Lindsay no longer has Shapiro in her corner, but watching her estranged father and “friends” on Larry King Live on Tuesday night, I realized that what she really needs is a “dream team” of a different sort. I’m not talking about agents or PR reps who could remake her image. I’m referring to a dedicated team of treatment professionals and other recovery supporters who could help her get back on track.

After her stint in jail—which is likely to be around three weeks—she’ll head to three months of mandated in-patient drug treatment. Some commentators have suggested that treatment won’t work for Lindsay unless she’s ready to admit she needs it, but people who become addicted are rarely able to see that their behavior is out of control before others do. Research has shown that those who are coerced into treatment by the criminal justice system can be just as successful as those who seek treatment voluntarily. That said, barring a miracle or a spiritual epiphany, 90 days of treatment will not be enough to change Lindsay’s behavioral patterns. After all, she’s been in rehab three times before—without much success.

What will make the difference this time is if she remains in residential treatment for an extended period of time— at least six months, followed by a minimum of six months of outpatient care and ongoing monitoring. At the beginning, she should not head to a transitional living facility as she did in the days leading up to her surrender. Her best shot at recovery will be an intensive, medically based program where doctors and other addiction specialists are on staff—and are actively involved with the treatment plan.

According to probation reports, Lindsay has been taking a dangerous cocktail of pills, including the powerful opiate painkiller Dilaudid —leading her father and others to suspect prescription drug addiction. According to SAMHSA Administrator Pamela S. Hyde, “The non-medical use of prescription drugs is now the second most prevalent form of illicit drug use in the nation.” In May of 2008, my stepson died from mixing alcohol with prescription drugs, so I know first-hand that prescription medications can be just as lethal as heroin. If it turns out that Lindsay is, in fact, abusing prescription meds, she’ll need a team of experts to work with her and with each other: a psychiatrist who is highly skilled in psycho-pharmacology, a pain specialist, and a host of other substance abuse professionals.

Additionally, the criminal justice system should remain involved to ensure that Lindsay’s progress and her drug use is continually monitored—and that she stays engaged with the process. In the treatment system, those who have the most success are those who are monitored for a considerable length of time. This type of supportive monitoring will hold Lindsay accountable and offer her additional treatment if she veers off course.

The eventual goal for Lindsay—or for anyone who struggles with substance abuse—is independence and self-management. Like diabetes, addiction is a chronic condition. However, relapse is not inevitable. Just as diabetics must monitor their disease and adjust their medications, Lindsay must learn to adjust the volume and intensity of her recovery support for the rest of her life. She needs a “dream team,” but she also needs to keep her eyes on the prize. This could be her moment to get it right.

 Deni Carise
Chief Clinical Officer, Phoenix House

Some commentators have claimed that Cameron’s five-year sentence—half the 10-year mandatory minimum—reflected celebrity treatment.  But, celebrity scion or not, the court system grants judges latitude to consider the circumstances. In this case, Cameron’s life-ruling addiction may have influenced Judge Berman’s decision to save him from an unreasonable—and counterproductive—prison term. What he, and others struggling with substance abuse, need is comprehensive drug treatment, not simply a long stint in jail.

Cameron Douglas is a classic and tragic example of early onset drug use. In fact, as his Oscar-winning dad told Matt Lauer, his eight months under federal lockup while awaiting his sentence was his longest period of sobriety since age 13. Although Michael Douglas expressed optimism that this time, his son would kick the habit and “start afresh,” we as treatment professionals know that it’s not so simple. When someone starts using at such a young age, his addiction becomes a disease of the whole person that affects thinking, attitude, and behavior. Without treatment—no matter how long Cameron stays behind bars—his chances of long-term recovery are remote to non-existent.

While it’s unclear where Cameron will serve his time, we can only hope that Judge Berman’s recommendation to the Federal Bureau of Prisons includes appropriate time in treatment—and a parole condition that he receives continuing care. We at Phoenix House have a long history of working with parolees and ensuring that they receive the services they need to remain drug-free. These recovery management services are what will matter most in saving Cameron’s life—and preventing him from landing in jail again for drug-related crimes.

For Cameron’s sake—and the sake of the 23 million Americans who meet criteria for substance abuse—I hope that criminal justice reform brings greater recognition that addiction is a chronic medical condition. Incarcerating drug users without providing them with the help they need drains state and federal budgets and wastes taxpayer dollars. It doesn’t give substance abusers the tools to find their way, nor does it effectively fight crime. We need to get the word out: jail time alone will never work.

 David Deitch, Ph.D.
Consultant and former Chief Clinical Officer, Phoenix House
Emeritus Professor of Psychiatry, University of California, San Diego

Beyoncé and her mother Tina Knowles with Phoenix House clients who will be among the Cosmetology Center's first students. (Photo by Ben Hider)

PH: What first drew you to Phoenix House?

Beyoncé: When I started doing research to play the role of Etta James in “Cadillac Records,” the film was covering a period in her life when she was struggling with drug addiction. I read about the work that Phoenix House has done and continues to do to help those in that same struggle.

