The next step for reality programs

It’s creepy -- and compelling -- to watch clean-cut Josh, a 20-year-old expectant father, talk about death as he shoots heroin into his foot after a month in rehab. Or to see 21-year-old Ally, an art student, overdose on drugs, or others steal from helpless, enabling parents, prostitute themselves, grow haggard, promise loved ones they’ll quit, clean up, relapse, sob, and then, maybe, do it all over again.

Television viewers have grown used to seeing 12-steppers, sponsors and sober cops coping with inner demons in their dramas. But this season, a new round of reality shows and documentaries is showing a darker face of recovery -- the real one. The people on these shows don’t just describe hitting bottom, they show you what bottom looks like.

What they get in return is up for debate.

Last month, A&E; introduced “Intervention,” a reality series that stages a surprise confrontation with friends, family and an interventionist for people battling addictions to drugs, gambling, sex or food. (Alcoholics will be included but are harder to recruit because they’re less likely to admit they have a problem, an executive said.) The Discovery Channel recently aired “Intervention House,” a documentary style show on which former drug addicts Ricky and Melba McGee, still struggling with family and financial problems, try to help other addicts get clean in Las Vegas.

HBO is currently airing “Dope Sick Love,” a documentary that follows two junkies bottoming out on the streets of New York, and on April 18 the cable network will premiere “Rehab,” a documentary that shows the trials of five young, middle-class addicts, including Josh and Ally, in a San Jose rehab camp. (All programs use only the first names of the addicts.)

The creators of these shows say they represent a force for good. The addicts get a chance to overcome their addictions and the audience gets an education.

But inevitably there are critics who contend that the shows run the risk of exploiting the addicts for the sake of ratings or to pump up profits for rehab centers. They question how the sanctity of treatment can be maintained in the face of constant filming or a manipulated environment and wonder whether the treatments depicted on the shows are even appropriate. And while the standard 12-step approach encourages addicts to submerge their egos, television can’t help but feed those egos through the attention and promise of celebrity.

Most of the subjects are young, and many either relapse over the course of the shows or simply refuse to give up their substances.

John Schwarzlose, president and CEO of the Betty Ford Center, said he has turned down many producers who ask to film the daily drama at the Rancho Mirage treatment center. “Even if a patient would give permission, we would never allow it. We feel it’s our job to protect them,” he said.

“People die of addiction every day. We’re not going to make it a circus on a television show,” he said. “I’m hoping these shows go away.... I don’t think it will help anybody.”

But the creators argue that any effort to help is better than letting addiction take its tragic course. Even if the addicts don’t kick their habits, the creators hope the negative examples will inspire others to quit, while, of course, providing enough drama to attract viewers.

Sam Mettler, the producer of “Intervention,” pointed out that his show does not film the actual rehab process. “We don’t want to violate the sanctity of therapy and rehab,” he said. “I will film the symptoms, but the cure is too delicate an operation for us to go into with cameras.”

Sheila Nevins, president of HBO Documentary and Family, defended “Rehab” as helpful and educational. “Addiction has a tremendous draw. Almost every family faces it, and because it’s considered a moral issue, it becomes a secret. When you see that other people’s suffering is like your own, it’s touching, relieving. Also there’s a shortage of information about it.”

Naturally, the first job of any producer is to entertain, said Stuart Krasnow, executive producer of “Cold Turkey,” a series on Pax that tricks smokers into a “Real World”-type house where they must cope with withdrawal and one another’s short tempers. “The additional benefits are frosting on the cake.”

Unlike the documentaries that appear to record whatever the addicts would be doing anyway, “Cold Turkey” unapologetically manipulates their environment. Krasnow (“Average Joe”) compared the smokers to rats in a maze constructed by producers. “It’s not a natural environment for a rat, but a lot of learning happens when a rat is in a maze.” Like a lab experiment, the show offered a reward: Winners of the challenges got to divide a $100,000 prize. After six months, four of the 10 contestants had started smoking again.

That ’15 minutes’ thing again

At first, producers of the rehab shows worried that they would not be able to find addicts willing to appear on national television at their darkest and most vulnerable moments. They were astonished by the flood of enthusiasm that greeted them.

“What is one person’s exploitation is another person’s 15 minutes of fame,” Nevins said.

When he asked clients at the rehab center for releases, Steven Okazaki, the director of “Rehab,” said he was shocked. “About 75% said they wanted to be in the film.”

Young adults have grown up immersed in a media and confessional culture nourished by daytime talk shows and public soul-baring. They are also used to being filmed: Starting at birth, their every moment has likely been documented on video. Okazaki said MTV’s “The Real World” has had an enormous impact, leading viewers to think it’s normal to have the worst moments of their lives shown on television.

“You sense with young adults that media is not this antagonistic thing. It’s their friend,” Okazaki said. “When you ask them if they want to be in a documentary, it’s like they’ve already thought it through: ‘OK, I’ll grow up, try to get a job, be in a documentary.’ ”

But Okazaki was equally surprised at how readily their parents agreed to be filmed: “All the parents said yes.”

In the case of “Intervention,” desperate parents’ motivations can include the financial. When the parents of Alyson, a volatile 27-year-old college dropout living in Texas, started shopping for a rehab they could afford, Alyson needed a drug fix at least every three hours. She said a treatment center referred them to the “Intervention” producers, who subsidize treatment along with some centers involved in the show. A 30-day residential treatment program ranges from $15,000 to $30,000.

Alyson’s parents also told her she might help others by participating in a show that would document her addiction. “I was so high at the time, I said, ‘Why not?’ It sounded like fun to me,” she said.

