Cooler than Dr. Phil, brainier than Dr. Laura and way buffer than Dr. Ruth, Dr. Drew Pinsky has quietly become America’s go-to authority on drugs, sex, celebrity meltdowns and everything else we care passionately about.His latest venture, Celebrity Rehab With Dr. Drew, on VH1, casts him as the first action hero of his genre: a bespectacled silverhaired doctor (in a black muscle shirt, no less) battling valiantly to rid Hollywood of coke fiends, sex addicts and crackheads. Pow! A UFC fighter lays off booze. Bam! Porn star Mary Carey trades group sex for group hugs.

Critics were dubious. One called the reality series opportunistic and “as shameless as a highlight reel of car-crash footage.” But Pinsky’s sober tone and unflagging compassion have elevated it above sideshow spectacle and offered a glimpse inside rehab – vomit, psychotic tantrums and all – capable of scaring anyone straight. Season two is on the way.

Pinsky, 49, has always maintained his balance while walking the line between the crass and the credible. Twenty-five years ago, during his medical school residency at the University of Southern California, he volunteered to answer phone calls from horny, misinformed teenagers in the middle of the night on KROQ, an FM rock station in his hometown, Pasadena, California. The Sunday-night segment was called “Ask a Surgeon” until the station realized its gold-mine potential, signed up Pinsky for a two-hour show five nights a week and called it Loveline. At first Pinsky lugged gynecology textbooks into the studio but soon recognized his natural gift for speaking off-the-cuff yet intelligently about everything from whether penis size matters (“Come on, people. Get a career!”) to sex with the family dog (“In general, a lousy idea”).

Loveline went national in 1995, and an MTV version debuted a year later. Teamed with Adam Carolla in front of a live audience full of teens, Pinsky came off as the one brilliant guy in the frat house. Carolla moved on, but Pinsky still takes calls five nights a week (his new sidekick is disc jockey Stryker). Part of Loveline’s success has to do with Pinsky’s keen radar for childhood trauma. If callers have been molested or physically abused, Pinsky inevitably finds out and often pinpoints the age the abuse began. “It’s a superpower I don’t quite understand,” he laughs.

As Pinsky has branched out with campus tours, writing books and making cameo appearances on television and in movies, he has become a pop icon. But he clearly isn’t some media quack. Through it all he has maintained a full-time medical practice, held an assistant professorship in clinical psychiatry at USC and served as chief resident at a Pasadena hospital. Did we mention he has a wife and teenage triplets?

Not that multitasking is new for him. Growing up, Pinsky used to make rounds with his father, also a physician, between homework assignments. Later he was a star of his high school theater department, quarterback of the football team and – why not? – head of the student body. Lately, a typical morning has him driving 40 miles round-trip from Pasadena to Culver City to do his new daytime radio program, Dr. Drew Live. Afterward he’ll have a quick lunch before seeing patients at Las Encinas Hospital, where he is director of the chemical-dependency program. He may do a promotional photo shoot, a commercial voice-over and a CNN appearance, as he did one recent afternoon, then race back home and squeeze in a workout and dinner with his kids before making the trip back to Culver City for Loveline.

Pinsky still found ample time to sit with Contributing Editor David Hochman for several interviews at home and in the Loveline studios. “His focus is unbelievable,” says Hochman. “One interview ran five and a half hours, and Pinsky could easily have gone another three. He’s one of these rare people who are completely present in every encounter, which is why every caller, every patient, every screwed-up junkie believes Dr. Drew is all theirs.”

Playboy: So many people are battling addictions to so many things – drugs, drink, porn, gambling, spending – that recovery is now considered a movement. How did we get so screwed up?

Pinsky: The 1960s and 1970s did a number on our society. Remember the Me Generation? It’s the reason for every addiction we face. It’s why I have people dying around me every day. In 1968 drugs and alcohol became the solution to everything. They were going to give us the answers. In retrospect that was the nuttiest load of bullshit of all time. The spread of that idea gave way to a loosening of the family structure and our sexual boundaries and ultimately created an attitude, pervasive in the 1970s, that said, “Whatever’s good for you, man, that’s cool.” Well, guess what? It wasn’t cool, and we’re paying for it now.