PH: Before you took on the role of Etta James, what was your attitude about drugs and alcohol?

Beyoncé: I understood that if you drank too much or did drugs that it could be dangerous. I read a lot about people who have lost their careers, their homes, their children and sometimes their lives after becoming addicted to drugs or alcohol. I always asked is it not easy to just stop, to just say no, like we were taught? I understand now that it is a disease and just like no one chooses to catch a cold, no one chooses to be an addict.

What were the most important—or the most surprising—things you learned from the women in treatment at Phoenix House?

Beyoncé: The most important and surprising thing I learned from these incredible women is how strong they are. They have accepted that they are struggling but they have made the decision to get better. They are driven and focused to break the addiction and do better for themselves and their families. Their stories are still filled with hope. They refuse to give up.

PH: What inspired you to create a cosmetology center at our Career Academy and what do you and your mother Tina believe it can do for the people we serve?

Beyoncé: The inspiration for the center really came from the women I met at Phoenix House. It was their stories of what they had been through and how positive they were about the future that inspired me and my mom to come up with something that would teach them a skill, make them feel good about themselves and prepare them to return to work. No one knows about beauty more than my mother. She owned a beauty salon when I was growing up and I spent a lot of time there, I loved it and everyone supported and inspired each other. My mother and I believe that anyone can succeed with a little help. The cosmetology center can help these women, and men, to achieve their goals to be independent, self-fulfilled and ultimately help in their recovery process.

PH: How can we best remove the stigma that keeps so many victims of addiction from getting the treatment that can help them control this chronic disease?

Beyoncé: The first thing is to recognize that drug addiction is a disease. No one chooses to be a drug addict. When someone gets sick, everyone works to get them better. There is no blame and no judgment. If everyone understands that as a fact, I think the addict would feel more comfortable seeking treatment. It has to be so difficult to have to cope with the disease of addiction and to also feel afraid to seek help.

An unfortunate example is Dr. Conrad Murray, Michael Jackson’s personal physician who, last week, was charged with involuntary manslaughter in the King of Pop’s death. Giving Jackson propofol, a medication designed to induce anesthesia, as a sleep aid, the cardiologist went outside the proper use of the drug as well as his own level of expertise. While it’s unclear whether Jackson had an addiction problem, he was reportedly using a variety of heavy meds, including daily injections of the narcotic pain reliever Demerol. A responsible physician would have looked at Jackson’s drug-seeking behavior and evaluated the possibility of substance abuse. But instead, Murray appears to have let celebrity and maybe a handsome sum of cash cloud his medical reasoning.

Few doctors are fortunate—or in Murray’s case, unfortunate—enough to treat one of the most famous recording artists of all time. But celebrities aren’t the only ones willing to pay physicians top dollar to feed their prescription drug dependence. In a disturbing CNN segment that aired last Wednesday, reporters investigated the prevalence of pain management clinics in South Florida that essentially sell prescriptions to substance abusers and dealers. Once again, the temptation of easy money leads to a reckless misuse of medicine.

As a doctor of internal medicine who has been practicing for 17 years, I believe that Murray and the docs on the CNN program are anomalies in what is still a caring field. However, even docs with great integrity may be unknowingly over-prescribing medications and contributing to a patient’s substance abuse. Because I treat men and women who are recovering from addiction, I closely monitor my patients’ medications and curtail the dosage if I feel it’s no longer appropriate.

For doctors in private practice, I recognize that monitoring is more difficult and the risk of abuse may not always be forefront in their minds. But physicians in any setting must be hyper-vigilant. This means looking at patterns and examining whether complaints match actual symptoms. It means scaling back if a patient’s dose and length of use seem to exceed their medical needs. Although the perception of pain varies, we must use our best judgment to prevent misuse—before it’s too late. While few of us would go to Dr. Murray’s extremes to satisfy a patient, his reckless behavior should serve as a wake-up call to all of us.

I have been in the substance abuse field for over 20 years, first as a treatment provider and then as a researcher. But it is through the eyes of a person in long-term recovery who has buried family members and close friends (one who was sober over 17 years prior to relapsing) that I understand the battle DJ AM faced.

Recovery, no matter how many years one has nurtured it, is never fully self-sustaining. It needs continued attention and dedication, just like any other chronic health problem. So, I ask, can someone in recovery ever be 100 percent confident they will not go back to drugs or alcohol?

Last year, DJ AM suffered critical injuries when a Learjet carrying him burst into flames during an aborted takeoff in South Carolina. He and Travis Barker of Blink-182 were the only survivors. After more than a decade of clean living, he found himself needing pain medications with abuse liability; he reportedly developed problems with opiates and benzodiazepines.

Then, he shot MTV’s Gone Too Far—an intervention-style reality show set to premier on October 5. He said his inspiration was to work with other addicts in recovery, his passion since the beginning of his sobriety.

