Life in a rehab house

Lindsay Lohan has been five times. Charlie Sheen is also 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 the 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 that 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, like 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 a 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, featuring 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 a 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.

The 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 employ counselors who are in recovery themselves. 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.

But there are some differences.

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.

Even celebrities have stayed at Phoenix House, though Henderson, the program’s director, keeps their names private.

All residents are assigned jobs at the facility, from groundskeeping duties to administrative work. Residents do the cooking and cleaning, too.

The 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.”

Many Phoenix House patients abused methamphetamines, he says, so treatment programs are tailored to the specific needs of those addicts, who often have issues with learning retention.

Promises, on the other hand, serves an elite, specialized crowd: very successful professionals. Their drugs of choice tend to be alcohol and prescription opiates, Sack says, and their problems are unique.

They’re accustomed to a certain lifestyle (hence the luxury amenities) and to getting their way. They may also be public figures, facing the additional challenges fame can bring.

And they may not really want to be there.

“Most who show up here have not made the conscious decision that they want treatment. … They want to get someone off their back,” Sack says, adding that work and legal problems are the most common precipitants. “The people who show up are, at best, ambivalent.”

Therapists at both Promises and Phoenix House use a technique called motivational interviewing to help patients find their own reasons to stop using drugs. Though on opposite ends of the cost spectrum, both facilities use evidence-based methods to help their patients learn to enjoy healthy, drug-free lives.

All addicts, regardless of background or income, share some key things in common: Their condition has destroyed their self-worth, and perhaps their family and career, and 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.”