Playboy: In what ways?

Pinsky: Addiction has become the problem of our time, which is why my attention has gradually shifted from sex and reproductive health to drugs and alcohol. Somewhere from 60 percent to 70 percent of outpatient mental-health visits have a concomitant substance diagnosis. It’s all rooted in the destroyed family systems and parental abandonment that started 40 years ago. But the real engine behind the dysfunction we’re facing – the surge of addictions, the issues of teenage pregnancy, sexually transmitted disease – is physical and sexual abuse. Childhood trauma, particularly sexual trauma, was the rocket fuel that launched us into the mess we’re in now.

Playboy: Are you suggesting that if you’re an addict now, you were sexually abused as a child?

Pinsky: You were traumatized in some way, and very often it was sexual. It has been coming on strong for years, to the point where if you need to see me in my addiction practice, there’s almost a 100 percent guarantee you suffered childhood neglect, physical abuse or sexual trauma. It’s always there. Always. I teach medical students to read trauma literature and have them ask addicts about trauma, and it always comes up. When you experience the terror and helplessness that comes from trauma, they shatter your brain’s ability to regulate. Normally we build our capacity for emotional regulation from other people, but if you’ve been traumatized, you exit that frame. When you’re forced to become autonomous at the age of eight, you become an adult projecting your chaotic feelings onto the world and grounding yourself in strange, dangerous ways.

Playboy: What does that look like?

Pinsky: It looks like Britney Spears. You get involved with substances as a way to cope, or you surround yourself with people to maintain your identity, to keep yourself pumped up. A lot of people in the public eye who behave strangely have mental illness we can learn from, and much of it is based on childhood trauma, without a doubt. Take a guy like Tom Cruise. Why would somebody be drawn into a cultish kind of environment like Scientology? To me, that’s a function of a very deep emptiness and suggests serious neglect in childhood – maybe some abuse but mostly neglect. If you feel completely empty and suddenly you find a family that fills you in a deep and spiritual way, you will go in that direction. His taking that narrow base of expertise and using it to influence so many people is a dangerous combination. But he is just gratifying his emptiness. I think emptiness drives Paris Hilton, too. It’s behind her addictions. I think she’ll be a Scientologist before we’re done.

Playboy: Spears, Hilton, Cruise, Mel Gibson, Lindsay Lohan – the list goes on. Are celebrities actually crazier than the rest of us?

Pinsky: Yes. Flat-out. I’ve treated a lot of people, and one thing I’ve noticed is that the very wealthy and the very famous have a much closer affinity with the indigent street person than with the rest of us. There’s the narcissism, the addiction, even the outlandish dress and mannerisms, but there’s also an element of having nothing to lose. Often they’re not interested in building a family or community and don’t put great value on relationships.

I don’t like dealing with movie stars, because they often have no education, so they don’t know what they don’t know. They’ve read a little bit and think they’re experts. Nobody holds them accountable or tells them no. There’s no role for a teacher because you can’t teach people who know everything. And so there’s no wisdom. That’s why a guy like Cruise becomes so dogmatic with his beliefs.

Playboy: Do you think our round-the-clock obsession with celebrity culture is turning stars into monsters?

Pinsky: My rough sense is the media culture doesn’t create mental illness, but it does exacerbate it. I’m writing a book about this. I did a study a few years back on narcissism among celebrities and found no matter how long you’ve been famous, you start and end with the same level of narcissism. The 17-year-old contestant on American Idol is just as fucked up as anybody who has been a celebrity for 20 years. The only difference is you get to act out more if you’re a bigger star, because you have more money and nobody says no to you. But the pathology is the same.

The public’s obsession with celebrities has to do with envy – not jealousy, which is “I want what you have.” Envy is darker, and it’s a driving force in America right now. It’s the idea that I’m going to bring you down to my size. We lie in wait for celebrities to fail, and then we say, “Get them! Kill them! Destroy them!” That explains TMZ and all the gossip magazines. They serve the same function the guillotine did during the French Revolution. They’re sacrificial instruments. Killing celebrities makes us feel better about ourselves.

Playboy: Did we all somehow kill Heath Ledger?