I, like DJ AM, believe it’s important that people with past addiction problems commit to helping others. But he may have truly “gone too far.” The drug-using world might not have been one he was prepared to re-visit, given his recent losses and difficulties with pain medications. “I have to calm down after every shoot,” he was quoted as saying. “It’s very intense.” In video excerpts, he described buying a crack pipe to show how easy it was. Then he said, “I walked out…holding [the pipe]…and I realized my palms were sweaty and I was like, ‘Wait a minute, this is not smart for me.’”

Even after 11 years of sobriety, this isn’t unusual. Ask any one of us in recovery when someone inadvertently changes the TV station and a scene from Scarface shows a group of people snorting cocaine. It’s been over 24 years since I’ve snorted coke, but suddenly, I’m holding my breath—as if I’d just done a line.

So, should DJ AM have done the show? Is MTV at fault for his relapse and death? Here’s the bottom line: Just as people with diabetes are responsible for eating a sensible diet and exercising, we are also responsible for managing our recovery. But, just as the spouse of a diabetic assists their partner in managing their illness, we need people to help us, too.

Based on my research, my clinical background, and my own recovery experience, if I had been DJ AM’s friend, I would have told him, “Examine your motives. Think ahead to any emotions that might arise. Make plans to have the folks who support your recovery nearby when you’re taping and after each session. Talk to them, tell them what you’re feeling, and renew your commitment to your recovery each night. Most importantly, promise you will call me before you pick up a drink or a drug.”

And if I had worked for MTV, I would have advised them, “Make sure DJ AM has someone with him during filming—a long-term recovery mentor who knows him well and will help him process any cravings. Don’t ask him if the show is bothering him; he might be the last to notice it.”

 We have to wonder if this type of support might have saved his life.

This Saturday, September 12, I will think of him when I represent Pennsylvania as the state delegate at the A&E Recovery Rally—one of the key events for National Recovery Month. An expected 10,000 of us will march across the Brooklyn Bridge. I will walk in memory of my stepson, who died of an overdose just 15 months ago at the age of 30, and my old friends Mark and Mike, both of whom lost their battles with addiction.

 And I will walk in honor of DJ AM, who wanted so deeply to offer those in recovery meaningful support.

 It’s now up to us to carry his mission forward.

The great strength of “The Cleaner” is the show’s ability to dramatize the downward spiral of addiction, showing how drug misusers “get stuck,” and the difficulty they have of getting “unstuck.” In life, as on TV, an “intervention” is often the means of “unsticking” someone deep in drug misuse. Interventions may indeed be as dramatic as kidnapping or substituting sugar for the user’s drug of choice. But, while bringing together a team of “significant others” to “confront” the user makes for good viewing, it actually occurs rarely. There is an extraordinarily broad range of intervention strategies and they are employed every day in any number of different venues—family dining rooms and kitchens, therapist’s offices, business offices, factory floors, lecture halls and hospital emergency rooms.

The process of getting the drug misuser “unstuck” can begin in any one of these settings—but it only begins there. An intervention just starts the process, because getting unstuck requires serious engagement of the individual in a program of treatment responsive to his or her unique needs—a process pursued in an appropriate setting and involving others. These others may be trained professionals. They may be men and women with similar histories of drug involvement. A community of faith may be a critical part of this recovery process, as well as friends and family. Medications may be involved, cognitive behavioral therapies, prayer, hope, encouragement and opportunities to learn about oneself and master the skills needed to offset the long-lasting craving that comes with addictive behavior.

In short, while “intervention” may be as dramatic as those of “The Cleaner” or—as is more often the case—slow and guided, what counts is what follows!

We at Phoenix House have learned that what follows is a process of learning how best to achieve lifestyle change and continuing recovery. It is a process that varies from person to person. Each day, Phoenix House cares for more than 7,000 people in various settings and stages of recovery. We pledge that each receives the help he or she needs and each is treated with professionalism and respect. We recognize differences in need and our service delivery continuum is designed to respond to these differences. And, while “The Cleaner” deserves our applause, viewers also deserve to know that, no matter how getting unstuck begins, the greater need is for the rest of the process, which is what most of our field is there to provide.

David A. Deitch, Ph.D
Chief Clinical Officer, Phoenix House

Those who knew him tell of his physical and psychic pain. But most addicts suffer psychic pain — often not fully appreciated until they begin to unearth their demons in treatment.  Like Michael, many addicts are hooked in the course of proper medical treatment. Most physicians appreciate the potential for patients becoming addicted.  This can occur even with the most prudent medical management.  But the combination of sorrow over declining bodily powers and physical pain provide an all too common pathway to prescription drug misuse.  Sadly, there are physicians who become passively or actively involved in their patient’s addiction to prescription drugs.  Moreover, it’s also very difficult to say “no” to someone with Michael’s star power.  Many prescription drug addicts see multiple doctors, zigging and zagging between different doctors and different pharmacies.  Their dose levels rise, and their overall function falls.

I suspect the puzzle of Michael Jackson’s drug use and bodily failure will be more clearly analyzed.  But ultimately, his death should be remembered, as was Elvis Presley’s, as preventable, and the enablers, professional or otherwise, should be held accountable.