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Perhaps Charlie Sheen Should Try a Different Approach

Charlie Sheen's repeated relapses -- and returns to treatment -- suggest that perhaps he might look at different approaches to his addictive problems. What he's been doing doesn't seem to be working so well for him -- as it has failed many others.
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Charlie Sheen's repeated relapses and returns to treatment, now covering decades, suggest that perhaps he might look at different approaches to his addictive problems. What he's been doing doesn't seem to be working so well for him -- as it has failed many others.

Sheen has been in and out of standard disease, 12-step therapy of the kind depicted on "Celebrity Rehab" and "Intervention" and practiced at Betty Ford, Hazelden, and virtually every other public and private treatment program in the United States. But this is not the standard treatment everywhere (in much of Europe and the British Commonwealth, for instance).

Other approaches -- which have more often been empirically validated in clinical trials -- include motivational enhancement (allowing addicts to grasp the divergence between their behavior and their values), skills training (including problem-solving, assertiveness training, emotional self-management), community reinforcement (integrating rewards for sobriety into people's daily lives -- including their families and social groups).

These other approaches are generally labeled "cognitive-behavior therapy" (CBT). Although evidence-based, CBT doesn't seem to many people to be medical enough to deal with a genuine disease. In the U.S., we instead hope that medicine will ultimately discover the secret to addiction. In the meantime we call addiction a disease, but rely on group meetings and admissions of powerlessness and submission to a higher power -- hardly in themselves medical treatments -- to cope with alcoholism and other addictions.

Powerful figures have recently been re-orienting their approaches to addiction. One such professional is University of Pennsylvania psychiatrist (and father of an addict) Thomas McLellan, who became Obama drug czar Gil Kerlikowske's deputy director (although he resigned within the year):

We've also got to intervene earlier in ways that aren't quite as threatening, that enable people to take control of an issue that they may not be able to understand is hurting their quality of life. I'm very interested in, and this office is very interested in, screening and brief interventions. ... The other thing, without question is, we've got to develop much more attractive, engaging, enduring treatments. If this is largely, at least today, about lifestyle management, that's what treatment really is.

(Disclosure: I have a CBT and life-management treatment program administered at St. Gregory Retreat Center. In addition to CBT techniques, we believe that people should strive to attain a greater purpose for themselves -- whether religious, political, artistic, community or family-oriented -- to guide themselves out of the thicket of addiction.)

Which brings us back to Sheen. From a distance, Charlie seems to lack some things: (a) a genuine appreciation of how his behavior is not in his own best interests and violates the things he most values in his life -- like his career and his family, (b) ways of spending downtime that he enjoys other than imbibing substances and hanging out with prostitutes, (c) a belief that he can -- and the know-how to -- extricate himself from dangerous, escalating situations. While 12-step approaches teach people that they can't cease consumption or remove themselves from a using situation once they have begun, we teach the opposite -- and techniques for doing so. These techniques, called relapse prevention, don't assume that addicts lose ultimate control of themselves when imbibing or using.

If his treatment has thus far been steeped in the 12 steps, objective research indicates another approach is more likely to lead to a positive outcome. At this point, it might seem worth Sheen's time to try something else. AA, after all, defines insanity as "Doing the same thing again and again while expecting different results." (Thanks to Steven Slate.)

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