Pinsky: No, opiates mixed with benzodiazepine killed Ledger. Those are severely addictive drugs, and you become tolerant of their effects. So you take more and more to get high, and suddenly you stop breathing. What upsets me about Ledger, though, is people around him are still trying to cover up his problem and minimize the situation. If they had stopped lying and minimizing when he was alive, he would still be here. By not stepping up and going, “Hey, this kid’s struggling. Let’s be honest,” they killed him. I’m an expert on this. I’m telling you: Addiction needs to be dealt with honestly. You’re as sick as your secrets, and if addicts are allowed to keep their addiction a secret, they will die.

Playboy: But look what happened to Anna Nicole Smith. When people tried to stop her, she left the country.

Pinsky: That’s what addicts do. She surrounded herself with people who supported her disease, and she died. This is why it’s so challenging to bring addicts into treatment. You can’t force them. And celebrities surround themselves with sycophants who know their meal ticket will be cut off if they call the bad behavior into question

Playboy: How do you get an addict to change before it’s too late?

Pinsky: The tallest order I can think of is to get somebody willing to make and sustain change, particularly when you’re dealing with lifelong patterns. One thing I know is, willpower doesn’t work. Saying “Just change!” won’t make a difference. That’s why I get so frustrated with the Dr. Phils and pop psychology today, which amounts to yelling at people to get better. Addicts have intense neurobiological patterns in the brain that have a grip on them, and willpower doesn’t work.

Playboy: So what does work?

Pinsky: I’ve seen only three things motivate change on this front. One, a neardeath experience. Two, you look in the mirror and feel genuine disgust. And three, for women in particular, the loss of your children.

Playboy: Losing custody of her kids didn’t stop Spears.

Pinsky: That’s right. So she’s likely to keep spiraling until she has a near-death experience. The alternative is to get her sober long enough to regain her faculties and hopefully gain some insight. But that takes time. To get better, Spears needs 12 to 18 months of serious treatment in which getting sober is the main priority in her life. Lohan, meanwhile, is on the right track. I firmly believe that. Her dad has some sobriety, so that predicts well for her. She doesn’t seem to have other pathologies. She’s just a straightup hard-core addict and has taken six months to focus on cleaning up. But she has to continue. She needs 12 solid months of treatment and focus, or she’s going to have a giant relapse. Frankly, I have a feeling something dangerous will happen to her – a near-death experience – and then she’ll get sober.

Playboy: Are you concerned about any other celebrities?

Pinsky: I’m interested in what’s really going on with Angelina Jolie. I’ve never seen someone remit heroin completely. You’re either still on heroin, OxyContin or something else. You’re on methadone, Suboxone or some other replacement therapy, or you’re in recovery. Unless you’re dead. Is she still using something? Is she in recovery? By the way, if she’s in recovery, I don’t see any evidence of it, because people in recovery invest themselves in simple, selfless acts of service, not global self-serving acts. So that intrigues me. I mean no disrespect. I don’t disrespect any of these people. Everybody’s just struggling. But I don’t like distortions and dishonesty when things are passed off. It drives me crazy when 23-year-old celebrities go into the hospital for “exhaustion.” For Christ’s sake, football players perform on the gridiron in 120-degree heat, and they don’t have hot flashes or dehydration. That does not exist.

Playboy: Okay, this is too good. Who else intrigues you?

Pinsky: Of course Mel Gibson intrigues me a lot because I admire his work. I love his movies, so I have great admiration for the messages he puts into them even though I don’t philosophically align with him. What I find interesting about Gibson is he pushed on all the ethnic and religious fronts. That’s where he got off the track. But he’s a straight-up alcoholic. I would love to see him get sober. If he does and can really embrace the program, he would be right back at the top of his game.

Playboy: Who gets the Dr. Drew seal of approval?

