Episode 99: The Cruel, Voyeuristic Quackery of Rehab TV Shows

Citations Needed | January 29, 2020 | Transcript

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Celebrity Rehab with Dr. Drew, VH1, via Access Hollywood

[Music]

Intro: This is Citations Needed with Nima Shirazi and Adam Johnson.

Nima Shirazi: Welcome to Citations Needed, a podcast on the media, power, PR, and the history of bullshit. I am Nima Shirazi.

Adam Johnson: I’m Adam Johnson.

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Nima: In the last 20 years, the topics of substance use and treatment have become the stuff of televised entertainment: heart-wrenching stories of desperation and redemption, of suffering and survival. Shows like A&E’s Intervention and VH1’s Celebrity Rehab with Dr. Drew, which depict people with substance use disorders and their experiences navigating recovery in rehab, have gone a long way to shape our common narratives about what addiction is and how it should be addressed.

Adam: The central conceit of these shows is that anyone struggling with addiction must follow the same road to recovery: Stay at a for-profit treatment facility for approximately one to three months, requiring, among other things, complete abstinence from drugs and/or alcohol, no matter how excruciating or dangerous this may be. While these methods are effective for some, they’re profoundly harmful for many others.

Nima: In promoting this one-size-fits-all approach to treatment — which can be accompanied by punitive and often humiliating experiences — these shows reinforce techniques and philosophies that are not only scientifically debunked, but also have the potential to endanger people’s lives. Meanwhile, they serve as an advertising platform for these for-profit rehab centers themselves, many of which have been shown to be prohibitively expensive, ineffective, and, in some cases, deadly.

Adam: On today’s episode, we’ll examine the pseudoscience, myths, and fundamentally quasi-Christian self-help ideology promulgated by this genre of television; the ways in which these shows exploit addiction for the sake of a story; and the relationship between rehab television and the multibillion-dollar for-profit treatment industry.

Nima: Later on the show, we’ll be joined by journalist Maia Szalavitz, whose three decades of writing on addiction, drug policy, and neuroscience has appeared everywhere from High Times to the New York Times, The Washington Post to The Guardian, VICE to TIME, Scientific American to The Atlantic. Among other books, she is the author of the New York Times bestseller, Unbroken Brain: A Revolutionary New Way of Understanding Addiction.

[Begin Clip]

Maia Szalavitz: Our entire culture has this idea that the best way to deal with addiction is to go to 12-step meetings, take moral inventory, surrender to a higher power, make amends to the people that you’ve wronged. And while you can debate forever whether that’s spiritual or religious, what you can’t debate is whether that’s moral. Because it says right in the steps, “moral inventory.” Do we ask people who have depression to take moral inventory? Do we ask people with schizophrenia to take moral inventory? Do we ask people with cancer to take moral inventory? No, we do not because we don’t believe that their problem is that they are a sinner.

[End Clip]

Nima: So before we really dive in, we want to note that this episode was researched and written in close collaboration with and guidance from Zach Siegel, a friend of the show who appeared last as our guest on Episode 78: The Militarization of U.S. Media’s Drug Coverage. Zach is a journalist and currently a Fellow at Northeastern University’s Health in Justice Action Lab.

Adam: We want to start off by talking about these very popular shows that began to crop up back in the mid-aughts. So you have the show Intervention on A&E, which somewhat Orwellian-ly stands for arts and entertainment, uh, I guess it’s entertaining. Uh, this series follows a person with a form of substance use disorder who has or will soon hit “rock bottom” and this culminates with an intervention staged by their family and or friends and an interventionist. And during this intervention, the person struggling with substance use is presented with an ultimatum. You go to a treatment facility, which is almost always abstinence-only, or you be cut off from your social and financial networks, your financial and social support system. And it usually ends with the person choosing treatment, at least temporarily.

Nima: Yeah. I used to watch the show all the time, like, I don’t want to be—I watched Intervention for a while before it was, like, just too much and I stopped watching. I didn’t want to feel that way anymore. But, like, I definitely watched Intervention for a while. I want to be clear about that.

Adam:I have not watched these shows. I watched these shows for the recording. I’m not that guy who’s was above it. You know, you, I watch shit. We talk, I mean, look at the references I make. Not a lot of Dostoevsky, let’s be honest, but, um, just a simple country lawyer, folks. But these shows I’ve always found to be tawdry.

Nima: Well, yeah, but you know, I think just as we will discuss on this episode, the fact that this is entertaining is the point, right? It’s not that these shows are unwatchable, it’s that they are immensely watchable and the narratives that they push —

Adam: Get people killed.

Nima: And the treatments that they push are really, yeah, really wind up being sinister and, and oftentimes dangerous. One other show of course, is Celebrity Rehab with Dr. Drew. It aired on VH1 from 2008 through 2012, hosted by self-described “addictionologist” Dr. Drew Pinsky of Loveline fame—of course the syndicated radio show that ran from the early 1980s until 2016. I certainly giggled along with Loveline for a years when I was a preteen. Uh, and then Loveline was actually turned into an MTV show for a few years at the end of the ‘90s. But Celebrity Rehab centers on faded, past-their-prime pop-culture figures of various stripes — many of whom had already cycled through the VH1 reality-show universe, extended universe — and these pop-culture figures have used drugs or alcohol, they have addiction, they stay at an abstinence-only inpatient rehab clinic called the Pasadena Recovery Center and they are filmed while doing so. It essentially adopts a Real World approach to kind of grouping strangers, in this case, celebrities, in one place and — what else? — just watching what happens.

Adam: Yeah, so we’re going to be talking about AA, Alcoholics Anonymous, a lot and NA, Narcotics Anonymous. We’re going to be critical of those systems, but I want to be very clear—I know this is sensitive for a lot of people who have found solace in those programs—that we are not endorsing or not not endorsing them. AA, as any medical professional will tell you, or NA, works for some people and that’s good for them. But there’s some pseudoscience that’s involved in the fundamental basics of it and the extent to which it does work for a lot of people, it works for reasons that are explicable, which we’ll get into later—it has to do more to with community and fellowship, et cetera, et cetera. But we want to make sure we are not trying to tell people who are in those programs that those are not good for them. We are obviously very much not medical professionals. I went to film school. Nima, what did you major in?

Nima: Classics, man. You know this. Shit.

Adam: Classics, right? Classics. Film school. Definitely not, not —

Nima: But don’t take our word for it!

