Rehab and Repentance Shouldn't Mix

05/25/2011 12:00 pm ET

With the spate of celebrities entering rehab after committing what used to be called "sins"-- from adultery to racist slurs to homosexual infidelity to homophobic rants-- lots of stories have been written about whether psychological treatment for such issues can help. Other articles have examined whether such treatment-seeking is a cynical ploy for image rehab, not a genuine desire for transformation.

But no one is asking the most important question, which is, if addiction is a physiological disease, why is rehab a place to go for repentance?

No one would dream of having chemotherapy to atone for having indulged in "meth and man-ass;" nor would anyone seek an organ transplant to show a sincere desire to overcome racism.

In cancer treatment, doctors seek to use the lowest dose of chemo possible, to minimize pain and suffering-- but when people seek addiction treatment, the "toughness" of treatment is considered positive. For example, after the extramarital affair of San Francisco Mayor Gavin Newsom became public, the director of the treatment program he entered for alcoholism praised him for seeking help "from a place he knows would not be light."

That program, Delancey Street, is known for using a tough, confrontational approach to addictions. Research shows, however, that toughness and confrontation are not actually effective: studies of alcoholics find that the more a client is confronted, the more he drinks and the more likely he is to drop out of treatment.

Addiction treatment has traditionally been tough because addicts are seen as sinners. Rehab entry following bad behavior is thus acceptable because treatment is known to be punitive. Consequently, whenever the press covers posh rehabs, it piously asks whether "soft" treatment could possibly work-- and whenever celebrities need image make-overs, they stress the ascetic aspects of rehab.

This moral confusion makes effective addiction treatment difficult to sell: an enormous body of data now shows that kind and empathetic care is far more effective than punitive and harsh programs, but even though they work better at changing behavior, the gentler programs don't satisfy the public's desire to see addicts punished.

Further, the use of rehab as penance reinforces the public notion that addiction is a moral, not a medical, problem. Rehabs need to screen patients-- even rich celebrities-- to determine whether they actually have an addiction before accepting them. Treatment policies should be based on what actually improves outcomes-- not what looks "tough enough" to the public. And those who need to repent should go to church or temple or do community service, rather than taking up addiction treatment beds that could go to people with actual medical problems.