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Ford Center Hailed for Impact on Addiction Tx


 

Betty Ford–the former first lady whose husband, 38th president Gerald R. Ford, died in December–announced in April 1978 that she was undergoing rehabilitation for addiction to prescription drugs and alcohol. Her experience led her 4 years later to help establish a treatment facility, the Betty Ford Center, in Rancho Mirage, Calif.

As the nation recently mourned the passing of former President Ford, it marveled at the impact his wife has had on the way in which addiction is viewed and treated by physicians.

However, it is difficult to isolate the center's influence on addiction psychiatry within the overall evolution of the field during that period, said Dr. Marc Galanter, professor of psychiatry at New York University, New York, and former president of the American Academy for Addiction Psychiatry (AAAP).

The AAAP was formed in 1985, and the subspecialty recognized by the American Board of Psychiatry and Neurology in 1992. “Overlapping with other trends … [the center] played a significant role in legitimizing the field,” he said. “It put addiction on the map.”

Mrs. Ford, whose self-disclosure came in interviews and a memoir, also was instrumental in promoting public acceptance of alcoholism as a valid medical disorder, Dr. Galanter said. “She opened up the discussion of something not really acknowledged previously.”

Dr. Robert L. DuPont said Mrs. Ford's story changed the image of an addicted person. “She made it a disease that a good person could have and get well from,” said Dr. DuPont, who served as White House drug chief under President Ford and was the first director of the National Institute on Drug Abuse. In particular, her openness led to wider recognition of substance problems in women, he said.

The Betty Ford Center, which this year celebrates its 25th anniversary, extended that influence. The respectability of a former first lady, a popular image of elegance, and the glamour of A-list clientele that have included prominent entertainers (Elizabeth Taylor, Robert Mitchum, Liza Minnelli, and Johnny Cash) and sports figures, such as Mickey Mantle, have helped neutralize the stigma of addiction treatment.

In reality, those associated with the center emphasize, celebrities have made up only a fraction of the 26,000 clients and family members treated since 1982, and the cost is in “the low-average range”–about $23,000 for the standard 30-day program, according to Nancy Waite-O'Brien, Ph.D., vice president of clinical services. Also, the setting, while pleasant, is not luxurious. Residents, for example, share rooms and housekeeping duties.

In the area of addiction treatment, the center has innovated less than it has lent visibility and cachet to techniques and programs developed elsewhere. The basic program follows the rehabilitation protocol that Mrs. Ford underwent at the San Diego Naval Medical Center, a 12-step “recovery” approach based largely on the Minnesota Model.

Dr. Galanter noted that family involvement in treatment, a focus from the outset, has since been adopted more widely. “That an intervention was done on Mrs. Ford did much to legitimate that concept in addiction psychiatry,” he said. In his New York University substance abuse program, for example, “network therapy,” a more sustained, less confrontational approach, enlists family and peers to bring in–and keep–patients in treatment.

The center's program to maintain supportive contact with clients after discharge was new, said Dr. DuPont, who has been involved with the center since its beginning. And while programs for addicted physicians and other professionals were pioneered elsewhere, “the center has made [such programs] a major commitment,” he said.

Work with women has been “the most innovative” aspect of treatment at the center, Dr. Waite-O'Brien said. Equal numbers of male and female clients are admitted, and patients follow gender-specific treatment tracks.

“Women experience addiction differently from men,” she said. “We address the fact that women addicts have been sexually abused much more frequently than men,” and that men deal more with absent-father issues and with anger.

Beyond treatment, almost since its inception, the center has sponsored clerkships for medical students, who spend a week working with clients and clinicians. “It fills a void medical schools have created,” said Dr. Mark S. Gold, distinguished professor of psychiatry and chief of the McKnight Brain Institute at University of Florida, in Gainesville. “We've sent students there for years, and they come back and say they couldn't appreciate the practice of addiction psychiatry without this kind exposure.”

Dr. Gold noted that much of the work at the center has been corroborated by research: It represents a melding of “science and the Big Book [the central text of Alcoholics Anonymous].” The long-standing inclusion of dietary counseling and exercise regimens in the center's programs, for example, predates the research finding that food and drugs of abuse compete in the brain area associated with rewards and craving, he said.

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