Pinsky: Well, Craig Ferguson, the Late Late Show guy, is a huge hero of mine. He talks about his recovery gently but clearly and is a great model. Robert Downey Jr. is another guy I greatly admire. Severe addict. Severe. With severe issues from childhood. I’ve never treated Downey, but we’ve talked and I’ve supported him over the years. When he was just getting sober, he asked me one of the toughest questions I’ve ever been asked. He said, “Should I ever work again?” And I thought, Here’s a guy who gets it. He’s fully aware that being famous and in that environment could actually kill him. Clinically, the clearest answer would be “No, don’t ever work again because it will jeopardize your sobriety.” But should I deprive the world of one of its greatest artists? I told him I just couldn’t answer that. I figured he would negotiate it, which he did. He took two years off, and that was smart. The most important thing you can do in recovery is lead a simple life. I know that goes against everything we’re made to believe we want in Hollywood, but the reality is, in order to get well, no matter how rich or famous you are, no matter how many Escalades you have, you have to remake your life so it’s simple. Otherwise the temptations are too great.

Playboy: This year you allowed cameras to follow a group of recovering celebrities through their addiction treatment on Celebrity Rehab. How do you respond to critics who say you were just cashing in on their misery?

Pinsky: [Long exhale] Here’s the difference, and I hope I’m not splitting hairs. First, everyone offered their consent, and as celebrities, even as fucked up as they were, they were fully aware of what granting consent means. Mary Carey summed it up best when she said, “After what I’ve done on camera, this is nothing.” But I also felt very strongly that people need to see what the disease of addiction is, and that’s what Celebrity Rehab is really about. Cameras certainly climb into every other aspect of medicine, whether it’s cancer surgery or plastic surgery. Just because addiction is a brain disease, we have a problem with it. But a brain disease is no different from others. All diseases make us miserable. There’s also a myth that rehab is a spa treatment or some kind of publicity stunt. I thought it was really important to show the reality: These people have family histories and medical histories, and the process of getting sober is fucking hard.

Playboy: But this wasn’t exactly Frontline. In one episode you had a wet T-shirt contest.

Pinsky: I wasn’t there for that, but allegedly that wasn’t encouraged. Allegedly. Listen, this was the best I could do based on the limitations of television, and thank God we created a show that lots of people want to watch, so we’re going to have an impact with this material. What I’ve learned about television is this: Doctors don’t make good TV. The 12-step program and hospitals are boring. If you want to address these important issues in a way that will get more than 200 people to tune in, you have to piggyback onto people who understand entertainment. The public needs to hear from physicians more than anybody because there are so few of us out there. We stay aloof; we’re too holier-than-thou for all that. But you have to find a way to talk about these things, even if they’re weird and uncomfortable. That’s what we’ve been doing on Loveline, after all.

Playboy: You’ve hosted Loveline longer than most of your callers have been alive. Aren’t you tired of harassing kids to use condoms?

Pinsky: No, because I don’t really have to anymore. The awareness of these issues has increased immeasurably since I started. Back then the word chlamydia had never been heard before. Gonorrhea was some kind of weird term. The kids had no idea what I was talking about. I’d literally have to start with “You know, there are these bacteria that can be transmitted from one person to another. When you get them, they grow and cause a discharge or pain with urination.” Now callers have grown up knowing about AIDS. They’re aware there’s an HPV vaccine that can help fight STDs. Hell, they know what STDs are, which is a vast improvement. By the way, people always say the oral contraceptive pill was responsible for the sexual revolution. I think antibiotics were. Think about this: Throughout human history, if you got a sexually transmitted disease, you died. Not just syphilis or gonorrhea but a urinary-tract infection. You died. Pregnancy – you died. So in every encounter, sexuality presented the prospect of death. Then antibiotics came along and we were unhinged from that threat. For the entirety of human history we were afraid and then, boom, no longer. Yes, oral contraceptives added to that. We no longer feared childbirth, which had been killing 20 percent to 30 percent of women. Those two factors unhinged us from our biology, and narcissistic behavior has been flowering ever since.

Playboy: What kind of reaction did you get from higher-ups when you started out in radio?

Pinsky: It wasn’t good. Younger physicians understood, but my superiors were outraged. I remember an article about me came out when I was an intern, and the director of my residency program freaked out. He called me into his office and was screaming and spitting, and I was mortified. “You’re sick,” he said. “There’s something wrong with you for doing this. Stop or else.” But I thought it was important. I had to remind myself that this was something worthy, even though there was no blueprint for this sort of career.

