There Are, After All, Sad Clowns?

Charlie Sheen is being lectured by "Dr. Drew" Pinsky - that's right, the guy who profits from a "celebrity rehab" show - that he needs to take rehab seriously. Would that mean going on Dr. Drew's show, so his private disclosures and embarrassing moments, as well as what seems to be a considerable amount of contrived drama, gets broadcast to the nation? ("We have Heidi Fleiss coming on the show... Hey, who's her ex-boyfriend who was convicted of domestic violence - Tom Sizemore. Let's get him, also. Oh, and he has a drug-using girlfriend - can we sign her up, mid-season?")

My initial reaction was, "That's like being lectured on seriousness by a clown," but then (as the subject indicates) I remembered that there are sad clowns.

It's not that I don't think Dr. Pinsky could run a decent drug rehab clinic. It's that I see him as instead choosing to create a public spectacle that puts him in the role of savior, involves stirring up drama for the benefit of the cameras in a context in which turbulence should be minimized and people should feel safe, and using what is ostensibly the medical treatment of patients in his clinic as an opportunity to build his own public image. It's great that Dr. Pinsky admits his own narcissistic tendencies, but not so great to see them play out like this.

Drug Treatment Expenditures

Although the article contains too few details to give any real insight, London's Guardian shares a report suggesting that a huge investment in drug treatment produced little in the way of results:

Despite a £131m boost in funding for the National Treatment Agency last year, the numbers emerging from treatment free of addiction has barely changed from 5,759 three years ago to 5,829 last year.

This amounts to an increase of only 70 more people, a hefty price tag of £1.85m for each addict to get clean.

The response is that "successful treatment takes from five and seven years" and thus that critics are expecting results too quickly, but also,

Every £1 spent on drug treatment saves £9.50 to the rest of society.

That sounds like a convenient, made-up figure. Why don't we invest the entire GDP in drug treatment, for an easy 950% return each year?

I would venture that the following factors are relevant to the slow start, despite a huge investment:

• The broadened availability of treatment means that it is now being offered to (or required for) a much larger population of individuals who are not ready to be sober;
• The broader reach of drug treatment is likely also to bring treatment services to dual diagnosis (or triple diagnosis) patients - those with concurrent physical and/or mental illness which complicates drug treatment - but without offering adequate, coordinated treatment for those other illnesses;
• Increased funding does not mean that there will be immediate availability of trained, qualified drug counselors necessary to staff new and expanded programs, or that newly created or funded treatment programs will be quality programs;
• Increased funding does not necessarily mean that the best treatment modalities are being identified and followed.

A lot more study is needed, along with certification of treatment programs. (And not just in the U.K.)

Office-Based Treatment for Opiate Addiction

With abuse of prescription opiates and opioids at record levels, it seems obvious that a lot of doctors are a part of the problem. However, very few seem willing to be part of the solution.