Let's talk recovery

Times Staff Writer

Rush LIMBAUGH in rehab.

Shortly after his Oct. 10 announcement that he was addicted to painkillers, the conservative radio talk-show host checked himself into an undisclosed addiction rehabilitation facility. Instantly, Limbaugh -- who over the years has insisted that drug addicts are simply common criminals -- found himself the subject, rather than the instigator, of heated social commentary.

But it was the first two words of the statement -- Rush Limbaugh -- that made the story, not the second. Because everyone, pretty much, has been in rehab.

A generation ago, seeking professional treatment for drug or alcohol addiction was a last resort, cloaked in silence and secrecy. Nowadays, terms like "rehab," "detox," "12-stepping" and "working the program" are part of the vernacular with a shock value of zero, unless -- as in Limbaugh's case -- a huge amount of irony is involved.

Along the way, "going into rehab" seems to have become cultural shorthand for many things, some of which are related to recovery from an addiction, some of which are not.

It can be an apology for bad behavior and a pledge that the behavior will not be repeated; it can be a bid for time out of the spotlight or a method of stalling a divorce. Certainly, it has become a no-brainer legal-defense tactic -- if your client stands accused of assault, possession, domestic abuse or embezzlement and drugs or alcohol are even remotely involved, then step one is: Send him into rehab.

"It is a way to stop the clock on the conversation," says social critic Virginia Postrel, author of "The Substance of Style: How the Rise of Aesthetic Value Is Remaking Commerce, Culture, and Consciousness." "There has been a big shift in the way it's used, from shameful to almost admirable. Saying you're in rehab is a way to say the problem is being dealt with, it's in the past, 'nothing to see here, folks, let's just move on.' "

"Rehab" has come to mean so many things to so many people that those in the addiction recovery profession fear that the public has lost any sense of its true meaning.

At the Betty Ford Center in Rancho Mirage, the terms "rehab," "detox," and "28 days" are forbidden among the staff and the literature. "This is a licensed addiction hospital," says president and CEO John Schwarzlose in tones meant to kill the sizzle. "Slang like 'rehab' does a disservice to the fact that this is a very complicated disease and today the treatment has become more complex than ever before."

The celebrity factor has a lot to do with the shift in meaning and fashionability. Twenty years ago, a few high-profile individuals including former First Lady Betty Ford and Jason Robards decided to use their fame to increase awareness about addiction and its treatment. This allowed ordinary mortals to draw strength and hope from the knowledge that addiction knows no demographic boundaries. It also meant that the public would now be informed every time a starlet detoxed from painkillers.

Celebrity sobriety also faces a medium versus message problem -- it's a bit difficult to feel pathos for someone whose alcoholism is announced by a publicist.

Schwarzlose has to deal with the slang issue on an even more particular level -- "Betty Ford," who remains a living, breathing person, is also often used as pop-culture code. Schwarzlose remembers watching an actor on "Good Morning, America" answer a question about his problem behaviors. "He said: 'Haven't you heard? I'm a Betty Ford kid now.' And he hadn't even been here. I checked."

Silence, he believes, has been replaced by glibness, which is just another way of minimizing the serious and widespread problem of drug and alcohol addiction in this country.

When the Betty Ford Center opened 21 years ago, there were fewer than 700 treatment facilities in this country. Since then, that number has grown to 13,000; in the last 10 years, the amount spent on treatment has doubled to almost $7 billion. But still, Schwarzlose says, "What dictates most people's attitudes about drugs and alcohol is confusion." Many people, he says, don't understand some of the basic tenets of the recovery profession -- that addiction is a chronic disease, that there is no one-size-fits-all treatment, and checking into an addiction facility is only the beginning.

"The cavalier nature of the language flies in the face of a serious disease that requires serious treatment," he says.

And that cavalier attitude, according to Schwarzlose, is no longer confined to the language. "Boutique" centers, where the rich are allowed to continue conducting business, are popping up all over. Some facilities offer programs that last but a few days or advertise detox in a matter of hours, which Schwarzlose finds troubling.

"If you were looking at how heart surgery was handled and found that one hospital kept patients for 10 days and others two days, you would probably have some serious questions," Schwarzlose says.

Some, however, think that defining addiction as a disease is the very reason people expect it to be "cured" in a few weeks.

"If you think addiction is a medical disease, then if a person goes through treatment, they should be cured," says Jacob Sullum, author of "Saying Yes: In Defense of Drug Use," which argues, among other things, that not all recreational drug use is abuse. Sullum believes that addiction is a pattern of behavior, not an illness. People who think of it as an illness, he says, represent the tendency to medicalize behavioral problems.

"So people get confused," he says. "They focus on giving up the drug, as if the drug itself is the problem.... They overlook the psychological and spiritual aspects of the process."

Calling addiction a disease is appealing, he says, but that makes it too easy for people to assume they can overcome serious personal problems by "taking the cure."

Treatment, says William Moyers, vice president of external affairs at Hazelden, a 54-year-old Minnesota treatment facility, "is literally just the first step. Sobriety involves more than just not drinking or drugging. It involves completely re-thinking your life."

The idea that "rehab" is a quick fix, says Moyers, has been reinforced by many health insurance plans, which have in recent years decreased the length of stays they will cover. "Rush Limbaugh is lucky he can afford a month in rehab," Moyers says. "Most people can't."

Although Moyers is encouraged by the prevalence of "recovery speak," he worries that people still have the same misconceptions they had 20 years ago -- that addicts are weak, that drunks would be fine if they sobered up.

"The majority of people have been impacted by addiction," says Moyers. "But we don't talk about it. Many people think of it as a hopeless condition, many people see it as a moral issue."

In many of the public conversations regarding Limbaugh, supporters have argued that addiction to painkillers is "morally" different from addiction to other substances. Which is why, Schwarzlose says, there have been so many public figures entering treatment for painkillers lately. Some have legitimate painkiller issues, he says, but many are actually addicted to alcohol or other drugs. They claim painkillers, which have a bit more social acceptance, to save face. (He is not implying that this the case with Limbaugh.)

"They learn pretty quickly in here that it doesn't matter," he says. "Addiction is addiction -- whether it's to heroin or beer."

And those whose drug of choice is indeed painkillers find that sobriety, as defined by Betty Ford and Hazelden, means no alcohol or drugs of any sort. "It's a shock for some," Schwarzlose says, "when they hear there will be no red wine with dinner. We won't even give them an aspirin."

At Hazelden, Moyers sees people choosing to enter rehab as a way of dodging legal and career issues, but, he says, rehab is nowhere near as "fashionable" as it was in the '80s -- "the glory days when everyone was going to treatment and talking about it."

Rehab is less "cool," he says, because, while some still view it in the same light as a jaunt to the fat farm, others know that recovery can take a lifetime. Unfortunately, he says, the high-profile success stories don't make the cover of People, while those still struggling often do.

"Darryl Strawberry, Robert Downey Jr., Nick Nolte.... We see the high-profile cases who need several rounds of treatment," he says, "and we condemn them. We say, 'Oh, it didn't take with him.' But would we say that about a cancer patient who had to return for more chemo? For a diabetic who had to receive more dialysis? Some people are sicker than others."

A spokeswoman for Premiere Radio Networks, Limbaugh's employer, says he is due back on the air in "mid-November." Moyers wishes him well. "Limbaugh has sparked a re-awakening," he says. "It's a moment for the nation to come to a key understanding -- that this is our No. 1 health issue and it doesn't matter who you are or who you know."

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