Playboy: Did you stop?

Pinsky: I stopped for six months. But those were the six months when HIV really broke. It’s when the term safe sex was coined. It’s when the condom push came on. All of a sudden it looked stupid not to be raising awareness like this. So I came tiptoeing back, secretly doing more. Fast-forward to my becoming that guy’s chief resident and teaching partner. About two years later I remember him saying, “Are you still doing that radio thing? How about I take over once in a while?” Really? Hmm.

Playboy: What new issues have you heard about from callers?

Pinsky: I am amazed at people’s inability to understand how dangerous medications are. I’m not talking about hard drugs but rather what’s in the medicine cabinet. Pharmaceutical abuse is out of control, and it’s because kids have grown up watching their friends take psychostimulants like Adderall or Ritalin since they were eight: “They seem fine. Mom’s got Vicodin left over from her tooth extraction, and I took Paxil for a few years. What’s the big deal? It didn’t hurt me.” They just don’t understand that medicines are incredibly dangerous. I am very concerned about how far we’ve gone with the notion that everything can be solved with a pill.

The other huge issue is binge drinking. Kids have always drunk, but now it’s sort of extreme drinking and usually based on the hookup. The hookup has become the organizing experience of college life. In order to find somebody, connect with that person quickly and get them into bed, you have to drink – heavily – or smoke pot. Men do it to numb their feelings of anxiety and fear of rejection. Women drink to make their feelings go away because they don’t want to get attached to a guy they know they may never see again.

Playboy: But since the dawn of time people have been self-medicating to boost their confidence with the opposite sex. What’s the alternative?

Pinsky: Lately, one thing I’ve been discussing with guys is the idea that a male thinks foreplay means genital contact – not necessarily intercourse but some form of genital contact. I try to make them understand that, for a woman, foreplay is dinner conversation and all that. Guys hear this, and they say, “Talking? What the fuck does that have to do with sex?” But of course the data show the best way to evoke the sexual drive in women is through intimate conversation. So you talk a little and maybe you go for a walk or have something to eat, and the focus shifts and the nervousness starts to go away. And then you have sex. We actually have a name for that type of interaction. It’s called a date, but dating is dead in America.

Playboy: What about all the dating happening by way of, Facebook, MySpace, etc.?

Pinsky: Online dating quickly becomes a pseudorelationship unless you get off the wire quick and into the flesh. Mostly I see people infusing their online persona with so much fantasy and bravado that the people you connect with end up being false leads. But here’s where guys have a real opportunity to create a situation that will get them laid: Women want to go on dates, and that will arouse them. Make it happen. Plan a night, be present or at least pretend you are, and allow that to be a part of the whole experience of foreplay. The sex will take care of itself, don’t worry.

Playboy: What’s your analysis of Eliot Spitzer? How could a guy like that make such a stupid mistake?

Pinsky: If we all agree men are the way they are because of certain biological commonalities and genetic impulses – that we all crave diversity, that we’re driven by our sexuality – then the real surprise is that stories like this are not more common. Why don’t more men cheat? In fact the reason more men don’t cheat is because they have other priorities that supersede the impulse. Every man understands the desire. I certainly get the impulse. But I would never cheat. It would be intolerable. You don’t put yourself in situations in which that train could leave the station. It would be so shattering to me.

In Spitzer’s case I have a few basic theories. One is he’s severely narcissistic and part of him is walled off, a part he can never show to his wife. But because he’s narcissistic, he had to express it somehow, and it was easiest to rationalize doing it with a prostitute. Somehow that made it a special case. Another possibility is he and Ashley Dupré were involved for a while as part of this prostitution ring and he actually fell in love with her and couldn’t stop himself. That’s the most romantic spin. The Freudian analysis may be that Spitzer was reacting to his father, who is known to be a harsh person – a guy who came from nothing and clawed his way to success. Here Spitzer is outdoing his dad. But those guys often have a selfdestructive impulse that doesn’t allow them to stay on track without guilt or remorse. They would sooner obliterate themselves than surpass what Dad did.

