Britney in Rehab: Treating Addiction in America

Wednesday's headlines about Britney Spears voluntarily checking herself into a residential treatment center has once again focused the spotlight on addiction and the various treatment options available. While some facilities are more lavish than others, the majority of them base their treatment methods on current accepted research into the nature of addiction and its causes.

The National Institute on Drug Abuse (NIDA), a part of the National Institutes of Health, which is a component of the U.S. Department of Health and Human Services, defines drug addiction as “a complex but treatable brain disease.”

The most significant characteristic of addiction is that the user continues to crave the drug in spite of any adverse consequences that may result from its use.

Most current treatment programs accept the underlying concept of addiction being a chronic disease like diabetes or cardiovascular disease. That means that rarely is the abuser cured after only one treatment.

In fact, the Partnership For A Drug Free America sums it up this way: "To be sure, some people can quit drug use 'cold turkey,' or they can quit after receiving treatment just one time at a rehabilitation facility. But most of those who abuse drugs require longer-term treatment and, in many instances, repeated treatments."

The severity of the addiction determines whether or not the abuser is given treatment as an outpatient or as participant in a residential program. Residential programs are extremely effective for those with severe addiction because they intensify the amount of treatment the participant receives on a daily basis.

There are two types of residential programs. The first is long-term, which provides 24-hour-a-day care usually in a non-hospital environment. The most common model of a long-term residential treatment facility is what’s known as a therapeutic community.

Therapeutic communities typically require a length of stay of 6 to 12 months. The idea is to create a microcosm of society in which the resident can re-learn how to interact without the use of drugs. The community that is created encompasses both the other residents and the staff and they are all actively involved in the treatment. The focus is on developing personal accountability and responsibility.

Treatment is extremely structured, and is oftentimes confrontational, so that residents examine unacceptable beliefs and behavior patterns. They replace these with more constructive ways of interacting.

The second type of residential treatment is referred to as short-term. The original treatment model for this kind of therapy consisted of a 3 to 6 week hospital stay followed by additional outpatient therapy and participation in a program like Alcoholics Anonymous. As managed care reduced the coverage allotment for substance abuse treatment, the number of these types of programs has substantially decreased.

While residential treatment is probably the form of therapy most Americans associate with substance abuse treatment, it is not the type of treatment most Americans receive. According to Dr. Michael Miller, president-elect of the American Society of Addiction Medicine, the majority of substance abusers receive outpatient therapy as individuals, in groups and along with their families. These counseling sessions help the abuser examine their thinking processes and behavioral choices and teach them to learn to cope without drug use.

The four most common types of outpatient therapy, according to NIDA, are the following:

--Cognitive Behavioral Therapy, which seeks to help patients recognize, avoid, and cope with the situations in which they are most likely to abuse drugs.

--Multidimensional Family Therapy, which addresses a range of influences on the drug abuse patterns of adolescents and is designed for them and their families.

--Motivational Interviewing, which capitalizes on the readiness of individuals to change their behavior and enter treatment.

--Motivational Incentives (contingency management), which uses positive reinforcement to encourage abstinence from drugs.

Dr. Miller says that research indicates that the success rates with these types of programs are comparable to the success rates in treating other chronic diseases. However, he also added that success was predicated on the intensity and the quantity of treatment. While these programs boast a 60 to 70 percent success rate at present, as managed care continues to decrease the coverage allotment for treatment, these numbers will go down.

In spite of the known research into the causes and cures for addiction, not all treatment programs adhere to accepted practice. One such program is Passages Addiction Cure in Malibu, Calif. Co-founder and co-director Chris Prentiss developed his particular therapy in response to his son Pax’s addiction.

Chris spent 10 years taking Pax to a variety of doctors, psychiatrists and intervention programs without any success. He now believes that the accepted notion that addiction is a disease and that the disease is incurable is “nonsense.’ He says there are only four causes of addiction:

--A chemical imbalance

--Events in their past that continue to trouble them

--Current conditions in their lives with which they cannot cope sober

--Beliefs that are not true, such as believing they have the 'disease' of alcoholism.

The crux of the Passages’ program is the intensive one-on-one therapy that residents receive for 4 to 5 hours each day. During those sessions, they work with different members of the 10-member team assigned to discover the cause or causes of their addiction. The program has had an 84.4 percent success rate since its inception in 2001.

Addiction is far from a celebrity issue. Many Americans are discovering that the pressures of the non-stop pace in which we live have overwhelmed them. They feel the need to find a crutch like drugs or alcohol to help them cope. All too often, that crutch ends up taking over their lives. Understanding the options when it comes to treating addiction may save your life or the life of someone you love. Health contributor Maria Esposito contributed to this report.

Click here to check out Dr. Manny's book The Check List (Harper Collins, 2007), from which this article was excerpted.

Dr. Manny Alvarez is the managing editor of health news at, and is a regular medical contributor on the FOX News Channel. He is chairman of the Department of Obstetrics and Gynecology and Reproductive Science at Hackensack University Medical Center in New Jersey. Additionally, Alvarez is Adjunct Professor of Obstetrics and Gynecology at New York University School of Medicine in New York City.