Adam: Not qualified to give medical advice. Anyway, credentials aside, I just want to specify that because this is a sensitive topic and I want to make sure we’re doing due diligence. Let’s begin by defining what we mean by “addiction” for the purposes of this show. So the American Society of Addiction Medicine adopted a definition last year, quote “A treatable, chronic medical disease involving complex interactions among brain circuits, genetics, the environment, and an individual’s life experiences. People with addiction use substances or engage in behaviors that become compulsive and often continue despite harmful consequences.” Our guest, Maia Szalavitz, defines addiction as a learning disorder involving compulsive behavior despite negative consequences, as, quote, “you have to learn to associate the drug with some kind of relief.” This differs from previous, primarily biological definitions of addiction, which is ‘the requirement of a substance in order to function.’ This definition has been criticized for ignoring the psychological components of addiction.

Nima: We also want to, uh, you know, talk a little bit about where the rehab industry really came from. And of course we can’t do that without talking about AA, Alcoholics Anonymous. Most of the rehab reality-TV shows that are broadcast take their cues from one of the most culturally and legally dominant approaches to treatment, of course, AA, which introduced the 12-step self-help program and the philosophical framework that those with alcohol use disorder are quote-unquote “powerless” over alcohol and must look to a higher power in their process of recovery. AA was founded in 1935 by failed stockbroker Bill Wilson and surgeon Bob Smith, when the field of neuroscience was actually in its infancy, and treatment methods included lobotomies and engendering hallucinations, forcing hallucinations. Wilson had a habit of drinking two quarts of whiskey a day, which he kicked that habit after taking a hallucinogen called belladonna in 1934. While hallucinating, Wilson called out to God for help with sobriety, reported that he saw a flash of light, and immediately stopped drinking altogether. Wilson soon co-founded AA, adopting the principles from the evangelical Christian Oxford Group. In 2015, a writer for the Atlantic, Gabrielle Glaser, wrote about the rise of AA and she wrote this, quote:

AA filled a vacuum in the medical world, which at the time had few answers for heavy drinkers. In 1956, the American Medical Association named alcoholism a disease, but doctors continued to offer little beyond the standard treatment that had been around for decades: detoxification in state psychiatric wards or private sanatoriums. As Alcoholics Anonymous grew, hospitals began creating ‘alcoholism wards,’ where patients detoxed but were given no other medical treatment. Instead, AA members — who, as part of the 12 steps, pledge to help other alcoholics — appeared at bedsides and invited the newly sober to meetings.

End quote.

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Bob Smith (left) and Bill Wilson

Adam: So it has this evangelical component, which of course is huge to its rise and its prominence, right? You sort of recruit other people. As AA grew in popularity, a PR rep by the name of Marty Mann wanted to lend scientific credibility to the organization. So Mann partnered with a physiologist named E.M. Jellinek to create a survey for AA members, which was mailed to 1,600 people. The two only ended up with 98 surveys they considered valid, but from those surveys, they drew conclusions about issues like hitting rock bottom and what we generally understand as the “phases of alcoholism.”

Nima: In the 2015 Atlantic article, Glaser points out where there may have been some problems with this approach, writing, quote, “Though the paper was filled with caveats about its lack of scientific rigor, it became AA gospel.” End quote. And so, in 1970, Congress passes the Comprehensive Alcohol Abuse and Alcoholism Prevention, Treatment, and Rehabilitation Act, persuaded by Senator Harold Hughes, who was himself an AA member. This led to the establishment of the National Institute on Alcohol Abuse and Alcoholism and funding for the study and treatment of alcoholism. The NIAAA also funded the National Council on Alcoholism, a nonprofit advocacy group formed by Mann himself. The nonprofit became, in Glaser’s words, quote, “a mouthpiece for AA’s beliefs, especially the importance of abstinence, and has at times worked to quash research that challenges those beliefs.” End quote.

Adam: So the passage of the Hughes act fueled the growth of the rehab industry. We’re going to go through some history of that as well. So while the modern rehab facility has origins in the sober-living houses or the “inebriate asylums” of the 19th-century temperance movement and the subsequent temperance leagues of the Prohibition era, the 12-step rehab center really didn’t take hold until after World War II, when one of the first residential alcohol treatment programs, the Hazelden Foundation, was founded in 1949 in Minnesota. It used AA, of course, which of course at that point was the conventional wisdom, and the corresponding 12-step program as its basic guiding principles.

Nima: By the 1960s, Hazelden had integrated the “Minnesota Model” into its treatment approach. This model, obviously inspired by AA and developed throughout the ‘50s, includes an inpatient rehab stay involving detoxification, psychological evaluations, group meetings, and educational lectures. The Minnesota Model also posited that people in recovery could serve as counselors for people in rehab. Again, as Gabrielle Glaser notes, quote, “As the rehab industry began expanding in the 1970s, its profit motives dovetailed nicely with AA’s view that counseling could be delivered by people who have themselves struggled with addiction, rather than by highly trained (and highly paid) doctors and mental-health professionals. No other area of medicine or counseling makes such allowances.” End quote.

Adam: By the 1980s, with drug treatment codified as a form of healthcare under the Hughes act, accompanied by the rise of course of the War on Drugs and the high-profile establishment of treatment centers like the Betty Ford Center, rehab became a full-fledged industry.

Nima: As this industry became codified, right? As now, like, this is the way that things are generally done. What it has allowed for is the perpetuation of many myths and just other bad practices, oftentimes discredited science that kind of leads the way to understand rehab. And you see this through out, as we were talking about earlier, rehab entertainment reality TV. So a lot of, like, dubious medical and psychological practices are at work here. We’re going to go over a few of these myths and explain why they are shitty. So the number one thing that I think you hear whenever you watch these shows, whether it’s Celebrity Rehab or Intervention or Sober House, any of these, is the idea of hitting “rock bottom” as the only real catalyst to seeking treatment. So part of the premise of these shows is that prior to say the intervention, a person suffering from addiction has already hit or absolutely must hit rock bottom a term first popularized by AA itself.

[Begin Clip]

Dr. Drew: Well, I just wanted to welcome you guys. It has been a pleasure meeting everybody, and thank you for being honest and open and courageous to come in and participate in all this. So we thought it might be a good idea to go over some concepts about addiction. And I want you to know one of our goals here is for everybody to be seen as who they are and they really are. And sometimes that’s scary, never really done that, right? This is that spot. Do you have anything else you want to say about that?

Addiction counselor Bob Forrest: Well, there’s a certain point you hit and it’s just this low, this really bad spot. It’s called a bottom. And so this bottom that you hit, this lowest of low, if you can kind of survive it, it can spin you in a different orbit and then everything starts to fall into place. And so we’re going to go around about the bottoms.

Man #1: Mackenzie?

Mackenzie Phillips: Um, we’ll be here all day if I could tell you all the different bottoms I thought I’d reached.

