Charlie Sheen's repeated relapses and returns to treatment, now covering decades, suggest that perhaps he might look at different approaches to his addictive problems. What he's been doing doesn't seem to be working so well for him -- as it has failed many others.
Sheen has been in and out of standard disease, 12-step therapy of the kind depicted on "Celebrity Rehab" and "Intervention" and practiced at Betty Ford, Hazelden, and virtually every other public and private treatment program in the United States. But this is not the standard treatment everywhere (in much of Europe and the British Commonwealth, for instance).
Other approaches -- which have more often been empirically validated in clinical trials -- include motivational enhancement (allowing addicts to grasp the divergence between their behavior and their values), skills training (including problem-solving, assertiveness training, emotional self-management), community reinforcement (integrating rewards for sobriety into people's daily lives -- including their families and social groups).
These other approaches are generally labeled "cognitive-behavior therapy" (CBT). Although evidence-based, CBT doesn't seem to many people to be medical enough to deal with a genuine disease. In the U.S., we instead hope that medicine will ultimately discover the secret to addiction. In the meantime we call addiction a disease, but rely on group meetings and admissions of powerlessness and submission to a higher power -- hardly in themselves medical treatments -- to cope with alcoholism and other addictions.
Powerful figures have recently been re-orienting their approaches to addiction. One such professional is University of Pennsylvania psychiatrist (and father of an addict) Thomas McLellan, who became Obama drug czar Gil Kerlikowske's deputy director (although he resigned within the year):
We've also got to intervene earlier in ways that aren't quite as threatening, that enable people to take control of an issue that they may not be able to understand is hurting their quality of life. I'm very interested in, and this office is very interested in, screening and brief interventions. ... The other thing, without question is, we've got to develop much more attractive, engaging, enduring treatments. If this is largely, at least today, about lifestyle management, that's what treatment really is.
(Disclosure: I have a CBT and life-management treatment program administered at St. Gregory Retreat Center. In addition to CBT techniques, we believe that people should strive to attain a greater purpose for themselves -- whether religious, political, artistic, community or family-oriented -- to guide themselves out of the thicket of addiction.)
Which brings us back to Sheen. From a distance, Charlie seems to lack some things: (a) a genuine appreciation of how his behavior is not in his own best interests and violates the things he most values in his life -- like his career and his family, (b) ways of spending downtime that he enjoys other than imbibing substances and hanging out with prostitutes, (c) a belief that he can -- and the know-how to -- extricate himself from dangerous, escalating situations. While 12-step approaches teach people that they can't cease consumption or remove themselves from a using situation once they have begun, we teach the opposite -- and techniques for doing so. These techniques, called relapse prevention, don't assume that addicts lose ultimate control of themselves when imbibing or using.
If his treatment has thus far been steeped in the 12 steps, objective research indicates another approach is more likely to lead to a positive outcome. At this point, it might seem worth Sheen's time to try something else. AA, after all, defines insanity as "Doing the same thing again and again while expecting different results." (Thanks to Steven Slate.)
Shira Hirschman Weiss: Charlie Sheen: Shades of Mel Gibson?
Adi Jaffe, Ph.D.: Drug Rehab Treatment: America's Broken System
The purpose of the 12 Steps is not just to get clean but to be happily clean.
Here is a short synopsis of myself, I had surgery on my Left-Antrerior-Descender, the widowmaker, ~8 yrs. ago. I have been active my whole life, including vigorous exorcise and eating healthy, but what we thought was healthy years ago was not as we have discovered. I have cut out white flour/white breads, potatoes and we mainly eat chicken, fish, (that I catch most of the time).
Now, when it was discovered that I had blockages I was a little surprised because I ran for decades 4-5 days a week, rode my bike and weighed ~152LBS, 5'-10" tall, I also did many races from 5-k to 1/2 marathons and a few triathlons over the years.
I am like a lot of people where my HDL's are in the 30's range and I have tried a lot of different non-drug options to raise it, but it is tough to elevate it, although I have not tried the red-yeast-rimy
If you remember the famous runner named Jim Fixx, he did many marathons a year and was skinny and tall, he passed away in his mid-forties from the Widowmaker.
I still ride my bicycle about 2,000 miles a year from May-to-September and 4 years ago one my cohorts from work rode from the U.P. to my daughters in Colorado, 1,250 miles in 16 days.
Steve
if what he wants is to get high, then it's working out well for him
why should I care if some want to party themselves into the grave?
he makes his choices, and lives with them
As the Chinese proverb goes "the longest journey begins with a single step."
Mr. Sheen has yet to hit bottom. A twelve step program is unlikely to work until he does. Perhaps an alternate treatment would suit him better.
