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.