[End Clip]

Nima: Yeah. So the rock bottom concept suggests that people with serious addiction cannot truly accept the need for recovery until they’ve reached their lowest, most miserable point and have lost what matters most to them. That not only the greatest suffering and humiliation will lead someone to seek treatment, but that being cut off from the compassionate efforts by family, friends, and loved ones to try and help is essential for this progress to actually be made. So a major aspect of this, noted endlessly on addiction entertainment shows like Intervention, is disparaging and ridiculing those efforts by family and loved ones as further enabling addiction and preventing someone with addiction from actually hitting that bottom, thus further delaying the—hopefully in their case—inevitable recovery process.

Adam: The notion of rock bottom for some time now has had a lot of criticism. There isn’t really an objective standard of rock bottom. It is by its very nature kind of ill-defined and somewhat tautological. ‘Cause of course you don’t know your rock bottom until later because you don’t know what your floor is. But the more important part is that it’s very dangerous to sort of suggest someone has to kind of reach that point before they can seek or begin treatment. Especially because it is so vague. And how do you define rock bottom? And then in some senses, although this is obviously more difficult to prove, it can um, ignite one’s Thanatos, right? Their death instinct. Because if in your mind you’re thinking, ‘Oh, well, fuck it, you know, in for a penny in for a pound, let’s just go all out.’ And that’s not really a healthy way of doing these things because there’s always a further bottom.

Nima: Changing The Narrative, a project of Northwestern University’s Health In Justice Action Lab, explains that, quote, “there is no scientific evidence that backs up the idea that ‘hitting rock bottom’ or experiencing extreme negative consequences is what prompts recovery.” End quote. So rather, they say, the notion of rock bottom is, quote, “a narrative device, not a scientific concept, because it can only be determined retrospectively. If someone relapses, a new bottom needs to be found, which can occur repeatedly.” End quote.

Adam: And then there’s this idea of cutting people off, which is a corollary to this that you sort of cut people off or you cut ties with them until they go seek help. But studies show this can be very dangerous. The writer we mentioned earlier, in the Atlantic, Gabrielle Glaser, spoke with researchers who said quite frequently that hitting rock bottom before getting help was, quote, “akin to offering antidepressants only to those who have attempted suicide, or prescribing insulin only after a patient has lapsed into a diabetic coma.”

Nima: Another one of these common phrases, and myths really, is the idea of “Once an addict, always an addict.” AA holds that if a person is addicted to a substance, that addiction will last forever, and thus abstinence is the only possible avenue to take to recover. This logic is indiscriminately applied to AA members and it’s implicit in a lot of this rehab entertainment TV. On these shows, people with substance use disorders must attend abstinence-only facilities for the most part and practice abstinence forever thereafter.

Adam: But of course this doesn’t really apply to everyone. It works for some people, as we mentioned, but it doesn’t really work for a lot of people. A federally funded survey called the National Epidemiological Survey on Alcohol and Related Conditions showed that almost one-fifth of people who’ve had some form of alcohol dependence go on to drink at low-risk levels, constituting full recovery by the survey’s standards. Also, in 2014, a survey by the Centers for Disease Control and Prevention of 138,100 adults found that nine out of 10 heavy drinkers “are not alcoholics or alcohol dependent.” It also found that they can change their habits with the help of medical professionals. The study defined excessive drinking as quote “binge drinking (four or more drinks on an occasion for women, five or more drinks on an occasion for men).”

Nima: So, yeah. What this shows is that the idea of that addictions stay with people forever is not real. Again, it is a narrative device. It is rhetoric to say that you are a type of person forever, right? Implicitly this is who you are-

Adam: Yeah, it’s a totalizing experience.

Nima: And therefore this method of treatment is the only way out. A study in the Journal of the American Medical Association also found that over time, a majority of drug users who met the criteria for addiction no longer meet that criteria later in life. So people, believe it or not, can change the way that they use-

Adam: Well, it’s sort of, it’s like with crime rates, crime rates after the age of 35, basically, they can precipitously fall off. It’s one of the major arguments for having maximum prison sentences of 20 years because basically after the age of 50, people really don’t commit crimes. It’s extremely rare and people, you sort of age out of it, you age out of addiction as well, just statistically speaking. Now, of course, not everyone does. There are exceptions to that. But generally speaking, the idea that your totalizing existence, that you have the sort of scarlet letter for life is, I think, from what I understand as a, again, film student from UT, it’s not something to sort of sticks with you forever and that looking at it that way, can have, can have damaging effects about how people perceive themselves.

Nima: Another one of these myths is the idea of the necessity of tough love. The show Intervention encourages family and friends to have a “bottom line” during the intervention, meaning this: They must be willing to cut off all contact, finances, housing, and any other form of support if the person struggling with addiction refuses to go to the treatment that is offered by the show’s producers. This is known as a form of “tough love.” Now this approach — unsurprisingly, perhaps — is considered to be grossly unscientific and certainly out of date. As we said earlier, the definition of addiction that is accepted by the National Institute on Drug Abuse is that it is a disorder “characterized by compulsive drug seeking and use despite adverse consequences.” Meaning, that the threat of these consequences, or those consequences actually playing out, people actually being totally cut off, that is not going to succeed.

Adam: They’re already self-harming.

Nima: Right. That isn’t the thing that is going to serve as the ultimate impetus or catalyst for seeking treatment. So the concept of “tough love” is thought to have originated in an AA offshoot called Synanon, a treatment program developed in the 1960s for heroin users that degenerated into a cult.

Adam: Eh, what hasn’t though? Everything in the ‘60s degenerated into a cult, I’m just kidding. ‘70s, a bunch of cults, and then we decided we were over it, and we all became Republicans. Go ahead.

Nima: Synanon’s tactics included verbal attacks and assaults, which eventually gave way to draconian programs like behavioral “boot camps” for teenagers with addiction. Synanon was eventually completely shut down and discredited. Yet we’re still doing that kind of approach.

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Synanon members (Bettman / Getty Images)

Adam: Yeah. They were, yeah, they were shut down for like massive child abuse without any basis. Then there’s this concept of co-dependence, so in many episodes of the show Intervention, counselors tell friends and family members the person with a substance use disorder that they have a codependent relationship. This term is usually used when friends and family members continue to provide the person with a place to live or continue to allow drug use to prevent severe withdrawals. This framing has sort of recently come under more and more scrutiny. The notion of codependence is an outgrowth of the self-help movement. Hazelden actually had a publishing vertical called Hazelden Publishing, which released a book in 1986 called Detaching With Love. On its website, Hazelden brags that the book introduced the term “codependent” into the self-help lexicon.

Nima: But as we have seen this term, codependence, effectively pathologizes normal human behavior. Again, Health In Justice Action Lab says this, quote, “If a loved one is struggling, it is only natural to want to help them. It has no documented set of criteria and is not a real diagnosis.” This idea of co-dependence or enabling. “Pathologizing efforts to help a loved one struggling with addiction can be dangerous. Cutting them off, detachment, and other attempts to accelerate one’s pain and suffering may result in irreparable harm.”

