Not long ago the New York Times published a rather vitriolic article titled “An Intervention for Malibu.” For the most part, the Times chose to denigrate the 35 state-licensed drug and alcohol rehab facilities located in the small, upscale seaside village just outside Los Angeles. Much of the contempt centered on the fact that media vans and crews consistently clog the Malibu streets, with shutterbugs and TV crews alike hoping to catch the likes of Lindsay Lohan or Robert Downey, Jr. stumbling into or out of yet another treatment center. Residents of the town just plain don’t like the press swarming their ultra-swanky neighborhood, and I can certainly understand that.
But guess what? TMZ and all the other paparazzo would be stalking the celeb-infested streets of Malibu with or without all these salacious stories of superstar substance abuse. After all, their job is to hound celebrities, and Malibu is where a lot of those folks live, shop, and socialize. The fact that they also (sometimes) get sober there is almost incidental.
The Times’ other venom-tipped dart suggests that these high-end facilities are neither necessary nor worth the expense, and that addicted clients might be better off trying to find sobriety elsewhere, in “regular” rehabs. The simple truth is that there are less expensive treatment centers doing great work all across the country. All sorts of people go to these facilities and begin their trek down the road of long-term sobriety, physical health, emotional well-being, and a happy life.
So why would anyone, even a major celebrity, choose a luxury rehab?
Pretend for a moment that you’re a famous actor pulling in millions of dollars per picture, or that you’re heir to a fortune so large that your hobby is investing in professional sports teams, or that you’ve made a comfortable living trading on Wall Street, or whatever. The point is, you’re accustomed to gourmet dining, lavish surroundings, and the finest of everything. It’s how you live. Unfortunately, in addition to all the fame and money, you’ve got a problem with alcohol, drugs, and/or an addictive behavior like sex or gambling. You have two options:
- You can attend a traditional, garden-variety addiction rehab facility. There you will receive individual therapy, and you will participate in group therapy, psycho-education modules, 12-step meetings, and a variety of other activities designed to promote sobriety. You will sleep in a twin bed in a shared room. You will eat in a cafeteria with 100 or so other addicts seeking to heal. You will likely be asked to do chores, such as helping to clean the kitchen or bathrooms. You will definitely have to make your own bed and help to keep your shared room clean.
- You can attend a high-end addiction rehab facility. There you will likely receive more intensive individual therapy, and you will participate in group therapy with people you can relate to, along with psycho-education modules, 12-step meetings, and an even wider variety of other motivational and physiological activities designed to promote sobriety and healing. You will sleep in a large, comfortable bed in a private or semi-private room. You will eat meals prepared by a master chef; someone will clean your room. In between therapy and addiction treatment sessions you will likely get massages, yoga, and individualized meditation. There will be a pool, a gym, a sauna, and all sorts of other amenities. During free time, as opposed to playing UNO and watching the common-room TV, you can take tennis lessons and work on your horse-riding skills.
Which facility would you choose? (Remember, money is no object.) Note too that the only differences here are the available options – like adding in neurofeedback or acupuncture to your treatment, for example – that give you every opportunity to heal. These individuals want treatment that is finely tailored to their needs, based on how they live in the real world, which can be more thoroughly assessed in a small, intimate setting.
Frankly, the odds of a well-known or wealthy person choosing the first facility are slim to none. And even if they did, how long do you think they would stay in treatment? Not very long. Like it or not, for some people, these relatively small luxuries are a necessary component of early recovery. These are the same people who buy a Porsche, even though a Kia would get them around just as well. They stay at the Ritz, even though the local Motel 6 would provide a bed. The same applies here.
The Times rolls out expert after expert that claims there is no evidence that nice surroundings improve outcomes, yet they neglect to say that there is no evidence that bare bones surroundings and requiring you to do mundane chores improve outcomes, either. The old model of tough rehabs that smack down big egos so they can get sober is old-fashioned at best, and harmful at worst. That model is based on the idea that people with addiction are arrogant or somehow flawed and overlooks the decades of research showing that addiction is a disease that changes the brain in fundamental ways. Often the people we see in rehab might seem arrogant on the surface, but underneath this veneer we find a history of abuse or trauma, people who have battered egos and are terrified of a life without drugs and alcohol as a means of coping.
What the Times article fails to adequately address is the fact that people go to facilities like Promises Malibu and find lasting sobriety. Is the success rate higher than it is at less expensive but still competent rehabs? Overall, it’s relatively similar. What is relevant here is that the success rate is higher at high-end facilities for this particular clientele.
People who would run screaming from a typical rehab after one night on a lumpy mattress will stick around at Promises and other “high-end” rehabs. They stick around because, as the Times article states, “these facilities make the Four Seasons look like a discount motel chain.” In these types of settings these people appear to feel more safe, more comfortable and better understood. They often have a greater need for discretion, and people snapping pictures of you in rehab is much less likely to happen in a place where others have the same need for discretion.
What is wrong with offering these people nice surroundings where they are comfortable and feel safe and secure? If the upscale setting keeps these addicts in treatment, that’s fantastic, because the longer a newly sober addict stays in treatment, the better his or her odds are for lasting recovery. Basically, people who don’t complete treatment typically don’t get better, whereas people who make it to their graduation have a fighting chance. So are high-end rehabs the answer for everyone? Of course not. For starters, many people can’t afford those places any more than they can afford to spend their vacations at the Ritz, nor do they need a high-end rehab to get and remain sober. There is, however, a clientele for whom posh facilities are as key an element of early recovery as working through denial. Isn’t it the job of a treatment center, at least in part, to put as few barriers as possible between the client and recovery?
When viewed this way, country club rehabs are both necessary and well worth the expense for a specific population. Note please that addiction treatment is not designed to eliminate narcissism or ego, or to confront lifestyle choices (other than those directly leading to relapse and addiction). Those goals may be lofty and important, but they are also long-term and unrelated to early sobriety. In the 28 to 60 “treatment center days,” the primary jobs are to stop the addictive behavior, support emotional vulnerability, encourage socialization, promote various forms of self-care, and begin the process of longer-term healing. If you can afford it, what’s wrong with doing that in a room with a view?
Robert Weiss LCSW, CSAT-S is Senior Vice President of Clinical Development with Elements Behavioral Health. A licensed UCLA MSW graduate and personal trainee of Dr. Patrick Carnes, he has developed clinical programs for The Ranch in Nunnelly, Tennessee, Promises Treatment Centers in Malibu, and The Sexual Recovery Institute in Los Angeles. Mr. Weiss has also provided clinical multi-addiction training and behavioral health program development for the US military and numerous other treatment centers throughout the United States, Europe, and Asia.