Playboy: Let’s turn our attention to pornography. Not long ago industry giants were raking in big bucks putting porn on the Internet. Now on sites like RedClouds and YouPorn, amateurs show it off for free. What’s your take on all these citizen pornographers?

Pinsky: It’s weird. I don’t think people are anticipating the consequences. Those videos stay up forever. You’re 18 and stupid now, but what will you think in 20 years when your kids find it? It has something to do with how we all shove video cameras in kids’ faces from the time they’re, like, one, and every second of their life is in front of the video or cell-phone camera. It’s as though you don’t exist without being on video. Couple that with the desire for fame – and people have no limit to how far they’ll go for fame – and you begin to understand why all these celebrity sex tapes are popping up. The motivation for fame is autonomous and deep.

Playboy: How is the proliferation of porn changing sex?

Pinsky: It has totally changed things: The young male’s expectations of how women will respond to sex, what women want and how they want it are way off from the reality of who women are. A lot of kids have grown up watching porn, and one expectation is that women like physically rough, aggressive penetration. They don’t. Another is that women are as sexually charged as their male partners. They’re not. And let’s not even talk about anal sex.

Playboy: Actually, let’s talk about anal sex.

Pinsky: Well, anal sex isn’t really on the radar screen if you’re 40 or over, but younger guys have a preoccupation with it. They really want it. I’ve noticed this going strong for about eight years. At first I thought maybe it meant there was a lot of misogynistic anger about the feminism of the past 20 years, and anal sex was some sort of backlash. But then I realized it’s probably the result of pornography. It hasn’t been established in science, but my relationship with Playboy bears this out. Men in early and mid-adolescence have a period of plasticity or receptivity start equating sexual images with desire. And what arouses males around the ages of 13 to 15 becomes fixed, becomes musthave. For me, I found it all in Playboy, and that became my must-have.

Now a lot of guys discover pornography online, which is much different, and anal sex is always on the menu in pornography. One strange side effect is that anal sex has become a surrogate for maintaining virginity. Young women will call and say, “Well, I’m still a virgin, but me and my boyfriend were doing anal sex, so I’m still a virgin by doing anal sex,” which to me is, like, What? Virginity has become some sort of technicality. As a result, the baseball diamond has been revised. Oral sex is now second base, which astonishes me. Oral sex was once something in the dugout after you got to home plate – it was sort of perverse, extreme. Now it’s the same as making out, thanks in no small part to the whole Bill Clinton thing. But what’s lost is the notion that virginity once implied chastity. Anal sex is not chastity! We do a lot of coaching on Loveline to say “Hey, it’s not necessary to do anal just because you saw it in a video or heard Howard Stern talking about it.”

Playboy: Not to be obtuse, but what’s so wrong with anal sex?

Pinsky: It’s very simple: That part of the body wasn’t made for doing that, and I dread to see what will happen to these women down the line. Once women hit their seventh and eighth decades of life, a lot of anal pathology kicks in without having anal sex. So I mean, it won’t be pretty. You get fistulas, abscesses and, later, prolapses. One night on Loveline we talked to a nurse who was a surgical prosthetics salesperson, and she said her company’s biggest growth area was anal prosthetics and sphincter replacements, which are little rubber –

Playboy: Oh God, say no more! Um, let’s see – what has been your craziest call in 25 years?

Pinsky: There have been a lot of them, but one that really stands out was a guy who called and said, “I can’t understand why chicks always freak out when they find out what I was in jail for.” And we go, “Found out that you were in jail?” “No, no, what I was in jail for.” “Well, did you murder somebody?” “No.” “What happened?” “I stole a head.” “Huh?” This guy had broken into a cemetery, pried the marble front off a mausoleum, twisted some old lady’s head off, freaked out his little brother with it and then boiled the skull and put it in his snake’s aquarium because it needed some decoration. That was horrible.

Playboy: Wasn’t there also a hostage situation?

Pinsky: Ah, yes, Fletcher Dragge from the band Pennywise. It started off with his vomiting on me and ended with his threatening to blow us all to pieces with a hand grenade. He got drunk during the show and put his finger down his throat to throw up. He must have weighed 320 pounds, and he was stomping around the studio like Frankenstein’s monster. He started throwing up across the sound board. Everybody cleared out of the room except me. I climbed on a cabinet so I could get eyeball to eyeball with him, and I remember punching him in the face. It was like a cartoon. I punched him as hard as I could, and he didn’t flinch or move.