Adam: It’s good to know that a bunch of sexually frustrated Protestants in the ‘50s gave us our entire framework for this. A bunch of, a bunch of fucking repressed Calvinists came up with these ideas.

Nima: It’s like, yeah, isolate and humiliate and then people will just decide to get better. Right?

Adam: Yeah, that helps, like, if you’re trying to teach a two-year-old to like learn the violin, but it’s not necessarily, it’s not going to make someone a healthier adult. Needless to say, a number of people featured in the shows Intervention and Celebrity Rehab have died. There’s no proof that either of these shows are directly responsible for these deaths and we’re definitely not saying they are, so you know, don’t sue us, but they have clearly contributed to a sort of dangerous, unscientific, and sort of discredited treatment systems that can have serious repercussions. So at least six cast members of Dr. Drew’s, under Dr. Drew’s quote-unquote “care” have died. That’s a rate of more than 13 percent. So actor Jeff Conway died in 2011. Mike Starr died in 2011. Rodney King died in 2012. Joey Kovar, former Real World cast member, died in 2012 at the age of 29. Country music singer Mindy McCready died in 2013. Joanie Laurer, better known as the professional wrestler, Chyna, she died in 2016. So this is, from what I’ve been told, I have not done a regressive statistical analysis, but that’s way higher than the normal death rate for people who come in for recovery.

Nima: It’s, like, over 13 percent of the people that have been on Celebrity Rehab —

Adam: Have died. Obviously there’s a sample bias cause you’re on there by definition because you have problems with drugs. But nonetheless, it’s extremely high. Dr. Drew has been very callous and dismissive when he’s been asked about this. In a 2013 radio interview, he said he didn’t want to do the show anymore after all the deaths. He said, “I’m tired of taking all the heat. It’s just ridiculous.” Bob Forrest, one of the counselors on Celebrity Rehab, expressed outright contempt for the people who died, telling the Hollywood Reporter—we heard from Bob Forrest earlier by the way, he is one of the rehab counselors—he said quote “These are hardcore, decades-long fuckups and alcoholics who have decimated their careers and their lives. You’ve got to be awfully desperate and often close to hopeless to come on our show. But everybody’s looking for somebody to blame, so it’s going to be Dr. Drew.”

Nima: The rehab facility where the show was filmed, Pasadena Recovery Center, was actually shut down by the state of California in 2018 over these deaths and various other health code violations. Pasadena Recovery Center is not a medical rehab center, and is not staffed by doctors.

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Pasadena Recovery Center (Dean Musgrove / Los Angeles Daily News/SCNG)

Adam: And so one of the most obvious ethical problems inherent in these shows is that they subject people who are struggling with addiction to really gross and unscrupulous reality-TV producing tactics. Thus, these shows thrive on depicting people at their most dramatic, otherwise known as their most humiliated, most vulnerable, but oftentimes very dangerous. In addition, most of these shows are produced by people who lack any understanding of substance use disorders. So the show Intervention was created in response to the success of the reality TV show The Real World. Vulture published an oral history of the show in which producers recall the show’s inception and certain wacky episodes, revealing a fairly cynical understanding of their work.

Nima: So for example, creator and executive producer of Intervention Sam Mettler said this, quote:

And it really wasn’t until I was working at MTV on a project that I started to be introduced to the world of nonfiction. It was really when Real World was starting to pop, and other reality shows were coming out. And I said, ‘Well, there’s gotta be something here.’

He continued, quote:

I was never a drug user; that wasn’t my thing. I’d really only seen cocaine twice in my life before, at college. So I learned a lot very quickly. And I don’t want to say I became numb to it. But it did get easier, as with anything. I mean, yeah, I’ve had horrifying instances where I literally watched a woman for two hours hunt for a vein that wasn’t collapsed so she could shoot. But, to watch someone shoot up heroin? It got to be almost normal.

End quote.

Adam: Peter LoGreco, the director of the show, said, quote:

One that’s really memorable was back in April 2009, this guy Joey, who was a tattoo artist in Pittsburgh. When we got in the room, and he saw his family, he didn’t just walk out — he sprinted. But what ensued was pretty funny. We were on the eleventh floor of the Doubletree, and he got unlucky with the elevator and the subway, let’s put it that way. So he sprints off really dramatically, and then he’s standing there waiting for the elevator with me and the DP. So we get in the elevator with him, and we run after him into the street. And again, he gets caught in a busy intersection where he can’t go out into traffic. And so once again, we’re just awkwardly standing there. So he ends up crossing the street, and in the middle of the street, turns around takes a swing at the camera, hits the mic off of it — which is very dramatic — and then goes down the stairs into the subway station. We’re with him, and he takes another swing at us on the platform. But again, it’s this situation where he’s on the platform and there’s no train, and enough time passes that the entire family manages to get on the subway with him … and Ken Seeley just starts the intervention on the subway platform.

Nima: Amazing and hilarious. Right?

Adam: Well yeah, see the thing that you’re looking for is drama. This is not a sort of original media critique, but um, they’re obviously not very concerned with the health and wellbeing of these people, which in and of itself is sort of scummy, but is only really, really bad because it’s—people watch this and think this is actually how treatment should be.

Nima: Like, how this goes down. That’s the way to force people.

Adam: It’s the second-order effects that I’m actually more concerned about.

Nima: Right. And so Intervention was actually a pivotal series for its parent network A&E, bringing in remarkably high ratings. A network executive, Rob Sharenow, has reportedly said that, quote, “Intervention was a critical turning point for us. It signaled a big change in the network’s entire approach to programming.” End quote. You could see that, because following the success of Intervention, started broadcasting other disorder-centric shows, from Hoarders to Obsessed, The Cleaner, to a show called Relapse.

Adam: There’s a lot of tawdry tales, which we don’t have time to get into, but we’ll read you this one from an LA Times article in 2011, so Leif Garrett, a child actor and teen idol in the 1970s who was on a season of Celebrity Rehab, had stopped using drugs for several days before filming started. Garrett told the Los Angeles Times that the producers of the show quote “asked to get some footage of me using and I said, ‘I haven’t been using.’ They said, ‘We really have to get footage of you using.’ Anyway, I was easily talked into showing them.” VH1 has denied this happened.

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Leif Garrett on Celebrity Rehab with Dr. Drew, VH1

Nima: On a lot of these shows, the ultimate kind of climax of the episodes is when people actually accept treatment and they go to these lovely-looking rehab centers. Now, what this is doing oftentimes is serving as, like, an advertising vehicle for these places, right?

Adam: Yeah.

