Back in the big bad world

The British public likes to kick celebrities when they're down. And never more so than when the famous person has been treated for an addiction or "stress" at an exclusive, pricey clinic, talked publicly and boringly about their recovery - and then gone back to the sort of behaviour that sent them scuttling for professional help in the first place.

To go by the antics of Paula Yates, alleged last week to have been involved in fisticuffs with a photographer; Tara Palmer-Tomkinson, already back on the party circuit, sans drugs; and Kate Moss, who was treated for "exhaustion" and then thrust herself back into an exhausting lifestyle, one could get the impression that residential rehab doesn't work. So is the idea that if you throw enough money at a problem it will go away misguided, or is it true that a five-star change really is as good as a rest?

Perhaps it is more to the point to ask what support systems are in place for people once they fly out of these golden cages where they are encouraged to talk about their problems all day, and into the bad old drinking and drugging world where, frankly, nobody wants to know their innermost feelings?

Dr Mike Gossop, head of research at the National Addiction Centre at the Maudsley Hospital in London, says that addiction, like many other medical conditions, is a relapsing one. "Many people do not get better the first time and require more than one treatment episode. But whatever treatment is given, people require support beyond that and in this country those resources are not widely available."

But even when aftercare support systems are available, not all recovering addicts choose to use them. Forty-year-old Charlie has had two stints at Promis, a residential and daycare treatment centre for people with substance abuse problems and depressive illnesses. "I had a problem with alcohol and referred myself for treatment and spent 12 weeks there," he says. "When I left, they advised me to go to their aftercare programme but I didn't."

The first day he left the centre, he remembers wandering around Waterloo station "in a daze". "I was pleased to be out, but I was also ill at ease. That first night I had to go to a party. It felt like I was going in at the deep end, but I didn't drink. I didn't particularly enjoy it either."

Despite this Charlie stayed sober for a year and a half. After this, a friend asked him if he was still off the drink and Charlie joked that he only drank wine that cost at least pounds 100 a bottle. Unfortunately the friend had a case of the stuff, and that was that. Charlie went back to Promis, this time for six weeks, and checked himself out - against everyone's advice. Again he chose not to participate in the clinic's aftercare meetings, though he does attend some AA meetings. For Charlie, who has a busy social life and a thriving wood business, the idea of becoming a professional ex-addict does not appeal.

Dr. Robert Lefever, a former GP and the director of Promis, does not dispute the notion that recovering addicts seem to turn going to meetings into the new compulsion. "Therapy doesn't work for addiction because an addict can outwit anybody on a one-to-one basis. You need a 12-step programme." Lefever says the residential part of the programme is like a kickstart, and that the aftercare is vital to sustain the recovery.

Psychologist Oliver James, author of Britain On The Couch, questions the efficacy of the residential kickstart on its own for addiction problems. "They are too short term to make a fundamental change to a person's personality and way of behaving," he says.

Though James thinks fellowship groups such as Narcotics Anonymous and Alcoholics Anonymous are good for a couple of years into recovery, he thinks meetings need to be supplanted by therapy. "People are brainwashed into thinking it is a disease and that is OK in the beginning, but further down the line you need to get into the causes behind it."

Clea Carryer, a counsellor at the Priory Altrincham, says that the whole residential programme is precisely about helping people to cope with the real world. "Very often problems are more acute than people realise because when they go back out into the world, they are not out of their minds on drugs, so they see how difficult it is," she says.

Surely this would be an argument for making the Priory less "nice"? "But people coming into a programme like this need to feel safe in order to get on with therapy," says Carryer.

Once outside the caring, sharing environment that is the Priory, do the non-famous fare any better than their higher profile counterparts? Yvonne, 30, who spent five months in residence at the Priory Altrincham for tranquilliser abuse, has taken a slightly more circuitous route back into real life. "After the five months in the Priory, which broke down into a three-month stay, then a relapse and then another stay, I went into extended care in a secondary care unit, where I lived for six months with other recovering addicts," she says.

A self-confessed former wild child, Yvonne says she lacked the resources to cope with the real world, that she had never worked or run a home. "The secondary care unit gave me life skills and a routine," she says.

Yet Yvonne, like Charlie, describes feeling a mixture of exhilaration and fear when she first got out. "You have all this support, and then you are left to your own devices. I went to NA meetings and back to the Priory aftercare groups, but I have always been my own worst enemy."

Despite all the good reasons for staying off the drink or the drugs, ex-addicts are often the first to admit that getting pissed and doing drugs can be fun, and they miss that. Clea Carryer says she has seen people come back who say that life didn't feel fun anymore. "Recovery is hard work. When people complain of boredom we say to them that perhaps they are not doing something right."

The other big problem is the sense that everybody is either treating you with kid gloves or waiting for you to slip up. But Carryer says that the people who do come to meetings often say it's not as bad as they thought it was going to be. "They find that everybody isn't looking at them." Which, for celebrities in particular, might just be a blissful change.

THE FIRST WEEKS AFTER TREATMENT...

Gloria Zimmer, 45.

Finished residential treatment for alcoholism 18 months ago.

The day after I was released I went to a party. It was the sort of knees- up that I had been cautioned to avoid in those early days of sobriety. An acquaintance, a noted lush who had heard of my recent incarceration, cruised by, champagne glass in hand and, with a pitying sneer, enquired: "Miss Sobriety I presume?" Although I knew she was drunk I was deeply shaken. Shortly afterwards I went on a family holiday to Spain, the land of castanets and sherry. I must have been mad. During that week I consumed two bottles of Worcester sauce in an attempt to make the tomato juice taste like a cocktail. My family was concerned but I didn't have the heart to ruin their holiday by confessing that their drinking was ruining mine. I felt fragile, as if I no longer belonged to the normal world: a freak.

Those first few weeks were the biggest test of my survival I had ever faced. I did everything I could to distract myself from the temptation to drink. Three months earlier I had been given a life expectation of just weeks. It was only through living a day at a time, sometimes even an hour at a time, and in talking to fellow alcoholics, that things began to get better.