Charlie Sheen has had as bad and as highly publicized breakdowns as any human being can have, covering a period of decades (you know he shot a girlfriend, right?), being repeatedly hospitalized and jailed, yet you reckon he hasn't hit bottom.
What is hitting bottom? It's recognizing and deciding that something isn't good for you and doing all you can to shift the behavior. Some people quit drinking the first time they become sick from alcohol - and all the way up until Charlie's point and beyond. HITTING BOTTOM MEANS NOTHING. Deciding your personal values have been violated to degree beyond which you refuse to accept means everything.
The 12 steps' self-congratulatory newspeak - which you so proudly endorse like it was delivered by God on the mount - is nothingness and gobbledygook, which I can only pray you recognize so that you mend your ways before you go to your grave.
I would reserve my efforts to this personal prayer on your behalf were it not that this bullshit is harming the actual treatment and ability of addicts to recognize and change their own behavior - waiting as they are for God to break through the heavens to show them that they have "hit bottom."
Shame!
Sheen said it was hard to get his son's attention, but his chance came after Charlie Sheen was hospitalised for a drug overdose in May 1998 and then skipped hospital.
"This was a criminal matter. And so that was the wedge; that was the leverage I had. That is what I took to the court; that's what I took to the sheriff. It was the only way I got him," said Sheen.
After Sheen reported the overdose to the judge, his son was ordered into a rehabilitation program.
A failure to connect - do you think? In my post, I describe the outlines of a different way to go about it: "motivational enhancement (allowing addicts to grasp the divergence between their behavior and their values). . . .Charlie seems to lack. . . a genuine appreciation of how his behavior is not in his own best interests and violates the things he most values in his life -- like his career and his family.
Ceasing production of his show, being hospitalized and arrested, embarrassing himself and his family could serve as motivations he accepts to change, do you think? ME is a well-validated technique empirically - worth a try?
what he really wants - evidenced by his behavior - is another
legalize it - all of it
There's a huge market out there of alcoholics who would like to manage their drinking and drink socially. About 16 years ago there was a self help group started by a woman, I believe, called MM or Moderation Management (of drinking). Her group was receiving fair publicity and had some growth in the mid 1990's. After all, there is a lot of appeal to the idea that one can gain control of a behavior or over consumption of a substance, even after much evidence is accumulated to the contrary. Unfortunately for the MM program, the founder was arrested for DUI, with four times the legal limit of alcohol in her. She killed two people in that accident. http://www.seattlepi.com/local/mod11.shtml
Anyway, what would Charlie Sheen learn in such a program? New goal- Two drinks a night.. an extra one on the weekend... and, perhaps he might date only one pornstar per evening? That isn't what he wants. Many ill people will suffer as they pursue controlling the uncontrollable.
http://www.youtube.com/watch?v=ihHLbBkf-Qo
which Marc Sadoff brings up here to indicate - what? - that Charlie is doing well, that he should stick with AA until he succeeds, that his problem is he hasn't been trying hard enough to abstain, that no alternative to AA is necessary? Help me out here, Marc.
http://alcoholism.about.com/library/weekly/aa000708a.htm
If we are to blame the accident on the recovery group Ms. Kishline was attending at the time it occurred, then the group to blame would be AA, not MM. However, I don't feel that the accident was an indictment of either group. Both approaches are needed.
Doctors looking for ways to "fix" the addict might go back to what used to work for them - lobotomies.
The notion that AA is not treatment is just ridiculous.
Seriously though, I agree. If 12 steps works and for many people it does work. Why knock it. Different people need different things. I don't get all the anger.
There's no doubt that hundreds are a mere drop in the bucket when compared to the more than 12,000 programs in the U.S. It's certainly part of the work we're doing on www.allaboutaddiction.com and it's nice to hear Dr. Peele move a little away from his good old "addiction is just a social creation" stance.
Good job!
Until he faces actual negative consequences of his behavior and "gets" the conflict between what he is doing and his values...no treatment will help unfortunately.
If you look into Motivational Interviewing, I think you'll find that it speaks to exactly the problem you're highlighting. In a manual on the technique, released as part of Project MATCH, mentions this on page 8:
"Develop Discrepency: Motivation for change occurs when people perceive a discrepancy between where they are and where they want to be. The MET approach seeks to enhance and focus the client's attention on such discrepancies with regard to drinking behavior. In certain cases it may be necessary first to develop such discrepancy by raising clients' awareness of the personal consequences of their drinking. Such information, properly presented can precipitate a crisis (critical mass) of motivation for change."
So you see, MI based methods are focused on developing motivation as well as capitalizing on it.
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http://www.thecleanslate.org/charlie-sheen-rehab-insanity-addictio/
'Course in the interim they're risking a fatal crash.