When a celebrity like Lindsay Lohan is arrested on suspicion of drunken driving and drug possession shortly after leaving a rehab center, the public may question whether treatment for substance abuse works, experts say.
But Lohan's relapse is not so much an indictment of rehab as a predictable slip in what is typically a long and painful road to recovery, they say.
When stars backslide, "It definitely doesn't look good for rehab centers because you get this biased view that people don't do well after rehab," says Dr. Bernadette Solounias, medical director for Father Martin's Ashley, a residential drug and alcohol treatment center in Havre de Grace. But for every high-profile failure, there are plenty of anonymous success stories, Solounias says.
Because recovery is often a halting process, "I think how drug treatment works is misunderstood," says Michael M. Gimbel, director of the Office of Substance Abuse Education and Prevention at Sheppard Pratt Health System. "There are so many people who do relapse that people often believe it doesn't work. [The Lohan case] makes it a little worse because it's so high-profile," says Gimbel, who will celebrate 35 years of sobriety Oct. 1.
It's difficult to "measure success in drug treatment," Gimbel says. But on any given day, in any part of the world, there are gatherings of people who have remained sober, at least for one more day. "We have millions of people who are in recovery programs such as Alcoholics Anonymous and Narcotics Anonymous," Gimbel says. But, "because our people are silent, no one really knows how successful treatment really is."
Less than two weeks out of rehab for the second time this year, Lohan was arrested Tuesday after an early-morning car chase in Santa Monica, Calif., on charges of driving under the influence and cocaine possession. According to an Associated Press account, Lohan, who faces previous drunken-driving charges, was receiving medical care after her release on $25,000 bail.
But whether an addict enters a structured treatment center with no perks, or a deluxe center with an ocean view, recovery can only happen when clients are willing to change their behavior, Solounias and other experts say.
"In a nutshell, treatment works and recovery is possible, but only if the patient takes responsibility for that process," says William Cope Moyers, vice president of external affairs for the Hazelden Foundation, a private alcohol and drug rehabilitation center in Minnesota. As Lohan struggles, the public may get the wrong impression that Promises Malibu Alcohol and Drug Rehab Treatment Facility, where she stayed for more than six weeks, failed to "fix" her.
But relapses such as Lohan's are an anticipated "part of the illness," Solounias says. And recovery, she adds, "is a life-long process. Rehabilitation is really only the beginning."
Effective programs, when "melded to the patient's willingness and acceptance [of the demands of rehabilitation], can result in dramatic recovery," says Moyers, who wrote about his own history of drug addiction in Broken. "There are some bad programs out there, but it starts with the patient and follows with the program. Together, they can be a dynamic duo."
When she was 18, Carrie Schwartz entered Caron, an addiction treatment program in Wernersville, Pa., for help with drug and alcohol abuse. Today, the 22-year-old Pennsylvania resident is in recovery. She reflects on her experience at Caron and how it may have differed from the 21-year-old Lohan's. "It is truly up to you [to decide] when you're willing to use the tools and live the life they're trying to teach you," Schwartz says.
But she questions the revolving-door practices of celebrities such as Lohan and Britney Spears, and whether their lack of commitment may be connected to the treatment centers they choose.
"Are these people going to reputable facilities or lovely rehabs on the beach where they can get out and do what they want? And are they really staying sober all the time? When I came through Caron here, it was on a lock-down ward."
Treatment centers "vary from place to place," says Dr. Susan Blank, Caron's executive director of psychiatric and psychological services. Some "are like spas" that cater to the wealthy, but "most of the treatment centers have very structured environments," Blank says. "They aren't free to come and go or use cell phones. [Addiction] is a medical illness and it's treated like a medical illness." Similarly, "you don't let a patient dictate how you treat diabetes, or dictate how they're going to be medically treated."
And like diabetes, addiction is a chronic disease, Blank says. "There is no cure, but there is management. A big part of that falls back to the patient to be willing and able to take care of themselves."
Lohan's cavalier approach to her illness indicates that she isn't ready to do the hard work required for recovery, Gimbel says. "A person is not going to change until they feel pain, that their compulsive behavior, whether it's drugs or gambling, is causing them pain," he says. "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."