Nima: And so what is not discussed, if ever, is that these facilities are non-medical, inpatient rehab centers, which typically housing people in recovery for 28 to 90 days and they charge tens of thousands of dollars per month. Now non-medical rehab centers are largely unregulated and unscientific, yet on these TV shows they are presented as legitimate and authoritative, as, like, the place where good things can happen. Now, the thing is, as an Orange County Register investigation of the rehab industry has found, no degree, medical or otherwise, is required to get a license to run a rehab-related business in the state of California.

Adam: So I could run a rehab-related business, but I could not be a hairstylist. You have to get a license for that.

Nima: Right. Also, there are no systems in place to measure the success rates of recovery programs, but the relapse rate for opiate addiction, for example, maybe as high as 90 percent. An addiction counselor told the Daily Beast in 2017, quote, “There’s a total lack of accountability, not just from program to program, but even within treatment systems, from counselor to counselor.” End quote.

Adam: Again, you have, what makes it bad is all this pseudoscience and claptrap and Protestant bullshit is put on TV and people begin to internalize it. People even with addiction problems begin to believe these things.

Nima: That’s right. And it even drives public policy.

Adam: And it drives public policy. It drives lawmakers. It drives people’s own interpersonal relationships with people with substance issues. And that gets people killed. That’s not a good thing.

Nima: To discuss this more, we’re going to speak with journalist Maia Szalavitz, whose three decades of writing on addiction, drug policy and neuroscience has appeared everywhere from High Times to the New York Times, VICE, Time, Guardian, The Washington Post, and elsewhere. Among other books, she is the author of Unbroken Brain: A Revolutionary New Way of Understanding Addiction. Maia will join us in just a moment. Stay with us.

[Music]

Nima: We are joined now by Maia Szalavitz. Maia, thank you so much for joining us today on Citations Needed.

Maia Szalavitz: Oh, thank you so much for having me.

Adam: So we’ve spent the majority of this show talking about the conventional wisdom that’s kind of grounded in pseudoscience that has manifested, both reinforced and of course created by, reality-television shows that serve as the kind of pop-cultural ether with which we understand these things. So a few of these cliches like “rock bottom,” “tough love,” “once an addict, always an addict” are things that I think most people, including myself, sort of believed for a long time because they were sort of just -isms, right? And now one of the things we do in the show is dissect cliches ‘cause cliches are a vehicle for lots of really toxic stuff and we like to unpack them and sort of talk about their origins and whether or not they’re based on anything in science. Can we talk about cliches like this and what their relationship is with the sort of current consensus in the medical community and what are some of the sort of downsides of these concepts?

Maia Szalavitz: Sure. So the idea of hitting bottom comes from the 12-step program Alcoholics Anonymous. And the idea is that you reach this dramatic turning point, after which you stay sober forever. And the problem with that is that that’s really a story of sin and redemption and it can only be defined retrospectively. In other words, like, let’s say I hit bottom and I start going to meetings and I get 90 days and then I relapsed. Okay, so now what’s my bottom? You can’t really tell what the bottom is until I’ve died either sober or drinking. Right? So it’s a completely unscientific concept. It’s a narrative concept and in fact, most people’s recovery does not start at the worst point. Indeed, a lot of people recover, not when they’re at their worst, but when they get some hope that things can get better.

Adam: Yeah. It seems like there’s this, one of the things we talked about that I’m wholly fascinated with from an ideological standpoint, is that there’s this kind of Christian morality to the whole thing. It of course dovetails with capitalism and sort of personal-responsibility narratives but also, you know, it sort of follows the three-act structure of filmmaking, right? Your character at the end of the act two has to be at their lowest point, and then they kind of rise like a phoenix and conquer their demons. But it seems, like you said, it’s a bit of a tautology because how do you know until later anyway, so what does that even mean? And I guess my question to you is, to what extent does this maybe encourage self-destructive behavior because people will continue to act in an unhealthy way until they find this nebulous rock bottom?

Maia Szalavitz: Well, it does that, but what it really does is also worse because the definition of addiction, according to the National Institute on Drug Abuse, and all the medical experts really, is compulsive behavior that continues despite negative consequences. In other words, if negative consequences, like hitting a dramatic bottom, were going to fix the problem, the problem wouldn’t exist by definition. So this is fundamentally a problem. And yes, it also contributes to this idea that if we’re only mean enough to people with addiction, if we just kick them and kick them and kick them and lock them up and humiliate them and break them, then they’ll hit bottom and then they will get better. And that’s a terrible—we don’t treat anybody else like that. We recognize that human beings do not respond well to being crushed. And that, in fact, child abuse is one of the biggest causes of problems. It doesn’t fix problems, and adult abuse doesn’t fix problems either. So that is really the big problem with hitting bottom.

Nima: Yeah. And so we see, like, on all these shows and you know, I’m thinking of Intervention, which does this, I mean, on every episode, which is scolding the families and loved ones of those who have addiction and you know, saying by helping them in any way you are enabling them.

Maia Szalavitz: Well, and that’s another ridiculous nonsense.

Nima: (Chuckles) Yes.

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Maia Szalavitz

Maia Szalavitz: The idea of enabling. Because if you just look at the research, who is more likely to get better? Somebody who’s homeless and has absolutely no resources and is completely unenabled to do anything, even eat? Or somebody who is rich? Let’s be real. The odds of recovery are much better if you have resources. And the idea that we should disable people to help them is again, a moralistic bit of nonsense. So this whole enabling thing, for example, there’s now so much research on heroin-prescribing as a way to treat the most intractable heroin addiction, that there’s a Cochrane review of it. So this means that there’s a lot of high-quality data, otherwise they can’t even do the review. Right? So, and what does it show? Okay, now giving people free heroin is probably the ultimate in enabling, right? And you’d figure none of these people would ever, ever, ever stop, right? Well, actually, they’re more likely to stop and more likely to get their lives stable and to either go on to abstinence or to methadone or to stay on heroin but be employed and be there for their families and all of this kind of thing. So if that kind of enabling, where you’re actually giving people the drug they want, doesn’t cause problems, then the whole idea is again ludicrous.

Nima: So thinking about how these shows are produced, you’ve written, Maia, that in the production of shows like Celebrity Rehab and Intervention and others, quote, “unethical practices such as taking kickbacks for patient referrals are also rampant.” End quote. Can you tell us about these conflicts of interests and how these shows and just, like, the rehab industry in general, even when it’s not being exploited for pure entertainment value, what these conflicts of interest are and how these shows and this industry really thrives on them?

Maia Szalavitz: Sure. So let me make clear that I’m not accusing Dr. Drew of taking kickbacks or anybody on the staff of that.

Nima: I’ll do that, but that’s fine.

