Why is it that most opioid-dependent patients aren’t enrolled in medication-assisted treatment (MAT), despite its proven effectiveness?
One reason is the link between so-called reality television and negative perceptions about methadone and buprenorphine. That’s the thinking of the authors of “Messages About Methadone and Buprenorphine in Reality Television: A Content Analysis of Celebrity Rehab with Dr. Drew.” Published online in Substance Use & Misuse, January 8, 2012, the article analyzes all episodes in the first four seasons of Celebrity Rehab with Dr. Drew.
First aired in January 2008, the show features Dr. Drew’s interactions with celebrities being treated at the Pasadena Recovery Center, a residential facility in California. One wonders what motivates patients to go “on camera”—such as the woman who allowed her withdrawal convulsions to be shown to hundreds of thousands of viewers.
Linking reality TV and attitudes toward MAT seems logical. TV exposes us to nuances—tone of voice, facial expression. When a fatherly “Dr. Drew” softly confides, “methadone just takes your soul away. It’s no way to live,” people listen intently, and many take it to heart.
Researchers analyzed the quantity and slant of the show’s messages about treating opioid dependence with methadone and buprenorphine. They watched all 39 episodes of the first four seasons of Celebrity Rehab with Dr. Drew, and coded the data using scientifically accepted methods.
Of the 33 patients portrayed, 13—about 40 percent—were using or had used opioids. Of these, 4—about 30 percent—used methadone or buprenorphine.
The two main messages: methadone and buprenorphine are primarily drugs of abuse, and are not acceptable treatment options.
References to Methadone and Buprenorphine
Times referred to
As a drug of abuse
Rejected as a treatment option
Endorsed as treatment option for opioid dependence
Mentions of methadone and buprenorphine in Dr. Drew’s show “highlighted harmful effects and focused on how and why patients should stop using them,” the authors found.
For example, Dr. Drew advised a patient trying to cope with opioid withdrawal symptoms that methadone can create another addiction. Thus he “reaffirmed a negative perception that has been cited as a reason for forgoing enrollment in medication-assisted treatment,” the authors noted. Dr. Drew also said some patients develop severe methadone withdrawal that “leads to medical and psychiatric complications that require hospitalizations.”
The authors found that Celebrity Rehab with Dr. Drew reinforces negative stereotypes, presents misinformation, may perpetuate existing stigma toward addiction and its treatment, and undercuts support for its expansion.
Roose R, Fuentes L, Cheema M. Messages about methadone and buprenorphine in reality television: A content analysis of celebrity rehab with Dr. Drew [published online ahead of print, 2012]. Substance Use & Misuse. doi: 10.3109/10826084.2012.680172.
AT Forum Opinion: What’s Behind Dr. Drew’s Attitude
What’s behind Dr. Drew’s attitude? Surfing the Web and watching him in action provides clues. The folksy “Dr. Drew” (“Dr. Drew Pinsky”) is at times a showman, at times a controlling father-figure, and at times seemingly a friend—but always an authority who is not to be questioned.
Dr. Drew is fully credentialed: board-certified by the American Board of Internal Medicine and American Board of Addiction Medicine, licensed private practitioner, assistant clinical professor of psychiatry at the University of Southern California.
In his 2009 book, The Mirror Effect, Dr. Drew admits that he has some traits of a “closet narcissist,” having scored a 16 on the Narcissistic Personality Inventory. He has been a TV series actor. Has starred on several reality shows, including Sex . . . With Mom and Dad. The New York Times has described Dr. Drew’s combined career in medicine and mass media as requiring him to navigate “a precarious balance of professionalism and salaciousness.” In a 2009 interview, the Times questioned Dr. Drew about his practice of paying addicts to attend rehab—asking if luring cast members with promises of money and exposure didn’t cast doubt on their commitment to sobriety. “My whole thing is bait and switch,” Dr. Drew explained. “Whatever motivates them to come in, that’s fine. Then we can get them involved with the process.”
But where are the data for his methods? Dr. Drew doesn’t cite any studies in the huge body of evidence matching patients with treatment. Nor does he mention the ASAM criteria, which list methadone and buprenorphine as treatments of choice for opioid addiction.
There’s a big difference between obtaining exposure and publicity, and providing treatment for substance use disorders. We shouldn’t confuse them, as Dr. Drew does—buying exposure in the guise of treatment.
If there’s a place for the methods and opinions of the Dr. Drews of this world, it’s not in the realm of evidence-based addiction medicine.