“It was an opportunity to show the country that treatment does work,” said Jim Antonowitsch, founder of Oasis Treatment Center in Anaheim, where Alyson has spent the last seven months. He agreed to pay $20,500 for Alyson to be committed to a 90-day program, as opposed to a shorter one that might not have been effective for someone in her condition, to increase the chances of a “happy ending.”

Later, the idea that she might have been exploited occurred to her, but she became convinced that the producers were genuinely concerned about her and her recovery, Alyson said. No one affiliated with the show ever provided her with drugs, she said. “There were times when they said, ‘That’s enough. Put the bong down.’ ”

“I wouldn’t suggest TV intervention for everyone,” she said. “But intervention is a good idea.

“I’ve started over with no friends from the past. I don’t feel that I’m ever going to go back to that life. I’ve come too far.”

When he screened “Intervention” for the residents of the Oasis house, Antonowitsch said he covered the screen during the unsettling scenes of Alyson smoking crack because they could have triggered cravings in former addicts, including Alyson herself. Even so, some of the footage was disturbing to the recovering addicts. “One boy had to leave. He couldn’t stand seeing her the way she was,” Antonowitsch said.

The Oasis center received more than 550 calls and 50 e-mails, all positive reactions to the show, a spokesman said. Many came from mothers who related to Alyson’s family’s predicament, and others from people who heard about the show from other viewers. Five new residents were admitted as a result.

Okazaki said some of his subjects seemed to find comfort in being filmed. At one particularly low spot in “Rehab,” a hollow-eyed Josh is led in cuffs out of drug court; rather than looking back at his girlfriend, he turns to the camera and gives a hangdog goodbye look. “He was so desperately lonely,” Okazaki said. As he was filming the boy shooting up in his room, “He just started talking about what was going on in his head.” In some ways, Okazaki said the young people were “willing guides,” explaining their world to viewers.

In contrast, art student Ally was furious when she found out Okazaki was filming her as paramedics lifted her into their van after she had overdosed. But Okazaki said she did not know then that before the paramedics arrived, he was the one who found and revived her. “She probably would have died if we weren’t around,” he said.

Since that experience two years ago, he said, Ally has been drug-free.

The filmmakers may see documenting addicts at their low points as a public service, but the effort also takes a toll on them. After reviving an overdosed Ally, Okazaki said he could have used some help himself. “I had some form of post-traumatic stress afterward,” he said.

Krasnow said he needed to consult the on-set psychologist when the wrath of smokers in withdrawal became too much to bear. “We sat down for an hour,” he said. “I had to learn that in order for the show to be a good show, I had to let people go through particularly bad times....”

Since production started for “Intervention,” Mettler said, he has put on 20 pounds and taken up smoking again.

Risk assessment

In theory, at least, the rehab shows represent a new strain of unscripted programming aimed at telling positive stories of transformation (“Nanny 911,” “Starting Over.”) But they also carry within them the potential for disastrous results. A show like “Intervention” is risky, said Nancy Dubuc, A&E; Network’s senior vice president of programming. “It is a difficult show to watch and to produce. Nothing is contrived or controlled. You’re not always aware or can anticipate what the reactions are going to be.” Still, she insisted, that’s what makes it good TV. “From a viewer’s perspective, it’s what makes the show so powerful.”

On most productions, a team of medical and/or psychological professionals advise on casting and remain on set during the shooting to ensure nothing goes awry.

Barry Goldstein holds a doctorate in clinical psychology and earns most of his income from consulting on shows such as “Cold Turkey,” “American Idol” and “Joe Millionaire.”

On “Cold Turkey,” he said, “My job is not to help them quit smoking, but [to] stay in the game and function on the show.”

For smokers who smoke because of stress, being on a stressful show, away from friends and family, is theoretically “the worst way to recover from a smoking addiction,” he said. What’s more, he said, research shows tapering off is the best way to stop smoking.

“You have to weigh that risk in light of what the effects are going to be,” he said. “Where will the natural course of life bring them? If half quit, that’s half as many as were smoking in the beginning.”

It’s too early to tell whether TV viewers will warm to the reality-rehab genre, where endings are often unhappy or unclear. Pax has ordered a second season of “Cold Turkey.” After three episodes, “Intervention” averaged 1.3 million viewers, which made it one of A&E;’s top three shows (along with “Dog the Bounty Hunter” and “Cold Case Files.”)

If the trend grows, it will require the industry to continue to cultivate new, some say foreign, practices of caring about people and their lives well beyond their entertainment value. “That takes an investment of time, energy, forethought, risk management and planning -- not things the industry is terribly well-known for,” Goldstein said. He said informal standards are being developed as the shows mature.

According to Goldstein, “there is pressure on the industry of reality television to try to anticipate the worst-case scenario and prepare for that.” It’s not that easy a way to talk for Hollywood producers, he said. “They’re all optimists, used to pitching and presenting the best possible scenario.”

Even if the worst came to pass, at least one veteran reality show producer said he could see a benefit. “If somebody in the context of a show dies coming off drugs, it tells a story that people should see,” Krasnow said. “That’s the reality of what happens.”

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(BEGIN TEXT OF INFOBOX)

Addicts’ inside stories

“Intervention,” A&E;, 10 p.m. Sundays through June

“Intervention House,” Discovery Channel, aired in December and again in March

“Dope Sick Love,” HBO, HBO2, will air throughout April

“Rehab: America Undercover,” HBO, premieres April 18

“Cold Turkey,” Pax, second- installment premiere date TBA

Contact Lynn Smith at Calendar.letters@latimes.com.