LOS ANGELES - Lindsay Lohan has been five times. Charlie Sheen also is a regular. Someone tried to make Amy Winehouse go, but she said, "No, no, no."
Rehab is practically a rite of passage in Hollywood, and Lohan is its latest poster child. Her trips to treatment and travails once there - including an alleged altercation with a worker at Betty Ford Center a few weeks ago - have been well documented for the past three years. The 24-year-old actress follows a pattern: Get in trouble, go to rehab, get released, repeat.
It's all normal, say addiction specialists: Emotional flare-ups and repeated relapses are part of the process of recovery from addiction, whether the addict is famous or not.
National studies show the average person may need three or more stints in rehab to achieve recovery, says Geoff Henderson, senior director of Phoenix House, a drug-treatment center in Santa Ana, Calif.
So what really happens in rehab? And what's the difference between the pricey, private places favored by celebrities and the more affordable options frequented by less famous folks?
At Promises Treatment Center in Malibu, where Sheen spent 93 days this year, "we look at addiction as a physical and psychiatric disorder, not just a series of bad choices," says chief executive Dr. David Sack, a psychiatrist specializing in addiction treatment.
Scientists define addiction as a chronic illness characterized by relapses during recovery, such as diabetes or hypertension. As with those health conditions, managing addiction requires a sustained lifestyle change, and most rehab centers - regardless of cost and amenities - aim to bring about that change through counseling, education and community service.
A month of residential treatment at Promises costs $50,000. Betty Ford Center charges $26,000. Phoenix House costs $3,000 to $5,000 per month. All three programs develop personalized treatment plans for each patient that include individual and family counseling, group therapy, 12-step meetings, physical exercise and community involvement.
Promises could almost be mistaken for a luxury spa, comprising five ocean-view homes in the Malibu hills. There are three swimming pools, several whirlpools and a private tennis court (with a professional instructor on call). Patients live six to a house, each typically with their own bedroom and sometimes their own bathroom. An onsite chef works with the staff nutritionist to prepare three gourmet meals per day.
"This is the kind of place where, even if you weren't in treatment, you wouldn't mind spending a few weeks," Sack says.
The facility offers massage and acupuncture to ease the pain of detox, plus yoga and neurofeedback training help patients deal with stress and anxiety. It recently added equine therapy to its menu of services.
Betty Ford Center, which sits on 20 acres in the desert east of Los Angeles, also offers acupuncture and biofeedback. Residential patients share double rooms with views of the local mountains, enjoying meals shaped by the staff dietitian and personalized exercise plans designed by the onsite fitness trainer.
Phoenix House, which has locations across the country, is more modest. The mission-style Santa Ana facility houses residents in gender-specific dorms lined with bunk beds, and each is allowed a limited amount of clothing and personal items in their shared closet spaces. There are community rooms with big-screen TVs, an outdoor workout area with weights and an exercise bike, a baseball diamond and a garden with lemon, lime and guava trees.
All three facilities limit phone and computer use. All host a daily spectrum of emotions, from anger and fear to happiness and hope. All offer treatment for the psychiatric conditions that often accompany or predate addiction, such as depression, anxiety, bipolar disorder and learning disabilities. And all have alumni programs to encourage ongoing sobriety.
Phoenix House, where the typical stay is three to six months, may serve the most diverse population. Some patients come on government referrals straight from jail or homeless shelters. Others are private customers, paying for treatment out of their own pocket or through their medical insurance.
All residents are assigned jobs at the facility, from groundskeeping duties to administrative work. Residents do the cooking and cleaning, too. Betty Ford Center also assigns its patients daily chores, such as rounding up chairs and making announcements. At Promises, cooking, cleaning and household tasks are handled by a paid staff, but patients volunteer regularly at a local soup kitchen.
"Everyone contributes," Henderson says. "It creates a social dynamic of accountability to oneself and one's peers, and aids in developing a positive self-identity and positive peer relationships."
Therapists at both Promises and Phoenix House use motivational interviewing to help patients find reasons to stop using drugs. Although on opposite ends of the cost spectrum, both facilities use evidence-based methods to help their patients learn to enjoy healthy, drug-free lives.
Because addicts share key things in common, they need care, understanding and hope as they work toward recovery - whether it's in a fancy facility or a simple one.
"People who share a problem want to socialize. They want to share their story and want to learn how others are solving it," Sack says. "People of means just don't want to share a bedroom."
