Is Dr. Drew More Like Charlie Sheen than He Thinks?

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Could Dr. Drew Pinsky be following Charlie Sheen off the rails? Recently the “Celebrity Rehab” host claimed that Sheen was “in an acute manic state” — a public statement which teeters on the bounds of psychiatric ethics (more on that after the jump). Moreover, Pinsky — contradicting his own previous statements about 12-step programs being critical to recovery — told TMZ that Sheen, who denounces 12-step, “has got a point” and that “their success rates aren’t that great … but it DOES work when people do it.”

Dr. Drew’s assessment of Sheen may well violate a principle of the American Psychiatric Association’s (APA) ethical standards known as the Barry Goldwater rule, which was adopted after psychiatrists diagnosed the presidential candidate in a magazine article as “paranoid” and “narcissistic” and questioned his mental fitness for office — without ever examining him in person.

The Goldwater rule basically states that it is unethical for a psychiatrist to diagnose people without personally treating them. As for Pinsky, he did say that he didn’t know whether Sheen’s “manic state” was caused by drugs, withdrawal or bipolar disorder, so it’s possible that he believed he was not making a professional diagnosis. Nonetheless, his statement feels similar to those that originally troubled the APA and led it to adopt the Goldwater rule.

Of course, if Pinsky has actually treated Sheen, the public disclosure of his diagnosis or traits would be in violation of patient confidentiality. (Though one might argue that Pinsky continuously violates that rule with other patients by treating them on television.)

What about Pinsky’s 12-step comment — is he reversing himself? The doctor’s past statements about the recovery program have included “Without 12 step, in my experience, there is no possibility of recovery” and “Twelve-step work is an essential and necessary part of treatment” — the latter exhortation occurred last year on an episode of “Celebrity Rehab 3.” If he is upending his previous opinion, that would be a good thing: as the research clearly demonstrates, Pinsky would be correct to imply that 12-step programs are not the only way to recover.

This isn’t the first time Dr. Drew has publicly opined about treatment in a way that psychiatrists might find indicative of some type of professional diagnosis. Last year, when Lindsay Lohan was the celebrity wreck of the moment, he told RadarOnline that “If she were my daughter, I would pack her car full with illegal substances, send her on her way, call the police, and make sure she was arrested. I would make sure she was not allowed to get out of jail. I would then go to the judge and make sure she was ordered to a minimum of a three-year sobriety program.”

It’s hard to count the number of ways in which this statement is wrong. Obviously, buying illegal drugs and planting them on someone would violate medical ethics. There’s also no evidence to suggest that putting people into the legal system increases the effectiveness of treatment. Indeed, judges’ and prosecutors’ decisions tend to be based on the law, not the person’s need for rehabilitation — and once you put someone into the system, you have no control over whether subsequent judicial choices will mandate treatment or prison. Since prison is not an effective treatment, you are essentially gambling on someone’s access to care.

I’m not a psychiatrist and I’m not making any diagnoses myself here, but Dr. Drew may be in need of an evidence-based intervention.