By The WEEk magazine

The relentless shenanigans of Lindsay, Britney, and other celebrities suggest that their periodic stints in rehabilitation clinics aren't doing much good.

Does rehab work?

How long has rehab been around?

Sanitariums where people could "dry out" or recover from nervous breakdowns have been in operation since the 19th century.

But modern rehab, a full-fledged medical environment designed to get people permanently off drugs or alcohol, was launched in the 1940s by a group of Minneapolis doctors.

Their treatment regime, known as the "Minnesota Model," provided the template for nearly all of the 3,800 or so residential programs that now exist in the U.S.

What is the treatment?

Although techniques vary widely, many programs are based on the 12-step method pioneered by Alcoholics Anonymous.

Through group and individual counseling, residents are taught techniques for achieving and maintaining sobriety.

Patients often live in Spartan conditions, eating simple food, dwelling in dorm-like buildings, and performing chores to instill order and discipline in their lives.

What about celebrity rehab?

For the rich and famous, it's a different story. The last couple of decades have seen the rise of high-end detox centers that in many ways resemble luxury spas.
Costing up to $80,000 a month, they offer luxurious living and many of the amenities to which the wealthy have grown accustomed in their "real" lives.

The 27-mile-long beach enclave of Malibu, Calif., alone is home to 25 such establishments. That explains why their approach is now known as the "Malibu Model."

What are these places like?

They couldn't be more different from the old-style sanitariums. Take, for example, Promises, in Malibu, whose alumni include Robert Downey Jr., Britney Spears, and Charlie Sheen.

Residents there feast on "recovery lunches" that include Thai chicken-coconut soup, Korean short ribs, and sashimi.

They sleep on 500-thread-count sheets and can partake in "equine-assisted therapy"-i.e. horseback riding.

At Passages, also in Malibu, where Mel Gibson went after his DUI arrest, patients have access to personal trainers, and a former Spago chef prepares the food. And these places aren't even considered top of the line.

What could be better?

Beau Monde of Newport Beach, Calif., which has treated Nicole Richie and Courtney Love, is so exclusive that it takes no more than three people at a time.

After you arrive-via the clinic's chauffeured car-you can indulge in anti-aging treatments, concierge service, and even whale-watching excursions.

These sorts of accoutrements can leave the impression that celebrity rehab is more about the celebrity than the rehab.

"I've often said that if I had nothing else to do and a substance abuse problem and 40 grand lying around, I'd go there for a vacation," said Santa Monica, Calif., attorney Steve Cron.

Do famous clients get special treatment?

Frequently. Less than 72 hours after checking herself into Beau Monde last year, Nicole Richie checked out to go shopping.

While at Promises, Lindsay Lohan was allowed out to go Rollerblading at Venice Beach, an area known for its edgy street life.

At another institute, Wonderland, Lohan got "special dispensation" to continue filming her latest movie, I Know Who Killed Me.

"They're used to getting what they want and telling people what to do," said Dr. Herbert Kleber, a psychiatry professor at Columbia University. "Therapists and doctors are more often reluctant to challenge the behavior of these patients."

Why do the celebrities even bother with rehab?

Some truly understand they need help and are trying to get it. But for others, it's often a matter of public relations.

Earlier this year, Britney Spears checked into three rehabs in one week, getting tattoos and shaving off her hair along the way.

Paparazzi and gossip journalists covered her every move. "They're not concentrating on recovery, but on the media attention," said Beverly Hills addiction specialist Marty Brenner.

"What these celebrities really need is to be in an individualized program and getting their chemical imbalance straightened out-not telling the world."

Does this kind of rehab accomplish anything?

There are no authoritative figures on specific institutions or methods.

Government studies suggest that proper treatment can reduce drug abuse in 40 percent to 60 percent of cases.

But the Office of National Drug Control Policy reports that 80 percent of addicts ultimately relapse. Some experts think the success rate is below 10 percent.

For rehab to do any good, most professionals say, a minimum of three months is generally needed, with many addicts requiring a year or more.

The typical 28-day celebrity stay won't cut it. "Addiction happens slowly over time," said addiction specialist Maria Chavez. "And that's the way it should unhappen."

What does true recovery entail?

No matter who you are, it's not enough to get some counseling and take a sobriety pledge.

Addicts must avoid old destructive patterns, which means staying away from the people and situations that contributed to their substance abuse in the first place.

"Treatment works and recovery is possible," said William Cope Moyers of the Hazleden Foundation, which pioneered the Minnesota Model, "but only if the patient takes responsibility for that success."

Or, as addiction specialist Michael Gimbel put it: "If they really don't believe their life is at stake, they're not going to get it. The day Lindsay Lohan went out of treatment and went to Las Vegas to a party, I knew she didn't get it."

A disease in search of a cure

In the Malibu Model of treating addiction, the emphasis is on getting patients to make "better choices."

But the American Medical Association classified alcoholism and drug addiction as a disease 40 years ago, and the scientific consensus is still that addiction is primarily an organic condition.

Using magnetic resonance imaging techniques, the National Institute on Drug Abuse has shown that addicts' brains are physically altered so that when they're exposed to drugs or alcohol, they are incapable of normal, rational thought.

"An alcoholic taking a drink looks like anyone else engaged in that behavior," says Steven Hyman, director of the National Institute of Mental Health, "but what's happening in his or her head is different."

Most experts believe that addicts can stay sober only if they avoid all intoxicating substances for the rest of their lives.

"No one is ever cured, just as you would not be cured of diabetes," said Sharon Hartman, a director of the Caron Foundation, a rehab center in Wernersville, Pa. "One of the symptoms of addiction is there isn't a choice."

Source: THE WEEK magazine 8/10/2007

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[Photo by Dan Chavkin for Newsweek: Renaissance Malibu is one of a new generation of holistic, residential healing centers that can cost between $40,000 and $100,000 for a 30-day stay.]

NOTE by AddictionInfo editor: Classifying alcohol and drug problems as a medical "disease" is being disputed by many experts - see these articles, among many others on this site:

Why hasn't alcohol rehab worked for Lindsay Lohan and 93% of the problem drinkers in the US?

Addiction as a Disease: Birth of a Concept