Maia Szalavitz: I am accusing them of essentially committing malpractice, which I think if any of the relatives of the 13 percent, was it, of patients who died? Yes, it’s over 13 percent of the people who appeared on Celebrity Rehab died. That is an enormously high rate of death. And we know from the data that most of the people who died on that show were opioid-addicted people and they died after being taken off of drugs like methadone and Suboxone. Now, methadone and Suboxone are the only two treatments that we know cut the death rate by 50 percent or more if you stay on them. They are the gold standard. They are the standard of care. They are what we know keeps people alive, especially in a situation where we have a supply that is flooded with fentanyl. So taking people off those drugs, which is what he did in Celebrity Rehab, is doubling their risk of death. And we can see that in the actual outcomes that we saw for the people that he took off of these medications. Meanwhile, with his little counselors calling Suboxone ‘the root of all evil’ and this kind of nonsense. It’s just astonishing how far away from what we know works these shows are, and a point I want to add here is that what works in addiction treatment is actually really boring. You go, you pick up a medication, you slowly get your life together. You talk about your fears and your hopes and your dreams in an elongated way that allows you to overcome trauma rather than be retraumatized. But that is the opposite of what makes good television. So there’s this conflict, and there’s this thing that what makes good TV makes bad treatment, and what makes good treatment makes bad TV. And so we perpetuate and sell and continue to buy this stuff that actually does harm because it is more dramatic.

Adam: I want to talk about the second-order effects, cause obviously like you said, 13 percent of guests have died and obviously the people who are on the show are subject to dangerous pseudoscience. But, and I want you to sort of indulge me, maybe speculate a bit, I mean you may not have a ton of data on it, but just anecdotally from your observations or research you’ve done, how much do you think these kind of moralistic tropes, how much do you think they’re internalized by viewers and the public in general? And what are some of the negative second-order effects of those tropes that are reinforced by shows like this?

Maia Szalavitz: Well, I think it’s enormous because our entire culture has this idea that the best way to deal with addiction is to go to 12-step meetings, take moral inventory, surrender to a higher power, make amends to the people that you’ve wronged. And while you can debate forever whether that’s spiritual or religious, what you can’t debate is whether that’s moral because it says right in the step “moral inventory.” Do we ask people who have depression to take moral inventory? Do we ask people with schizophrenia to take moral inventory? Do we ask people with cancer to take moral inventory? No, we do not because we don’t believe that their problem is that they are a sinner. And while every human being in the world could benefit from taking moral inventory, uh, if you single out people with addiction as the only people who need this as medical treatment, yeah, you’re going to end up with a moralizing view of addiction. So we have all this stuff in the culture with Dr. Drew and Intervention and all of these treatments where we have people shouting at the top of their lungs: “It’s a disease! It’s a disease! It is a disease, but the treatment is prayer, confession and meeting.” And we don’t treat diseases like this. If you are simultaneously saying it’s a disease and the treatment is 12-step, you are undermining your own argument. All of these shows and all of the celebrities who are out about being in 12-step programs and all of this idea, you know, of the 28-day rehab, and Betty Ford, and you know, all of this stuff that’s in the culture, tells us that this is the only way to fix addiction. And in reality, most people who recover don’t recover via 12-step. And while certainly there’s plenty of people who benefit from the social support and even from things like moral inventory, if you force that kind of stuff on people, it can do a lot of harm.

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A scene from Intervention, A&E, via New York Times

Adam: Like I mentioned, I’m, I’m utterly fascinated by the kind of deviant—at some point down the line we decided that, let’s say alcoholism or drug addiction was a moral failing, not a, not something comparable to a cancer or, or you know, head cold, right? It’s something that you sort of decide to do. It’s not something done to you, which would explain why the origins of our most popular therapy is religious. It’s a sort of shame-based, social-based. What do you feel like, at the time that this model emerged, what were the sort of cultural forces, whether they be racism, whether they be in sort of non-sinister forces, like, say, some sort of culture force, that made this the thing people clung onto? Because obviously even today there are people who, like you mentioned, are helped by AA or helped by 12-step.

Maia Szalavitz: Sure. I mean this is the thing, what AA did was get us out of Prohibition. And that sounds really bizarre, but AA pushed the idea that people with alcoholism are different than everybody else, and everybody else is a normal drinker, and alcoholics are the people who can’t handle alcohol. So it’s not industry’s fault. We shouldn’t outright prohibit it. We should just worry about these people who have this particular problem. And that’s actually a better way of dealing with things than using prohibition. But it came with all the baggage of the time, which was all of this moralizing. And it’s important to realize that criminalizing addiction to the other drugs creates this enormous amount of stigma. And it is very—I would argue that it’s impossible to de-stigmatize something that you are simultaneously criminalizing because the entire point of criminalizing things is to stigmatize them so people won’t do them. So, alcohol is kind of an interesting exception, which was briefly criminalized, although I recognize that they didn’t criminalize possession, but they certainly illegalized sales and made it a whole criminal enterprise around it. So it becomes a very complicated cultural issue, basically. But AA grew out of the ‘30s and out of Prohibition itself. It ended up being really good for both the alcohol industry and for some people who had alcohol problems because it gave people a way to explain those problems on the surface in a non-moralistic way. Because when people don’t know the specifics of the 12 steps, they think, ‘Oh, it’s spiritual, it’s not religious.’ And they don’t think about the moralism that’s in there. So they think, you know, AA says it’s a disease and they just think it’s a disease like other diseases. And so all of that complexity gets washed away, basically.

Nima: Yeah. I think, you know, the kind of mortality play of rehab shows and the way addiction is thought of, everything you’ve just been describing, also bleeds into treatment as being in a way driven by the ideology perhaps of the medical professionals or those running the rehab centers themselves. So, like, for instance, Dr. Drew, to get back to Dr. Drew, it’s not just the moralistic cliches about personal responsibility that are thrown around all the time, like, there’s a reason why Dr. Drew shows up all the time on Tucker Carlson these days, because he basically has the same approach to addiction that he has to, like, homelessness, which is this moral failing, it’s this right-wing fever dream in glasses and a tailored suit. From your observation, by working in writing in this space of addiction and drug use, how do medical professionals let, either consciously or unconsciously, their own personal dogma—how does that impede their judgment? How do they often smuggle in their own sanctimonious scolding into what appears to be just sober medical advice?

