Facility directors and owners also argue that they offer celebrities and other VIPs a far better assurance of privacy. As they frame it, there's a more significant risk of exposure from the loose lips of economically disparate clients and low-paid staff. "My place is $78,000 for a private room. It's like [Montecito's] San Ysidro Ranch," says Taite of Cliffside. "You price out the horseshit, the people who are going to be a problem." Still, he and others insist, the fancy trappings of their mansions should not overshadow the seriousness of their services. As Harmony Place's Grant puts it, "This is a comfortable place to do uncomfortable things."
Many in the addiction community find this reasoning specious. "If you need your hand held and a special chef and an acupuncturist, you may not be ready for treatment," says Recover to Live: Kick Any Habit, Manage Any Addiction author Christopher Kennedy Lawford, a former actor. "I don't believe in coddling, especially coddling addicts in the entertainment business. The people who are sick here are enabled beyond belief, and this only furthers it."
Top Hollywood manager Jeff Wald, who swears by the Betty Ford Center after getting clean from cocaine there during the 1980s (he arrived with nine pieces of matching Cartier luggage and was grimly diagnosed by the first lady herself as suffering from a case of "terminal uniqueness"), insists that the privileged must be willing to untether from their familiar lives to have any true chance at getting better. "You have to look at yourself objectively, to get out of yourself and your ego," he says. "It's hard to do when you're in the same surroundings as when you're in your house." Gary Stromberg, a veteran music publicist and co-author of The Harder They Fall: Celebrities Tell Their Real Life Stories of Addiction and Recovery, agrees: "These people are pampered and babied, and then they seek out this kind of treatment where they are pampered and babied, and the end result is that they relapse often."
(Interestingly, the facilities report a recent decline in cocaine addiction among local clients, with a rise in prescription pain killers. Says Kat Conway, owner of The Scott, "I have people that come in on 15 to 30 medications," including Vicodin, Valium, Xanax, Klonopin, Oxycontin and Percocet.)
For all of their business success, the private rehabs have come under a barrage of ethical censure over the years. The private realm, from low-end to high, has been plagued by a slew of questionable practices, according to a March 12 report in industry journal Addiction Professional, including kickbacks for client referrals and shady insurance reimbursement issues. (The report did not cite any centers by name.) It doesn't help that California's state licensing board, the Department of Alcohol and Drug Programs, is notoriously hands-off in its oversight role.
Critics also take issue with the validity of their nontraditional treatments. Popular offerings include Reiki, acupuncture, meditation, drumming, painting, paddle boarding and neurofeedback. "We know that those things help the brain to heal, to be more prepared for therapy," says Cynthia Moreno Tuohy, executive director of trade group NAADAC, the Association of Addiction Professionals. These activities are meant to augment a 12-step program. (Though some luxury treatment centers like Passages don't hew to traditional 12-step recovery; it sees addiction as curable, in contrast to the mainstream view of addiction as lifelong and chronic.)
Opponents contend that these activities, though essentially harmless, haven't been scientifically proven to contribute significantly to better outcomes. Yet they are often used to help justify the high-end rehabs' steep price tags. (For their part, many of the facilities -- including One80Center and Cliffside -- claim to barely break even. The bulk of their monthly rates, they say, fund a high staff-to-client ratio, allowing for more customized care.)
In fact, the supposition that holistic methods are effective at treating addiction is too much for many experts to take. "These other things can help people deal with stress, but they are not powerful enough to deal with the cravings and addictions that bring people to relapse after acute care," says Dr. John Kelly, a specialist in addiction psychology at Harvard Medical School and Massachusetts General Hospital. According to Dr. Scott Walters, who focuses on addiction research at the University of North Texas, "There's no evidence that things like yoga, paddle boarding and equine therapy have any connection to outcome." Adds another addiction researcher, Dr. Michael Pantalon of the Yale School of Medicine (who also runs his own outpatient Center for Progressive Recovery in New Haven, Conn.), "I'd love to ride a horse if I have time, but that's not an evidence-based treatment."
Luxury rehabs self-report post-stay abstinence rates. There's no independent authority auditing their numbers. So their statistics, even if taken at face value, vary wildly based on shifting benchmarks (six months of sobriety, for instance, versus a year). And, insiders explain, those statistics often are artificially inflated because facilities tend to remain in touch more often with their success stories, not with their fall-off-the-wagon failures, who either move on, trying out yet another pricey rehab, or succumb fatally to their addictions. These treatment centers' affluent clients also can often afford to hire sober companions (or "recovery companions," as they prefer to be called), tasked with reintegrating addicts into the world. Although they're believed to be mere drink or drug interceptors, these shadowing counselors, who cost as much as $1,500 a day and are frequently employed by celebrities in recovery such as Demi Lovato and Nick Nolte (often for weeks or even months at a time), in fact take on a much more nuanced role, making sure their star clients follow their strictly regimented new routines while observing the client's entourage to ferret out enablers.
As it happens, no data has yet proved that high-end addiction care produces even a slightly better outcome than garden-variety rehab. (The recidivism rate among programs in the U.S. generally is said to be about 50 percent abstinence at the 12-month mark following treatment completion, though some argue it's as low as half that number.) "In fact, it's the cheaper programs, which are usually publicly funded, that tend to implement the really evidence-based practices because they're required to do that in order to get money from the government," says Harvard's Kelly.
But such facts certainly haven't dampened the continued healthy growth of the luxury sector, where a reliable revenue stream comes from apparently satisfied noncelebrity repeat customers in off their latest relapse, many overextending their own (or their loved ones') relatively limited financial resources. Notes Carroll of the $55,000-a-month One80Center: "They make mistakes along the way. And when they do, they go, 'F--- it, take me back to One80!' "