Another place to look at addiction portrayal in the media is Celebrity Rehab on VH1, the popular show about addiction treatment, currently in its third season. Dr. Drew Pinsky gathers eight drug-abusing celebrities together in a Southern California rehabilitation facility. According to Dr. Drew, the goal of the program is to show audiences the promise of “research-supported” care. Unfortunately, instead of showing the value of evidence-based treatment, the show perpetuates stereotypes about substance users and depicts treatment techniques that are not supported by research.

While commentary about this show could go on for pages, we want to focus on the myths it generates about how substance abusers ought to be thinking when they enter treatment. Consistent with other media portrayals, the idea seems to be that one must commit to doing whatever it takes to stop using, and that anything less indicates a lack of readiness. Celebrity Rehab goes so far as to state that those who are feeling any ambivalence are wasting everyone’s time by entering treatment at all, because they’re obviously not serious, not being real, just “talking the talk but not walking the walk,” or any number of other denigrating descriptions of their “lack of readiness.” In this entry, we offer counterarguments to these and similar claims.

Readiness for Treatment: Stereotypes presented in Celebrity Rehab

  • Substance abusers must be 100% motivated for treatment to be successful. Consequently, expressions of ambivalence are evidence of denial, stupidity, or craziness.
  • If a substance abuser does use a substance, it’s because he/she “didn’t want sobriety enough.”
  • If a substance abuser is “serious enough” about recovery, he or she should accept whatever treatment is offered and not ask questions or voice concerns/complaints.

Readiness for Treatment: Reality
In reality, people are rarely 100% motivated to change their substance use, despite the often obvious costs associated with it. The reason people are ambivalent is that their use (no matter how terribly it is affecting their lives) also serves one or more useful and/or gratifying functions. Some common reasons why people compulsively use drugs and alcohol are to decrease painful/uncomfortable feelings or increase positive feelings. When they stop using, they lose these benefits, which can make the decision to change very difficult and complicated (Hester & Miller, Ch 6). In addition, during the early stages of an inpatient admission clients are typically in some state of withdrawal which contributes to a desire to keep using that is the result of physiological phenomena, not emotional resistance or lack of intelligence.

Therefore, when beginning treatment, some level of ambivalence is natural and expected and should be discussed openly, not dismissed as a shameful personality flaw. Talking openly about the pros and cons of substance use can increase people’s awareness and understanding of their behavior, and can enhance motivation to make real changes. Engaging the client in trying to understand what they are craving or missing about their substance use can open up a discussion about the coping skills that are lacking or the pain the person is feeling. Engaging in this discussion can help clients step forward and accept help rather than push away from it.Instead of pretending that ALL USE is ALL BAD, research suggests that people need to sort out the mixed bag that is the reality of their use. They need to understand what they get out of it in order to indentify the coping skills that they lack and the variables in their life that need to change in order for them to be successful. In addition, research shows that people’s level of motivation and degree of ambivalence about change varies over time. Therefore, an essential part of treatment is an ongoing conversation about the reasons for wanting to make a change as well as about what factors are influencing the individual to want to return to using.

It isn’t radical to want a say in your own treatment path. In contrast to the “clinical” explanations made in the show, the reality is that those who don’t accept all aspects of treatment are not inherently “oppositional.” When ambivalence about change and about treatment is over-simplified (“lack of will power” or conversely “taking back their will”) an unnecessary moralistic tone is added that can make people feel trapped and shamed. Again, there is a significant amount of evidence that shaming and confrontational techniques are quite counter-productive. People have the right to make decisions about their own care, and in fact the evidence is overwhelming in indicating that the more clients participate in the treatment planning process, the more committed they are to sticking with their goals. Additionally, it can be very useful to anticipate what may be difficult about treatment, so that solutions are found and the potential for drop-out is minimized.

RESEARCH BULLETIN: Collaborative participation in treatment planning decisions enhances the likelihood of successful outcome in substance abuse treatment!