DOES "REHAB" NEED REHAB? DAVID M. REISS, M.D. The real costs of the drug epidemic and the "rehabilitation-medical-pharmacological-media complex" The...
DOES "REHAB" NEED REHAB?
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DAVID M. REISS, M.D.
The real costs of the drug epidemic and the "rehabilitation-medical-pharmacological-media
complex"
The tragic death of Philip Seymour Hoffman due to an apparent heroin overdose has
unleashed deep and sincere feelings of grief and loss; depressing consideration of what
his death has cost his family, his friends, the community of artists and entertainers and
the public at large; yet another re-awakening to the horrible tolls of addiction and
substance abuse; handwringing indignation at the inadequacy of the legal system to deal
with illicit drugs - as well as a full onslaught of "public education", publicity-seeking and
greed by the "rehabilitation-medical-pharmacological-media complex." Even the NYC
Police Department has joined the highly visible and intense reaction, quickly arresting
several persons for alleged drug-related crimes proximate to Mr. Hoffman's addiction - as
if it were not possible (if the motivation and will was present) for the legal authorities to
detain or at least dissuade scores of probable drug pushes daily, from thousands of wellknown
street corners, as easily as catching falling snowflakes.
There is nary a media outlet that is not prominently discussing the obvious pain and costs
of drug addiction (particularly heroin) and the need for better intervention - most often,
information is provided reasonably effectively and accurately; albeit not infrequently, with
a good dose of over-the-top sensationalism. In a society that has forgotten how to truly
mourn, there is once again what has become the typical outpouring of sincere grief in the
aftermath of a public tragedy - but grief that is also, sadly, somewhat out of proportion to
the individual loss suffered by the average person who did not personally know Mr.
Hoffman. We no long grieve as individuals or families - most businesses believe that it is
financially wise (and implicitly, emotionally sufficient) to only allow at most a few days
"bereavement leave" for personal loss; and at that, only for losses in the very immediate
family that are carefully documented. We bottle up our emotions until a publicly sanctioned
tragic event allows for a mass expression of grief that often proves shallow,
short-lived and ultimately ineffective in providing sufficient solace.
As a psychiatrist who has been involved in mental health hospital administration, frontline
evaluation and treatment, the California Workers' Compensation system and
addressing severe trauma (having participated on a community mental health panel in
Newtown the week of their tragedy) I am well aware that the true costs of addictions run
wild, an inadequate and broken mental health system, toleration of abuse and the
corporatization of medical care and disability management are far deeper than is
appreciated. The loss of an individual to untimely death, disruptive addiction or
paralyzing mental illness can impact a family for multiple generations, with multiple
persons across generational boundaries being negatively affected in regards to their
general emotional well-being and stability, their ability to function productively in society
and in the workplace, their exercise of sound judgment, their ability to tolerate and safely
cope with frustration and anger, and their ability to care for and about other persons in all
avenues of life. If you fully evaluate the pathology and dysfunction of over 10,000
patients as I have thus far during my career, you can map out how the specific pathology
you identify not only may have roots in biological dysfunction but has longstanding,
complex yet direct and important connections but to multiple tragic and traumatic events.
But we do have "Rehab." If "Rehab" were merely a semantic substitute for "therapy" or
"treatment", a term less-laden down by theoretical and practical errors made in the past
(in a field of study that is, realistically, relatively quite new), so be it. But "Rehab" has
become a substitute for true treatment and therapy. "Rehab" is spoken of as if problems
can be solved by a few weeks in a "special" setting, whether it be a run-down "sober
house" or a $50,000 per month exclusive program - followed by participation in a self help-type
of intervention ( A.A., N.A., etc.); and in the case of politicians and the "rich and famous", self-righteous public pronouncements and apologia regarding their
transgressions and transformation.
The very vigilant (and attention-seeking) media is constantly informing us of those in
public view who have "entered rehab" for a variety of issues or problems. Immediately
following the death of Mr. Hoffman, we learned that Selena Gomez reportedly "secretly"was in "Rehab" for two weeks for "emotional issues"; it had recently been publically
announced that Ke$ha had been in "Rehab" for an eating disorder; only a few days ago it
was publicized that the next stop for Dennis Rodman after North Korea and media
interviews was "Rehab"; and not all that long ago, we were informed that disgraced San
Diego Mayor Bob Filner entered (or was considering entering) "Rehab" in order to learn
(at age 71) that it is not wise to participate in sexual inappropriate behaviors towards
women.
"Rehab" programs to detoxify addicts and begin the process of education regarding
needed treatment and therapy can be very valuable. But "Rehab" must be seen as only
a beginning. I will not debate that "addiction is a disease" and that once heroin (or similar
drugs) invade the brain, powerful biochemical mechanisms gain a great deal of control.
But whether it takes the form of an addiction, depression, disruptive obsessional
behaviors, etc. - those pathologies do not exist of and by themselves. They exist in
individuals, all of whom are unique in his or her own way; all of whom have had different personal experiences and histories, and all of whom have developed distinctive
personality traits and psychological defense mechanisms. Further, each individual exists
within the context of social, occupational and family relationships that are often codependent
to the pathology present.
"One-size-fits-all" intervention can be useful for educational purposes and for an initiation
into treatment. "Evidence-based medicine/treatment" (which is all too often chiefly
pharmacological) succeeds with the statistically "average" person/patient. But education
is not treatment and individuals are not statistics. When a theory or intervention depends
on "all other things are equal" it is basically impotent and futile - all other things are never
equal. When treatment is based on "average" results from statistical studies it can be as
effective as concluding that if you have a hot coal in one hand and an ice cube in the
other, "based on the evidence of the average temperature", you should be safe and
comfortable.
In-depth, long-term, individualized treatment is expensive, no question. In-depth and
long-term suffering and dysfunction is more expensive - by many orders of magnitudes,
affecting many more areas of life, and extending far into the future of individuals, families,
businesses and societies.
_David M. Reiss, M.D. is a psychiatrist in private practice, based in San Diego and with_
_offices in California, New York City and Massachusetts. Dr. Reiss has been the Interim_
_Medical Director of Providence Behavioral Health Hospital, he is a California Qualified_
_Medical Examiner and he is a member of the Sports Lawyers Association. Dr. Reiss has_
_written and spoken internationally for professional and lay audiences regarding emotional_
_trauma, personality and character development and structure and mental health_
_treatment and well-being. Dr. Reiss can be reached at dmreiss@gmail.com; and via Twitter @DMRDynamics or contact Present Moments Recovery for more information._
