The Rich and Famous Part I
Over my lifetime I have seen a number of famous people suffer and ultimately die from overdoses and complications related to their struggles. Most recently the world learned that Demi Lovato, former Disney Channel star and beloved pop singer, was hospitalized due to an overdose. Combine her high-profile overdose with Prince’s overdose and death last year, it felt high-time to write a post about the issues around, the problematic world of rehab, and the dangers of stigma and privacy around the rich and famous and why this is all important and detrimental for everyday people struggling. This post will be the first of a series on these issues centered around Lovato’s and Prince’s stories and struggles, substance use disorders, and other mental health disorders.
Demi Lovato’s Overdose—A Cautionary Tale?
On July 24th, Demi Lovato suffered an apparent drug overdose, though details remain sketchy. She has stated in many interviews, including in her self-produced YouTube Video Documentary, Simply Complicated, that she suffers from Cocaine and Alcohol Use Disorders. She also alludes to misuse of Adderall, a diagnosis of Bipolar Disorder, and has been diagnosed with, and continues to struggle with, an eating disorder. While it is unclear what the facts are surrounding her recent overdose, reports suggest that EMS found her unconscious and revived her with Narcan (Naloxone)—a drug used to reverse opioid overdoses, such as Heroin or pain pills, and can be life-saving. If that is indeed the case, it would suggest that her overdose involved opioids such as, Heroin, Oxycodone, Fentanyl, or a Fentanyl derivative. Based on what we know, one cannot come to the conclusion that she has an Opioid Use Disorder. It is possible, however, that she does, or that she has sporadically used opioids—though again, that is purely speculative. The other frightening fact that many people are unaware of, is that the street drug supply is poisoned. Deadly doses of Fentanyl, a powerful opioid 1,000x more potent than Morphine (or Fentanyl derivatives such as Carfentanyl which is 5-10,000x more potent than Morphine), are showing up at alarming rates in Cocaine, Methamphetamine, and counterfeit pain pills. What that means is that an unsuspecting Cocaine or Methamphetamine user is now at risk for sudden overdose from Fentanyl. This has greatly ratcheted up the risk of death from any street drug use.
There remain many unknowns in terms of what happened and will happen with Demi Lovato. Current reports are that she is headed back to treatment, “rehab,” at the request of her family and other advisors after this recent overdose. What is “treatment” and will she truly get it? (More about “treatment” in a subsequent blog post). Will she be offered ongoing psychiatric care and evidence-based psychotherapy, Bipolar Disorder, and eating disorder? Does she have an Opioid Use Disorder, and if so, will this “rehab” offer her Suboxone (Buprenorphine) or Methadone to treat it? Will she seek support from a “personal development coach” or will she receive care from an psychiatrist and a therapist offering evidence-based psychotherapy for psychiatric disorders? These questions remain to be answered. I acknowledge that we do not truly know her care or medical history and that the stigma and norms within, especially among the rich and the famous, may prevent her from getting the care it appears she needs and deserves. Fortunately, she is still alive after her reported overdose, and, her future depends in large part on getting the right care; which includes ongoing, long-term care for psychiatric disorders on an outpatient basis—not the episodic, non-evidenced based care offered by many high end rehabs.
Rehab as Treatment
In Lovato’s documentary, “Simply Complicated,” she discloses that she went to rehab in 2010 where she was diagnosed with Bipolar Disorder. In the film, Lovato indicates that she quickly had a recurrence after rehab and then went to live in a sober apartment. The documentary, perhaps not surprisingly, is short on details of her drug use history and treatment. Other sources, including an interview with “Dr. Phil” in March 2018, reveal that Lovato lived in a sober living community for one year after her recurrence right out of Rehab. Although Lovato alludes to working with a therapist and “attending meetings,” there is little revealed about what type of treatment and follow-up she engaged in leading up to her recent recurrence and overdose. Her interview with Dr. Phil discusses her close relationship with her “Personal Development Coach” or “Sober Coach” Mike Bayer, founder and CEO of Cast Centers. It is also revealed that she has since become a co-owner of Cast Centers. Nothing in the interview discusses ongoing psychiatric care, or psychotherapy. Was she relying solely on her “Personal Development Coach” and 12-step/AA meetings? It is unclear.
