This story first appeared in the May 3 issue of The Hollywood Reporter magazine.
"We have three billionaires with us right now, and no one's complaining," says Justin Carroll, co-founder of One80Center, a luxury rehabilitation company in Los Angeles, as he bounds along on a recent afternoon tour of its posh properties. Nestled in Laurel Canyon, a building formerly known as the Lookout Mountain Air Force Station -- where a top-secret film unit was once tasked with documenting nuclear tests in the Pacific and Nevada -- is being converted into yet another treatment sanctum amid the area's burgeoning "Addiction Alps."
Carroll, 48, the English-Irish son of a diplomat, is a former soap star (David Hastings on Passions) and addict, now clean years after multiple stints in rehab. He and his partners, One80Center CEO Alex Shohet and Shohet's wife, clinical director Bernadine Fried, believe that they're about to open Hollywood's ultimate rehabilitation refuge. "You can't force them to recover," he says. "You have to conspire." The loftlike, 100,000-square-foot complex, painted bright white inside and out, will feature a pool, screening room, "Soho House-type" lounge "for the sober community," bells-and-whistles gym ("we want it to be Equinox-level"), auditorium ("for TED-like events") and even editing suites ("we'll have Pro Tools and Final Cut"). But wait, there's more: One80Center -- which has locations in Elizabeth Taylor's former estate above Beverly Hills and on a lush spread (where Harry Houdini is rumored to have lived) that boasts a $7,000 monthly gardening bill -- is installing a state-of-the-art recording studio to be named Recovery Vinyl. "It's going to look like the hall of fame once we have our friends sign the walls," says Carroll. "It will also be the only one in the business that doesn't smell of pot." With all of the deluxe upgrades, One80Center leaps beyond the by-now-quotidian Four Seasons aesthetic of the rest of the pack with the calculatedly hip vibe of a boutique hotel.
Welcome to the latest round in L.A.'s highly competitive high-end rehab wars. Price is no object for their crisis-driven clientele who never stay far out of the news, whether it's a celebrity vet like Lindsay Lohan mandated by a judge to return to the circuit or a famously addled rocker like Ozzy Osbourne announcing that he's fallen off the wagon yet again.
Luxury rehabs, clustered mostly along an archipelago of Malibu mansions and first birthed 25 years ago this past February by progenitor Promises -- whose A-list alumni include Ben Affleck, Robert Downey Jr., Britney Spears and Charlie Sheen -- has expanded in the past decade to roughly a dozen like-minded facilities, some offering rooms costing as much as $90,000 a month. Yet while high-end rehab has become an inextricable fact of show business life, most people know little about what such treatment, which is only loosely regulated, consists of. Nor how much more effective the luxury approach might be than that offered at such cut-rate in-town options as Cri-Help, Clare and Friendly House. Russell Brand even started his own nonprofit, no-cost program, Freehab, which received community development funds April 17 from the Los Angeles City Council to renovate and expand an existing 88-bed facility in the less-than-glam eastern San Fernando Valley.
By contrast, many high-end treatment centers have a predilection for unproven holistic methods (yoga, equine therapy) and extended stays (sometimes three months or longer). "These places try to get ahead of each other with holistic approaches," says Anne Fletcher, author of Inside Rehab: The Surprising Truth About Addiction. "A lot of them claim to be science-based; they're not. The reality is, if you stay at a rehab overnight, 24 hours is a long amount of time. They have to fill a day."
L.A.'s top-tier centers have come to specialize in industry cases -- always called "clients," never "patients" -- be they high-profile actors, producers or executives, whose distinctive issues range from out-of-control egos to enabling entourages. "When people come in here, they've often been 'yes'd' nearly to death," says Susan Winston, a therapist at Prominence. This population comprises between 10 percent and 30 percent of their customer base. But a sizable quotient of customers is drawn from a middle- and upper-middle-class demo that relies on insurance (which covers a portion of the cost, at best), loans and money taken out of mortgages.
The famous, of course, are the luxury rehabs' metier. Although the facilities make strenuous protestations about privacy, they benefit in national brand recognition when reports surface of a celebrity's visit, whether a David Hasselhoff at Passages or even a Brooke Mueller at The Canyon. This is because those researching rehabs are often low-information consumers, put in the spot of having to make a quick decision. A star's stay becomes an implicit endorsement.
How the star ends up at a particular treatment center also can be born out of expediency, not careful research -- especially when it's a contract forcing the issue and the celebrity's legal team has gotten involved. "By the time [it's the] lawyer," observes Cliffside owner Richard Taite, "you are doing crisis management. Something went very wrong, and this is the way to fix it." Adds a top entertainment attorney: "People at that point are less concerned with the clinical quality than in making sure they've put a lid on a problem. It's not an uncommon tactic when someone's facing a criminal charge, or they've just done something stupid or embarrassing publicly, like using some slur. If you're really serious about getting well, you go to [traditional places like] Hazelden or the Betty Ford Center." (Liza Minnelli and Ally Sheedy are alums of the former, Tony Curtis and Jerry Lee Lewis the latter; both facilities are known for being well-manicured but not tony.)
So why the need for luxury? Proponents of the high-end rehab scene say that their affluent clientele often would avoid treatment if opulent options didn't exist, since those accustomed to luxury are loath to give it up. Says Sherri Lewis, a 20-year veteran counselor and sober companion who's worked at several of the Malibu treatment centers: "You have to meet people where they're at if they come from backgrounds of privilege."
For the affluent crowd, the relative unrestrictedness of these costly programs proves just as appealing. At lower-cost, more spartan counterparts, the approach is arguably somewhat punitive (if modest enforced cleaning chores like sweeping are considered punitive) and the treatments far more regimented -- or, in the parlance of the high-end rehabs, less "individualized." Within the luxury treatment centers, clients -- when not doing one-on-one or group meetings or completing personalized homework -- can often hang out on-site with approved visitors for hours on end. And, following the first few days of intense lockdown, they're allowed to leave the premises as long as a staffer accompanies them. (As one rehab employee notes: "After a week, they're going for retail therapy over at the boutiques in the Palisades. But at least they're off the Xanax.")
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!' "