-time perspective, and profound helplessness and passivity - only one's "higher power" can restore them to sanity. However, "sanity" is a poorly defined concept, and is definitely not the same as clinical success, being instead a hazy amalgam of character flaw removal, surrender, groupthink, and, well, whatever the opposite of self-efficacy is.
In many of these programs, relapse is seen as less of an issue than accepting the program, which fits the AA tradition that ll that is necessary is a "sincere desire to stop" drinking or drugging. Unfortunately, when the public welfare requires an irresponsible substance abuser to CUT IT OUT, the goals of this kind of program don't serve the public interest. Useful advice on how to take responsibility for managing this chronic medical condition, including the most pressing task of how to manage urges, is almost completely lacking in too many of these "rehab" treatment programs. In fact, wanting to take responsibility fo managing one's addiction is often viewed as a heretical sign of "Egotism," (where "ego" is defined by the cute old chestnut "Edging God Out").
And, since addiction is a family disease, support and help automatically become "codependence" and "enabling." Unfortunately,when there is a true enabler, like Lindsay's mom, who make ridiculous excuses for the addicted person, these actions are actually trivialized and become simply run-of-the-mill evidence of the way the "disease"operates for everyone. It doesn't. That's wrong behavior when you're dealing with an addict in the family.
In my experience, stiff consequences for further use, combined with a seriously tight program of drug and alcohol testing, are a lot more effective in insuring the public safety than simply approving of the addicted person's participation in a program. Although it's often true that the willingness to demonstrate participation in the program can be a good sign, it's also often true that the attitudes conveyed in some of these programs (including the admonition to "fake it till you make it") can be associated with a lack of responsibility for future behavior..
So that leaves the staff member, I guess. She does have a right to make a police report if that's called for. And patients in an ordinary treatment facility are entitled to privacy. But BFC is clearly not an ordinary treatment facility. And it appears they follow the industry standard of hiring people "in recovery" themselves, who may, as a result, be less than professional. As this staff member appears from the news stories to have been. Which doesn't promise great results or professional treatment. But I still kind of feel sorry for the staff member, who probably got drawn into a scuffle with a particularly difficult client and now finds herself in the middle of that same freak show. I hope she can stay sober through it all, at least.
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