As Amber Portwood reports to prison, Creative Care Malibu's Dr. Karen Khaleghi said understanding the reality star's decision to forgo continued treatment for a five-year prison term really isn't about "choice."
"An addict is not in the driver's seat of their life -- addiction is," the co-founder and director of the addiction treatment center said. "They're not actively sitting down and going through their decisions, and weighing out the pluses and minuses of what they do in their lives."
Khaleghi and her husband, Dr. Morteza Khaleghi, have been treating addicts like Amber who are simply reacting to their "irrational" decisions for more than two decades -- since debuting their dual-diagnosis approach to the world of addiction treatment and recovery.
"Dual-diagnosis wasn't always accepted," she said. "We try to help people understand how they arrive at the place that they are -- finding out what drives them to medicating themselves and to deal with those feelings."
Triggers may be an obvious trauma, such as sexual abuse, or an "underlying abuse that's hard to put into words," she said.
At the hearing where Portwood told an Indiana judge to put her in prison, she claimed to have always been a "bad girl."
She has also gone public about her battles with bipolar and dissociative personality disorders.
"Most of the people who come to us have been through multiple treatment programs and they've been unsuccessful," Khaleghi said. "They might stay clean and sober while in a treatment program and then go straight back to their drug of choice.
"You have to deal with the physical addiction, of course, but you also have to deal with what led them to that place to begin with," she added.
Portwood herself has "been there, done that." She was in court-ordered rehab but landed back in front of the judge for the very thing that got her trouble in the first place -- illegally possessing prescription drugs.
Not exactly, says Khaleghi.
"The reality is, just because she's in prison, doesn't mean she's not going to have access -- though the access is certainly lessened," she said. "What she has to do [to get the drugs] is vastly different than what it is on the outside."
And the hard time itself doesn't guarantee the 22-year-old will learn her lesson.
"She can expect hard knocks, that's for sure," Khaleghi said. "But if it's just hard knocks, and she doesn't understand how she got to the place emotionally that drives her addiction in the face of all rational things, she will continue to use."
Portwood may very well be the first to admit that the heat of the spotlight has made her existing emotional problems worse.
"When I've given comments about the passing of celebrities over time -- like Whitney Houston, Michael Jackson -- the difficulty of celebrity is a lot of people are giving them what they're asking for, they're being abled in their addiction by those better served by that person being in that public eye," Khaleghi said.
But there is always hope, according to Khaleghi. As much as the public may mourn Amy Winehouse, there is Robert Downey Jr.
Once a poster child for celebrity addiction, the actor has enjoyed a series of professional (and personal) successes since getting sober in 2004.
"Celebrities have a lot of options," Khaleghi said. "They have sober coaches and sober companions."
The latter is what it sounds like, according to Khaleghi, who said rock bands, for example, may enlist the guidance of a sober companion at events to hold members accountable to their sobriety.
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