Rehab: for anyone familiar with the celebrity news cycle of the past ten years or so, it brings to mind images of bucolic California landscapes, Dr. Drew Pinsky's solemn stare, Lindsay Lohan on horseback, and, especially lately, Charlie Sheen.
Sheen and rehab go back more than two decades. Since his first stint in 1990, the 45-year-old actor has been in and out of treatment centers four times. Now, watching him tear through interview after interview, spewing nonsensical lines and leering at the world like it's the one with the problem, it's hard not to wonder: "What is this guy on?"
For those versed in addiction, the more pertinent question is what he's not on: a course of treatment that could right him and his family.
Sheen shunned traditional rehab after "bangin' seven-gram rocks" during a January bender and landing in the hospital. While he said he cured his substance abuse issues "with my mind" at the Mulholland Estates mansion he calls Sober Valley Lodge, addiction specialists at Promises' Malibu, Calif. facility, where Sheen completed a round of rehab in 1998 after overdosing on cocaine, question the actor's ability to tame temptation on his own.
"If the addict doesn't stop the behavior, there's no way to get through to them," said David Sack, a clinical psychiatrist who is CEO of Promises Treatment Centers. "If someone is downing five shots of vodka before they go into a psychotherapy session, that session is meaningless. If they're doing lines of coke or picking up hookers and then going into a therapy session, there's a question of how much value that therapy can have. So, to me, the idea that someone with multiple levels of problems would be treated at home seems like a long shot."
ABCNews.com recently toured the grounds of Promises' centers in Malibu and Los Angeles to get a sense of how celebrities like Sheen -- and Lohan, Britney Spears, Robert Downey Jr., Matthew Perry, Ben Affleck, and Christian Slater, all Promises alumni -- undergo rehab. Scratch out any visions of heated-floor bungalows and unlimited sea-salt scrubs: with dorm-like rooms, shared bathrooms, and 6:45 a.m. wake-up calls, Promises resembles a boot-camp more than a spa retreat.
Hard work happens here. While Malibu's ambiance makes the place more posh than the homely-by-comparison L.A. branch, both share similar daily schedules of exercise, multiple therapy sessions, Alcoholics Anonymous counseling, and meditation. The first days of detox are grueling. Clients cannot leave the grounds of either facility without supervision. They eat their meals en masse, comfort-food staples like pot roast and gumbo. Use of cell phones and the Internet is restricted at best.
The main difference between Promises Malibu and Promises L.A.:
"The clients tend to be older there," said Jason Levine, executive director of the L.A. center. "They tend to be masters of the universe or well-known people or people who have money -- here, you tend to get the children of those people or the middle-class types."