MALIBU, Calif.<br/>March 4, 2011 — -- 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?"
PHOTOS: Inside Promises: Where the Stars Go to Get Sober
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."
Neither program is exactly cheap, though. Promises L.A. charges $34,500 for its 90-day program -- 30 days on the L.A. campus and 60 days in outpatient treatment or sober living, where fees can be up to $1,000 per month. The cost for Malibu's traditional 31-day-program ("31 because we want our clients to leave here with 30 days of sobriety," Sack said) starts at $55,000 and goes up to $90,000 depending on special accommodations a client might request, like bringing a dog, wanting a single room as opposed to a double, or extending their time on site.
According to Sack, cultivating a comfortable environment -- Malibu's campus boasts hot tubs, sun decks and heated pools -- is crucial to attracting and treating clients of means.
"If you have people with needs who are highly successful, they're going to want to go to a place that's like what they know," said Sack. "When you tell people, 'We're going to put you in this institutional type of treatment,' you basically give them reasons not to come."
There is one accommodation Promises refuses to offer celebrities: the rehab pictorial. Lohan famously invited OK! magazine photographers to snap her riding horseback, doing yoga poses and reading from an AA tome when she checked in to Utah's Cirque Lodge treatment center in 2007.
"We never allow media to photograph any of our clients while they're in active treatment," Sack said. "We view that people are here to be treated and any interaction with media during the treatment phase is disruptive."
To that end, to ward off paparazzi and curious passersby, both Promises facilities boast no signage indicating who or where they are. L.A.'s two buildings are offset from a residential road. Malibu's campus is near the top of a precarious uphill climb. These aren't places that invite attention.
Promises Caters to Celebrities, but Not All Stick With the Program
Promises was founded in 1988 by Richard Rogg, a real estate developer who turned his attention to treating substance abuse after kicking his cocaine habit. Intended as an alternative to programs that scolded addicts into submission, Promises' aim has always been to push clients to deal with the personal issues that brought on their addiction, rather than simply stomping out the addiction itself.
The model involves therapy, and lots of it, often in group settings. Sack said the Sheens and Spears who come in are expected to share their stories with everyone else, just like everyone else.
"In fact, we've had very few instances where anyone's privacy has been violated," he said. "The clients are very protective of one another. They're very invested in everyone having a positive outcome."
Problems with celebrities come up when Promises takes them to public AA meetings. (Integrating clients into the wider world of recovering addicts is another mainstay of the program.)
"With celebrities, it becomes complicated," Sack said. "You can't take them into the community without the paparazzi chasing your vans and then you wind up with decoy vans and you sometimes feel like you're plotting a spy thriller rather than just taking people to treatment. Many of those clients will go out to other more private meetings with sponsors or what we call trusted servants -- our alums. "
For this, treating celebrities with kid gloves, Promises has become famous. It attracts addicts from around the world and frequently turns away would-be clients to avoid overfilling its facilities (Malibu's capacity is 36 clients; L.A.'s, 18). Meanwhile, Promises' programs are expanding. Last year, as pro golfer Tiger Woods sought treatment for sex addiction, the center established a partnership with L.A.'s Sexual Recovery Institute and its founder, Rob Weiss, who hopes that eventually, people in the public eye will tout the powers of sex addiction therapy the way they back AA's 12-step program.
"It's a lot harder to say that you have a sexual problem," he said. "It's much more personal, much more shameful. Culturally, it bears a lot of weight around morality and sin. We don't have figures standing up and saying, 'I have this problem.' It would have been nice had Tiger come out of treatment and said 'Wow, this really changed my life and I'm glad I did it, but unfortunately, he's not saying anything about the issues.'"
But treatment, no matter the type, doesn't always stick. Lohan and Sheen graduated Promises only to spiral down again spectacularly. Fellow alum Danny Bonaduce told ABCNews.com that Promises did nothing for him.
"They charged me more than $40,000 for my stay and I drank on the way home," he said. "But Malibu was beautiful. I remember thinking that if this place had a bar, it would be fantastic."
In his recent spate of interviews, Sheen also wrote off rehab as "fiction" and dismissed AA for its "five percent success rate." (He sang a different tune in a 1999 interview with ABC News, saying Promises taught him "about taking the power back, that there is a better way. You don't have to live like you did anymore.")
While Sack said Promises is "currently collecting data" on rates of relapse and recidivism among its alums and cannot yet report those figures, he and his colleagues noted that, like any other type of treatment for a disease or condition, some people need a higher dosage than others.
"You often hear people saying, 'So-and-so is going back to rehab, rehab must not work,' but it's just that not everybody's the same," Weiss said. "Sometimes people get it the first time, sometimes people need more. A lot of what you see in public are the people who need more."