Dr. Drew on Tucker Carlson Tonight, January 2020

Maia Szalavitz: Basically, a lot of medicalization is difficult to separate from moralization. And one of the tasks I have tried to take on is to try to say, ‘Are we really seeing this as a disease?’ What other disease do we think we need a hammer for to get people into treatment? What other disease do we think we need to arrest people? Are we going to arrest people for like eating an extra donut if they have diabetes? Do we think that’s really the way to treat a disease? So I’m constantly trying to get people to think, if this really is like any other disease, why are we having all of this exceptionalism? And that is right where people’s values get imported into it. Now, it’s important to say that addiction, because in some instances people behave very badly, lends itself to people getting moralistic about it. And because people’s ability to have self-control is hard to define when there’s not addiction in the picture, when there is addiction in the picture, it becomes even more complicated. And so it’s not random that this is one of the things that we pick on as something that we see as a sin. But we really need to understand that what happens during addiction is very similar to what happens during depression or other mental illnesses or developmental disorders. And basically people’s choices get narrowed not because they choose to have their choices narrowed, and that most people who get exposed to substances do not get addicted, and the ones who do get addicted almost always have either preexisting mental illness or temperamental factors that put them at risk, or environmental economic despair, or severe child trauma, or a mix of all of that. And you almost never find somebody whose life is going along brilliantly who suddenly gets exposed to an opioid and decides to become homeless.

Adam: That leads to, I think, a really kind of interesting question I have, which is this idea of like that once you’re an addict, you’re always an addict, that it’s this binary thing, you’re born an addict. And I feel like that maybe can do a lot of damage psychologically, maybe to some extent become a self-fulfilling prophecy. Is this something that you’ve seen come up as maybe a barrier to getting people to not view this as a moral issue? Is this something that has any basis in science or is this not really true?

Maia Szalavitz: It is not really true. If you look at the data, for example, there are these large epidemiological surveys which are kind of household surveys of tens of thousands of people, and they basically do a diagnostic interview of them to see if they have addictions or mental illness or you know, whatever’s going on with them. And what you routinely find is that people who meet criteria for addiction in one year, three years later completely don’t meet criteria and they have not gone to any treatment or done anything specific. They have just kind of aged out of it. And we know that the majority of people who meet criteria for these things get well without help and we know that they’re not dead because they’re there to be interviewed again. (Laughs.) So, um, the ‘once an addict, always an addict’ idea really is falsified by that. And it’s also falsified by the fact that some people have a serious problem with opioids and are perfectly fine with their control over alcohol or marijuana. And some people could never touch cocaine, but alcohol or weed is fine for them. So we know that it doesn’t always transfer over into every addictive behavior because otherwise everybody with addiction would also be a gambling addict and a food addict and you’d have all kinds of, everybody would always be sort of switching. So we know from the data that that isn’t what happens. Although if you are a person in recovery and it is working for you to avoid all substances, continue doing that.

Nima: Yeah.

Adam: For those who are listening who maybe think that they are an addict or have had history of addiction who maybe have fallen into this—I don’t want to be prescriptive here ‘cause I know you don’t want to do that—but what are some good sources people can look at who may be struggling with this? What are some good places they can go to that they can get a non-Dr. Drew version of how to handle this?

Maia Szalavitz: Sure. Well, I am of course going to recommend my book Unbroken Brain. Beyond that, there are a number of good resources online. In order to find good rehab, you kind of have to know what to ask. And I have, as a rule, not endorsed any particular places because sometimes you could go to a particular place and it’s perfectly fine and then they get a new counselor and they’re doing this old-fashioned kind of stuff.

Nima: Sure.

Maia Szalavitz: And so if you look online, like, every place will claim, ‘Oh, we do cognitive behavioral and motivational enhancement and dialectical behavioral treatment,’ but they just are using the buzzwords. Then if you get there, it’s still going to be 90 percent 12-step. So, I did a piece for FiveThirtyEight which lays out how to find good treatment for opioid addiction in particular. I would definitely recommend checking that out. German Lopez has done some really good work in the questions you should ask. The National Institute on Drug Abuse has some good resources. The Substance Abuse and Mental Health Services Administration has good resources, but the real problem with this field, and this gets back to something we were touching on earlier, is that there’s an enormous amount of fraud and an enormous amount of people literally taking kickbacks to get a referral. So, let’s say I go to Joe Schmo who is supposedly an independent person and is going to find the right treatment for me. I don’t know that what he’s really doing is, like, he gets paid $100 by this place and $50 by that place, so he’s going to send me to the one that paid $100 even though the $50 one would probably be a better fit for me.

Adam: Yeah, that’s kind of why I asked because obviously people listening to this know that we’re not, that’s not our thing. And we would be constructive and non-conflicted.

Maia Szalavitz: Sure. So I would also just say that if you, if you’re seeking treatment and you are looking for help for addiction especially, I’m going to like limit this to opioid addiction for now. So speaking regarding opioid addiction, we have two treatments that cut the death rate by 50 percent or more if you stay on them. They are methadone and buprenorphine, which is also known by the brand name Suboxone. Those are where you should start if you want to cut your death risk in half. If you want to stay alive, because many people, the majority of people with opioid addiction will relapse at least once, and that relapse can be deadly these days. You should stay on these medications for at least a few years, till your life is really stable, and then figure out where you want to go from there. And if you think that it’s working great and this is for you, just stick with it. I mean, I’m on my Prozac for life, that’s fine with me. I don’t see myself as a lesser person because of that. And I don’t think anybody who’s taking medications for opioid use disorder should feel that they’re not in recovery ‘cause they’re on a medication. So that’s a really important thing because so many of these inpatient programs, they will use the medication for, like, six weeks or they will just urge people to get off it really quickly. And unfortunately the 12-step program, Narcotics Anonymous, believes you are not, quote, “clean” if you are on medication. So in some meetings you’re literally not allowed to speak or count your days. So, what I would say for people with opioid addiction who want 12-step support, go to AA rather than NA because AA has a pamphlet that says your medications are between you and your doctor, and we are not doctors.

Nima: Yeah, I mean it kind of reminds me of the treatment centers that are featured in a lot of these TV shows. And you always see in the title cards that pop up at the end of episodes that give you a recap of what happened after the episode aired. And it’s always like, well, the treatment was funded by the show for X number of weeks or months. And then after that, hey, who knows, right? Like the cable company isn’t paying for it anymore. So then it’s like the treatment goes away and then it’s this new tragedy that there was a relapse or that this happened, that happened to this person that you were following and you, you know, whose life story you were invested in and your heartstrings were pulled. But the follow-through of the treatment is obviously not going to be fully covered for the potential hopeful long lifetime of these people. So then what does that do?