That was his first visit. Then he came back. He was going to make peace, but he got wasted again. He went totally insane and began talking gibberish. He kicked everybody out of the room and locked me and Adam in there with him. His own security guy came in. He was huge, and Fletch beat him to a pulp. Then he put his massive foot against the door and said, “That’s it. You guys are mine. I’ve got a grenade.” A SWAT team filled the control room, with guns drawn, and they got him out of there after about an hour. He didn’t have a grenade, but it was not my favorite experience on the show.

Playboy: Is that what made you start working out? Your arms are huge.

Pinsky: I used to work out a lot as a kid. At one time I was nutty about it. Now it’s mostly a stress reliever. I have a gym in my garage, and I try to get in there three days a week. My life is like a jigsaw puzzle or spinning plates, so it’s essential to have that outlet.

Playboy: What’s your take on steroids? We use all sorts of technology to become better, stronger and faster. What’s wrong with a little artificial help?

Pinsky: I’ve thought about that a lot, actually. I knew all about steroids before anybody because I was in that world of bodybuilders and gyms when I was 20. These gym rats would confide in me because I was in medical school. They told me what they were doing, and then they would deny it to everybody else. I watched some guys go from 17-year-old nothings to Mr. America with endorsements. For them, it was as if you could go from being a novice pianist to Mozart in two years just by taking a pill. How could they not be tempted by that? Of course, I see them now and they’re dying from the stuff. There’s depression, mania, rage and physical consequences that will cut their life short by 10 to 20 years. It’s their choice. I’m not sure what to think about the ethics of it all, but I must admit it’s kind of exciting to watch these guys in baseball hitting the ball out of the park. And I don’t think Congress should spend billions of tax dollars to investigate it. It’s a player’s prerogative.

Playboy: It’s a scary world out there. What’s it like with your triplets being 15? That’s the age when all the sex, drinking and drugs kick in, right?

Pinsky: I’m less freaked out about the sex than about drugs and alcohol. From hearing me talk, they know condoms are essential. They know about the perils of STDs and the complications of relationships. But drugs worry me. I don’t think kids ever tell you if they’re using drugs and alcohol, but I put it on record that if there’s even a hint of something, I will bring the whole thing down. I’ll have their asses hauled in by the police.

Playboy: So you’re not one of those parents who say “You can drink as long as it’s under my roof”?

Pinsky: To me that’s the worst kind of parenting. Drink here but not there? Please! It becomes “You can drink everywhere,” because that’s how the adolescent brain works. Kids need very clear boundaries. My thing is, if you do something illegal, you’re going to jail and I’m not bailing you out. And they know I’ve got perfect radar, too. The other thing is, don’t ever say “Not my kid.” Not my kid are some of the most dangerous words a parent can say.

Playboy: What’s your history of drug use?

Pinsky: Mine personally? Because my kids may read this, I’m going to follow the advice I give to parents, which is that talking to your kids about what you did or did not do as an adolescent is the equivalent of issuing them a license to pick up where you left off. I guarantee you. I’ve been through this thousands of times. When parents tell their kids, “Well, I experimented with pot when I was 15, but that was all,” the kids will think, Of course I’m going to experiment with pot. They did it; why shouldn’t I? It would be hypocritical.

Playboy: So what do you say to kids?

Pinsky: You say “We don’t talk about it.”

Playboy: Come on! Tell kids that and they immediately think it means you did it!

Pinsky: When the child hears that, it has an entirely different impact on his behavior than my saying “Let me tell you about my experience.” If you did or didn’t do drugs, it’s not up for discussion. Don’t lie to your kids – never do that – but you aren’t obliged to tell them everything.

Playboy: Won’t kids rebel against hardass parenting?

Pinsky: I can’t control what my children do in college. But while they’re living with me, forget it. The younger these patterns start, the harder they are to break. If I were Britney Spears’s parent, I would find out what she’s doing, pack her into a car, send her off loaded with all her drugs and call the police. That’s the way her life is going to be saved. But you haven’t asked me yet what I would do after I brought the hammer down.

