Rehab

There was an interesting article on the CNN website that lamented that Lohan and Spears were making a "mockery" of the entire rehab process.

Did it really take a strung out actress and a singer past her prime to do that?

Not that I feel bad for them, but really - how much of this is the fact that two good-looking girls are going all out and crazy as opposed to two guys?

There is hardly a tree in the New York suburb of Suffolk that has not been crashed into by a car owned by Bily Joel. And hardly a drug that Robert Downing Jr. has not used to excess.

I wonder about rehab. Does it really work? Are there studies out there that allow us to examine the efficacy and effectiveness of the most commonly used procedures in drug and alcohol treatment? Alcoholics Anonymous does not allow for independent research to examine these aspects of their treatment.

Furthermore, any individual who does question AA is often sent for re-training (at least here in New York). These re-training sessions are similar to the re-education camps that Mao Zedong sent those who opposed the Communist party.

At its core, rehab attempts to stop behaviors, and gives very few skills to replace behaviors. I mean, seriously, does playing squash really take the place of a good drink? (see the ads of TV and in our schools: "Do sports, don't drink").

Rehab is in essence a bunch of DRA procedures- a differential reinforcement of alternative behaviors. People are reinforced for playing ping pong as opposed to drinking or smoking pot.

The problem is that you can do both at the same time. Hey - just look at Sunday softball games - they are designed so you can drink and play at the same time. And Keith Hernandez, legendary baseball player of the 80's used to pop into the dugout between innings to down a cold and snort a line or two.

The issue which people in the rehab treatment community don't really get is that there is really nothing out there which is as reinforcing as drugs or alcohol. There is nothing really that can replace it.

Maybe it might be better to help these people change their environment, permanently. Rehab is a place that these people use which (to borrow a word from the field) "enables" these people. It changes their environment temporarily, allows people to feel falsely secure in this new environment, and discourages people from actually making changes.

It does, however, allow these people to talk about the changes that they want to make. But talking isnt doing.

So, when we blame Brittney Spears or Lindsay Lohan for "making a mockery" of rehab, consider that maybe the intervention of rehab is flawed. Where is the evidence?