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Scene from Intervention, A&E

Maia Szalavitz: So, I mean basically we say that addiction is a chronic disease, but we treat it like an acute disease. And we assume that you send somebody away for 30 days or 6 months or a year and then they’re fixed and then they go on with their life. And that’s not the way it works for most people with addiction, especially when you get to severe addictions like opioid addiction to the point where you’re physically dependent on opioids. So you really are talking about rebuilding somebody’s life. And that really takes time. And this is where the 12-step programs are incredibly valuable because they’re free and they’re everywhere. And if you can find help in that social support there, that is an enormous lifeline for many, many people. The problem is that many people are turned off by it and that they are told that this is the only thing that can work. But really, if you want to recover from addiction, what you’re going to need to do is find a way of coping with who you are without the substance that you have traditionally relied on. And what that’s usually going to mean is that you’re going to have to find another way to deal with either a mental illness or trauma or both, or some other source of despair. So it’s kind of like, I want to prescribe for people, you need friends, you need family, you need a purpose. And that purpose may be God, that purpose may be weightlifting, that purpose may be music, but I can’t tell you what it is because it’s going to be unique to you and you’re going to need to find a way to live within your own neurology and be comfortable in the world. And that’s going to be different for different people. So for me, I really need antidepressants. Obviously I have depression, but I also have real intense sensory issues. And this sort of turns the volume down on that to a degree that works for me. But other people may have the complete opposite problem where they’re like under-sensitive to things and need intense stimulation. So they might want to, you know, become a mountain climber or something. So it really, this is why it’s so complicated and this is why it’s so hard to find good treatment because it’s, like, we have many of these treatment centers and another issue that you run into is that they basically become slave labor. So ‘We’re doing job training!’ and you’re just, you know, mopping the floor for hours and hours. Well, yes, work can give people a sense of meaning and purpose. Slave labor generally not so much. (Laughter.)

So you kind of have to find your way through this. And really for most people, the best way to do that will be at home, with support of their loved ones, by putting together a menu of options to deal with your particular issues. Because, like, let’s say a rehab is going going to cost, like, $60,000. Now imagine instead spending that on making sure that you’re living in a place where you’re not surrounded by drug use, and that you have genuine psychiatric care, some kind of support group or you know, maybe you’re going to a gym, maybe you’re joining a dance club, maybe you are starting writing and taking a class. Maybe you’re going back to college. It needs to be a menu that works for you. So this is what makes it so difficult to treat and so ridiculous that we have this idea that one size fits all.

Nima: Yeah, no. And of course that the lack of healthcare access and that treatment is so exorbitantly expensive that it becomes prohibitive. And so the way out seems to be, like, getting on these rehab shows that actually just reinforce these bad notions again because then price is a barrier.

Maia Szalavitz: Well, right. And what’s insane is that, like, we pay for what you can get for free. Basically a lot of rehabs are essentially a fancy hotel, or perhaps a not-so-fancy hotel, with a lot of 12-step meetings, which you can get for free in any church basement.

Adam: Right.

Maia Szalavitz: And the therapy is generally given to you by either the other patients in a group where you’re just talking to each other, or by people whose only qualification is that they were previously a patient in such a group. So we are just paying enormous amounts of money for stuff we shouldn’t be paying for. And then people don’t have access to the real things, like dialectical behavioral therapy and cognitive behavioral therapy and actual evidence-based approaches that require people to have a certain level of training that we’re not willing to pay for. Except of course we’re willing to pay for these rooms! We’re willing to pay for these $1,000-a-day hospital beds where the treatment is the other patients.

Nima: Well, I think you have laid out so much important information. Can’t thank you enough for joining us. We’ve been speaking with journalist Maia Szalavitz, whose three decades of writing on addiction, drug policy and neuroscience has appeared everywhere from High Times to the New York Times, The Washington Post, The Guardian, VICE, TIME, Scientific American, The Atlantic. Among many other books, she is the author of the New York Times bestseller, Unbroken Brain: A Revolutionary New Way of Understanding Addiction. You can follow her on Twitter @MaiaSZ. That’s M-A-I-A-S-Z. Maia Szalavitz, thank you so much for joining us today on Citations Needed.

Maia Szalavitz: Thank you so much for having me.

[Music]

Adam: You know, this is powerful stuff. You know, we’re always hesitant to do things that involve issues of science and medicine because we are not qualified to do that. I definitely think we qualified that enough. But I will say that, you know, on both the Medium post and on Twitter and on Patreon, we’ll have links, you can check some of the stuff out. If you want to think about this or think about this differently, you know, we’re not going to endorse anything specific for obvious reasons, but if you have felt like these bromides about “tough love,” “rock bottom” have maybe not fulfilled or been detrimental to you or ones you love, you know, you’re not alone. This is a disinformation campaign that largely emerged from a combination of, of moralistic bullshit and self-helpism, which of course are both outgrowths of capitalism. Not that we’re blaming everything on capitalism, but we pretty much do. And that, uh, there’s another, more science-driven way, humane way, of doing it. You do not yell at, beat, humiliate, or videotape people who are recovering from cancer. Why do we do it to people who are recovering from addiction?

Nima: Right. And so these shows are not only exploitative from an entertainment viewpoint, but they’re also dangerous from-

Adam: Extremely dangerous.

Nima: Like, like from an actual health and staying alive.

Adam: Because, you know, his name is “Doctor,” Dr. Drew, you know, he, he looks the part, he’s, uh, he talks in this calm, doctorial manner and it’s, people can, like I said, people begin to both internalize and disseminate the stuff, and it’s mostly bullshit. It’s not a thing that-

Nima: Right. And just because it is enjoyable to watch doesn’t mean you also disassociate this from being true. Right? Like this is presented as reality. This is presented as saving lives, as helping suffering people. And in some ways it definitely can. And in many other ways it can be really, really harmful and detrimental. So, yeah, I watched Intervention for years. I haven’t in awhile.

Adam: Shame on you, Nima.

Nima And I, yeah.

Adam: I was too busy watching Masterpiece Theatre. I didn’t.

Nima: That’s right. That’s because you’re very cultured, Adam.

Adam: Yeah, I know.

Nima: (Laughs.) Well that will do it for this episode of Citations Needed. Thank you everyone for listening. Of course, you can follow the show on Twitter @CitationsPod, Facebook Citations Needed, become a supporter of our work through Patreon.com/CitationsNeededPodcast with Nima Shirazi and Adam Johnson. And as always, a very special shoutout goes to our critic level supporters through Patreon. I am Nima Shirazi.

Adam: I’m Adam Johnson.

Nima: Citations Needed is produced by Florence Barrau-Adams. Associate producer and writer is Julianne Tveten. Production assistant is Trendel Lightburn. Newsletter by Marco Cartolano. Transcriptions are by Morgan McAslan. Special thanks for this episode to Zach Siegel. The music is by Grandaddy. Thanks again, everyone, we’ll catch you next time.

[Music]

This episode of Citations Needed was released on Wednesday, January 29, 2020.

Transcription by Morgan McAslan.

Written by

A podcast on media, power, PR, and the history of bullshit. Hosted by @WideAsleepNima and @adamjohnsonnyc.

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