Playboy: Good question.

Pinsky: I would get them treatment, which, by the way, is exactly what the government doesn’t do for addicts. The government just gives them more jail and more punishment. Once I brought the force of God to bear, that would be the end of that, and we would go therapeutic from then on. If the government took a therapeutic posture, we would see the beginning of the end of the addiction pandemic. There’s always money for another jail cell, but there’s no money for treatment, and that’s horrible. That’s pathetic. That’s really why 60 percent of people in jail are there for drug-related offenses. It’s ridiculous. They’re not bad people. They’re drug addicts, and they can be treated. There is treatment for them, and we should be throwing resources at them as much as possible, but people don’t want to believe it’s possible to make them better. It’s hard to get them better. They don’t get better until they have to, I’ll give you that. But they will get better.

Playboy: Incidentally, with two daily radio shows, multiple medical practices, speaking engagements, television appearances and three hyperaware adolescents, how do you and your wife find time to bump uglies?

Pinsky: We manage to do that. Trust me, we do. Thank God. Probably a little less than I’d like to and a little more than she’d like to, such as it is. But we go to dinner every Friday and Saturday night. I’m very happily married, to my surprise. I didn’t expect marriage to be so hot. I was one of those guys who thought you live your life, you marry and you die. We started dating when we were 24, which means I’ve been with her longer than without her. It was crazy with her at the beginning when it felt like something from the eons was pulling on my genes. It was weird. That’s still there. That does not go away. Usually that kind of attraction comes from a very pathological place and puts you in dysfunctional relationship after dysfunctional relationship, but with us it seems to work.

Playboy: Do you ever enjoy a glass of wine?

Pinsky: Sure. I have two glasses of wine a week, and I don’t seem to have a problem with it. I’m not a guy who goes out and splits a bottle of wine with my wife, because I don’t like to drink and drive. Our rule is we have one glass and split the second glass, and that’s fine. Lately I feel weird drinking in public. I certainly won’t do it around patients or in a professional context since I know it makes people uncomfortable. But it doesn’t feel like a temptation. People assume I’m super straight-edge and somehow out to bum everyone’s high. That’s not my intention.

Playboy: So what is your pathology? How would Dr. Drew diagnose Dr. Drew?

Pinsky: I’d say there was probably an overly enmeshed, gratifying infancy followed by too rapid a rupture from that, as well as some lingering narcissistic co-dependency.

Playboy: Huh?

Pinsky: That’s psychobabble for not making a smooth transition from the idealized narcissistic union with your parents into autonomy and independence. That transition didn’t go smoothly for me. I pushed my parents away. Now my pathology is I experience myself almost totally through other people. Someone asks me to do something, and I do it – at the expense of the rest of my life, even if it means time away from my family. But after years of working on myself in therapy I’ve been able to hone that into something I can turn on and off. I think I’m pretty healthy, but it took years and years of work to get there.

Playboy: What’s gayer, your lifelong love of opera or Adam Carolla doing Dancing With the Stars?

Pinsky: [Laughs] They are exactly equivalent. Adam finally caught up to my estrogen level. He gave me 10 years of shit for opera, but now he’s in the club.

Playboy: After a career spent focusing on dysfunction, disease and dubious sexual behavior, are you still optimistic about humanity?

Pinsky: I am incredibly optimistic. I’m awed by the sensitivity and awareness of young people. These are tough times, no doubt, and things may get worse. Let’s put it this way: When Rome finally did go down, I don’t think they were talking about it going down. But it seems there’s enough dynamism, healthiness and thoughtfulness to turn this around. Young people are finally getting that the unrestrained behaviors of the past 40 years weren’t some cool part of the counterculture. They were actual pathologies. So now when someone at the age of 16 says “I’m just a sexual person,” kids are starting to realize that’s code for “I was sexually abused.” Or “Hey, it’s funny to do pot on weekends” or to laugh at wacky drunk celebrities – no, this is serious shit, and people are getting that now. The more we’re aware of all this, the healthier we’ll be as a society.