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Television Rehab: Treatment or Trauma?

Why expose these individuals to a "faux" rehab experience chock full of dramatic television experiences that favors ratings over treatment?
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I rolled my eyes when I first heard a rehab show was about to air on television. "Oh, that's great -- a producer-driven inpatient rehab show. Healing on television. Good luck with that."

I had no doubt it would be "faux" treatment riddled with inherent conflicts including: sensationalistic production tactics trumping what's right for the client, a total lack of confidentiality, no private time for the clients and also exposure to stressors that are absolutely unnecessary in the process of healing from drugs/alcohol and/or mental health issues. My other immediate concern was, "What happens when the cameras shut down and the lights turn off? What do those people do then? And are you doing more harm than good?"

I thought the problem was primarily ethical with a potential for medical consequences. And although I didn't expect great results, I never expected the recently-reported five deaths of participants from just one television rehab show.

Respect the disease!

As a double board-certified medical physician in both psychiatry and addiction medicine, I know firsthand the clinical treatment and research associated with addiction and mental health issues.

And having published, treated and worked as a director at inpatient rehab facilities, I can say with authority that it is common knowledge that addiction is a chronic and relapsing illness that cannot be cured. An addict is vulnerable to stressors, triggers and cravings throughout their lifetime, and continued aftercare and meetings are imperative to achieving continued sobriety from drugs, alcohol or out of control behaviors. An individual could be sober 20 years and then one day the wrong acute stressor sends them off-track.

Which begs the question regarding television rehab. Why expose these individuals to a "faux" rehab experience chock full of dramatic television experiences that favors ratings over treatment?

The proponents of television rehab state that these clients/people/celebrities didn't have the financial resources or motivation to enter a "real" rehab, or they needed to be tricked into doing rehab. But here's the problem. When you're in rehab, you need to feel safe, cared for, focusing on yourself, looking at your specific internal way of feeling and thinking and working on changing your lifestyle and behavior. You simply can't do that when your day's activities are set up by a production team and you have cameras, sound guys and lighting guys around you all day long. The negatives outweigh the positives, and it's not even close.

And don't forget motivation. Are these participants motivated by money (being paid to be on the show), fame (of being on a television show), validation (of being picked to be on the show) or do they genuinely want treatment? It's common knowledge that narcissism and self-centered behavior are definitive obstacles in the recovery process, and that's why service to others is such an important part of treatment.

And guess what you're doing when you treat someone on an inpatient basis on television? You're potentially making that behavioral obstacle more difficult.

Fame trumps reasonable thinking. Many addicts can't think for themselves when under the influence. The drugs, alcohol and behaviors do the talking. So aren't you taking advantage of these individuals when asking them to be on an inpatient show that may overlook serious psychiatric and addition concerns (because there's not a true team of clinicians) and thereby increasing the risk of potentially negative health consequences?

Want to help? Send them to a real inpatient rehab experience instead of the reality show version. And if they are on a show, send them to legitimate aftercare, paid for by the network, after the show is over. And keep them there for an extended period of time.

I'm all for discussion, debate, information exchange and entertainment. Talk shows do this well. And they should continue to discuss these issues. Even some reality shows make us think about other people, issues or even ourselves in a different way. And one could debate whether outpatient counseling, when the individual is not in an acute crisis, is problematic on television.

But when you're dealing with a potentially life-threatening disease and that person needs inpatient treatment, don't make it worse than it already is. Especially if you're a clinician.

These people need real help.

Respect the disease! Lights, camera, action. For serious addiction issues, let's limit the "action" to a legitimate inpatient rehab experience.

Dr. Reef Karim,

Psychiatrist/Addiction Medicine Specialist
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