Examining Rehab 2 With Dr. Drew – Episode 4

Our scene-specific blog commentary on Celebrity Rehab with Dr. Drew continues. Below, the doctor talks about the main points of the episode: Jeff’s despair, Tawny’s pseudo-self, Amber’s mom and that dramatic 911 call that concluded this week’s episode.

Do you think Jeff’s addicted to surgery?

It’s not that he’s addicted to surgery, it’s that some addicts use surgery as a way to justify their ongoing use. Celebrities go to lots of plastic surgeons, undergo lots of orthopedic procedures. Usually, at some point they’ll admit, “Yeah, I can get the Vicodin this way.” Jeff expects surgery to solve his problems. It’s a delusional insistence that surgery’s going to fix his pain, despite everyone telling him that surgery is not the treatment for the pain. It’s a delusional insistence that surgery is going to make him stand upright, when his surgeon told me that’s just not realistic. And then he begs no discussion – the surgeon tells him he’s going to walk straight, or he threatens to sue them. He leaves no alternative for intervention. In the meantime, this insistence that surgery is going to turn him back into a youthful Kenickie has sent his life on a very negative path. Things are not getting better, they’re getting worse. So why not try, just try, alternatives: aggressive physical therapy, yoga, being off opioids. And opioids, by the way, cause what’s called hyperalgesia, a worsening of chronic pain.

Is that what you mean when you say that the pain pills cause the pain?

Yes, they cause the pain to be intolerable. And of course, his addiction learns that if he’s experiencing pain, the addiction gets gratified. The addiction plays into it. And then he’s doing cocaine and drinking and he doesn’t tell his doctors that. Believe me, if he did, they’d be more aggressive about taking the pain medication away.

So essentially, Jeff’s holding onto his pain to hold out hope for surgery to hold out hope for pain pills, which will only bring more pain?

Yep, that’s what’s going on. It’s a conundrum. People like Jeff are so hard to treat. There are doctors out there that would call me cruel for making him come off the pain meds, and that we aren’t giving him enough main meds. In the meantime, he’s dying of addiction. His life is falling apart. It’s time for something different.

It seems like with you, Jeff’s testier than ever.

I’m fighting his disease and the disease is fighting back. I don’t take it personally, you should know. I have a huge affection for Jeff, and this is something I go through with patients all the time. This is the hard work. It’s the easiest thing to do, to say, “Let me write this prescription out for you. How much you want?” And then have him come back, smiling at me, “You’re the greatest doctor ever!” That’s easy. I can do that all day. That’s fun. This is no fun, but I know that’s all he needs.

Was there ever a temptation to be that kind of med-happy doctor?

Oh sure. I’m sure I was a co-dependent doctor most of my career. It’s the greatest thing in the world. The best patients are addicts when you’re giving them what they want. They show up to their appointments on time, they tell you you’re the best doctor. They may be going to three different doctors to get three different scripts, but you don’t know that! They’re wonderful when you’re giving them what they want. When you start to frustrate them, which is what they need, it’s hard work. I mean, it’s not very different than what I had to do with Gary when he wanted to be a treating professional. It’s like, “No. No. Hang in there. No. No. No.” And finally they turn. They come around. You have to be on the other side of that hundreds of times before you have the faith to do this work. Otherwise, you just cave. And, by the way, you need an entire team with you to withstand the onslaught of their disease.

It seems like you had to take on the role of mediator when you brought Vicki in to talk with Jeff. How was that?

I think I was more of a wall. I was just a source of limits and boundaries and structure. It’s really not a matter of right and wrong, it’s just getting the parties to exist in reality.

What prompts you to bring her in is his confession that he wants to kill her.

Yeah, if someone says they’re going to kill someone, you have to notify that person. There’s a whole legal proceeding that you have to go through, so rather than go through that, I said, “Let’s bring her in and handle it right now.” I didn’t believe he meant that, by the way, but I would still have to report it. It needed to be worked on at that moment. They were a heavy set of feelings Jeff was dealing with and we had to bring the situation back to reality.

You start calling Tawny her birth name Julie on this episode. Do you refer to her exclusively as Julie now?

It kind of comes and goes. Tawny is a woman of significant strengths and abilities, so we need her to embrace that and not shut her out entirely in favor of Julie. Mary Carey is a different story. I’m not sure Mary Carey has great strengths that help Mary Ellen. Tawny, on the other hand, is a very confident person that helps protect Julie. They need to be integrated.

When Tawny talks about sexual abuse, she follows it up with, “This is going to mess up his life.” Jeff’s response is “F*** him, he messed up your life.” Is that the healthy attitude to take?

Yeah, it helped Tawny at that moment. Protecting the victim amounts to blaming yourself for everything, and that’s not OK. Jeff really had it right.

Steven says, “I’m scared to leave this place. It’s safe here.”

We see that often and consider it real progress, because it’s realistic. Outside of a structure, he’s likely to use and it means he’s valuing his sobriety, he’s doing some work, he understands he’s fragile and he understands the power of his disease. When patients say things like that, it’s very positive.

Another major point is bringing Amber’s mom in for what you call a “life-saving intervention.” You’re referring not just to her life but her daughter’s too, right?

That was one of the more powerful moments for me. The mom hit bottom right in front of my eyes. I watched her go from scraping the bottom to landing on it. She gave up and went, “There’s no way for me to live. My daughter’s in treatment, I have no way to get drugs. This is as low as it gets.” I thought, wow. That was something I could work with. And she was admitted.

Is withdrawal more of a concern in older patients?

Oh yeah. People have heart attacks and strokes and pneumonia in withdrawal. Withdrawal is a dangerous process. As you get older, you can get complications. I ended up putting her in the hospital. She had all kinds of problems. She ended up in the I.C.U. A lot of this we couldn’t film because the hospital freaked out in the middle of it.

The episode ends with Jeff on the phone, telling the police that he’s being held against his will.

What follows that was one of the most stressful experiences of the entire show. It’s 12 at night and Jeff pulls this and all kinds of antics ensue. You talk to Vicki and apparently, he’s done this a number of times to her, too. It’s like calling 911 is his thing. It’s a strange impulse, but it’s a uniquely Jeff impulse. It’s just like Jeff, what the f***?