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Is Dr. Drew Too Dangerous for Prime Time?

Pinsky should either get with 21st century treatment or get off the air.
 
 
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With the news last week of country star Mindy McCready’s suicide by gun, the death toll among Dr. Drew’s Celebrity Rehab patients now stands at five, giving the show an unusually high mortality rate of nearly 13%. But what’s even more disturbing is that most of those deaths—possibly even McCready’s—might have been prevented if the program had utilized treatment practices proven to be most effective.

Although Dr. Drew appears to truly believe in what he does, addiction experts say that the treatment philosophy and policies demonstrated in his show and public statements often do not reflect the best evidence-based practices. His rejection of maintenance treatments, use of punitive detox practices and humiliating therapy and insistence that people cannot truly recover without complete abstinence through 12-step programs reflect the conventional wisdom of the 1980s, not the data of the 21st century. Indeed, Celebrity Rehab’s treatment—leaving aside the massive confidentiality violation of being televised—diverges dramatically from the National Institute on Drug Abuse’s (NIDA) Principles of Drug Treatment, a guide that lays out standards for the best addiction care.

Take the harsh way McCready was treated during her detox on season three of Pinksy's show, which premiered in 2010. As the cameras rolled, the country star began shaking and making involuntary movements. Her roommate, Mackenzie Phillips, simply laughed at her, apparently buying into the stereotype that addicts who seem ill must be faking it. But as Phillips belatedly realized that the seizure was all too real, the cameras continued to roll. She raced around, screaming and searching for a nurse; nearly a minute goes by with no one stopping the production to help. Instead, the cameraperson actually zoomed in as McCready shuddered and shook. 

Prior to treatment, McCready admitted to drinking and taking benzodiazepines (anti-anxiety drugs like Valium and Xanax)—both of which can cause withdrawal seizures if patients aren’t adequately medicated during detox. Indeed, withdrawal from benzodiazepines and alcohol—unlike methadone or heroin withdrawal—can be fatal because these seizures can progress into a condition called status epilepticus.

Charles O’Brien, MD, PhD, is the  director of the University of Pennsylvania’s Center for Studies in Addiction. He has developed drugs to treat dependence to alcohol, opioid and cocaine, done pioneering research into the clinical aspects of addiction and the neurobiology of relapse, been a longtime advisor to the government on drug policy and is widely seen as one of the top treatment experts in the world. He says that the death rate from such seizures can be as high as 10%. “If you properly medicate, you can usually prevent seizures,” O’Brien tells me. (To be fair, McCready had also suffered a previous head injury, which could also have caused the seizures.)

Seizures and other behavioral consequences of Pinsky's tough-love, no-medication, abstinence-only approach make for high drama, which is why some detractors have argued that Celebrity Rehab may put entertainment ahead of the most effective treatment—and even safety. For his part, Pinsky argues that drama is the only way to attract viewers. He told  The New York Times in response to criticism of such practices by other addiction specialists that “the problem with my peers is they don’t understand television…you have to work within the confines of what executives will allow you to put on TV.” 

 

Sadly, that’s not the only way in which the show fails to provide evidence-based treatment. Consider what happened to former Alice in Chains bassist Mike Starr, who, under the current standard of care, probably should not have been detoxed at all, let alone as rapidly as was done on the show. In 2011, he died of an overdose of unspecified prescription opioids.

In the first episode of season three in 2010, Dr. Drew  notes that withdrawal symptoms vary but that Starr is “in for a painful and even dangerous journey.” Starr was withdrawing from methadone, which he had been taking for 10 years to treat heroin addiction, a not insubstantial period of time.

 
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