What we do know about what has been disclosed, is that it appears that Lovato fell into the trap that many of the rich and famous do, which is to seek out “high-end” rehab programs that can cost in excess of $100,000 or more for 28 days of residential treatment. Many of these rehab programs have very little evidenced-based treatment incorporated into their programming and rely on 12-step, abstinence based, one size-fits-all approaches. Most do not incorporate psychiatric care, despite calling themselves “dual diagnosis” programs, because they offer a few groups and lectures on mental health issues. Too few of these programs provide medications, which could be life-saving, for psychiatric issues. According to The Journal of Alcoholism & Drug Dependence, less than 3% of people who qualify for a diagnosis of Alcohol Use Disorder are treated with medication. An article from the journal, Opioid Watch also discusses the underutilization of medications to treat Opioid Use Disorder:
- “Among opioid overdose survivors in Massachusetts, only 30 percent got treatment medication after the event.
- Death rates of those who received medication were about half the rates of those who didn’t.
- Fewer than 40 percent of US treatment facilities offer any FDA-approved treatment medication.”
The rich and famous also seem to rely on “sober companions,” much like Lovato (at a cost of $2,000 per day—from my research), personal development coaches, and other support services, often in lieu of evidenced-based psychotherapy or psychiatric care. In her documentary, Lovato acknowledges going through dozens of “sober companions.”
Most rehabs are episodic residential treatment for 28 days or perhaps 6 weeks of outpatient treatment. What other chronic illness do we treat in this manner? Can you imagine if we treated Diabetes this way?
Let’s say you get hospitalized due to an episode of high blood sugar, are diagnosed with Diabetes and your doctor says “Okay, we are going to discharge you to a 28 day residential treatment program. After that, you will attend 6 weeks of ‘after care.’ [whatever that means!] When you complete that, we suggest you attend self-help groups. If you run into trouble after that, we will put you back in residential treatment.” Insulin? Never mentioned. Why? Because your doctor views your diabetes as a moral failing or a “character flaw.”
This would never be tolerated as treatment for Diabetes or any other chronic illness, but the pervasiveness of 12-step approaches and rehab have inculcated society with the view that —moral failings or character defects. If people just went to 12-step meetings, prayed in church basements more, and adhered to the “just say no” mantra more, they would be fine. Right?
One would think that the rich and famous would avail themselves of the best, evidenced-based care around, though sadly, when it comes to —upscale, high-cost, country club-esque rehab centers and sober companions. If it costs a lot, it must be good…right? It is difficult to get data on the efficacy of rehab, as many of them do not track such statistics. They also do not provide long-term, ongoing care, meaning long-term results are hard to come by. There are suggestions in the literature that the efficacy of rehab may be as low as 10% for long term recovery—meaning that only 10% of people achieve sustained recovery. That should be appalling to us all.
We don’t know the details of Demi Lovato’s story, but it points to the pitfalls that many of the rich and famous fall into when it comes. Reach for the shiny object, keep up with the Jones, pick the most fashionable and high-cost rehab and surround yourself with high-cost support staff, coaches, companions etc. Why? Because this is what has been modeled in that community, and therefore for the lay public as well. What is missing from this picture is the pursuit of effective treatment rather than glamorous treatment. The Rehab Industry has built a powerful money making machine and lobby based on non-evidence-based approaches that jeopardize people’s lives and wellbeing. And because of the huge amounts of money involved, there is currently little incentive for them to change. They are founded on concepts conceived in the 1950s and not based in science or research; ultimately ignoring the last 60 years of research into the neurobiology of leading to cost-effective, compassionate, patient-centered, medically-based approaches to treat, the associated psychiatric disorders that often accompany them. It is time for this culture to be dismantled so that not only the rich and famous get the treatment they so desperately deserve, but that this treatment becomes the norm and available to everyone. The rich and famous can then model what getting good, appropriate, evidence-based treatment looks like, which will then be reflected in the press and social media.
