When Lindsay Lohan left rehab last month, she had an aggressive plan in place – and someone to help her stick to it.
Lohan, 27, reportedly enlisted the support of a sober coach to help her battle the temptations that often arise as addicts return to life on their own. Indeed, the call of drugs and alcohol to substance abusers trying to kick their habit never goes silent. For someone who has relapsed repeatedly, there's the specialist known as the "sober coach." They are paid at least $200 an hour to work one-on-one with recovering addicts, sometimes moving into their homes at more than $1,000 a day to fulfill a 24-7 role. They are motivators and cheerleaders, role models and mentors. They don't sugarcoat their words. And they resort to the unconventional to break a client's addiction cycle.
A coach might go grocery shopping with his client until that person learns not to stop in the wine aisle. He'll police an alcoholic's morning coffee routine to ensure no rum or brandy is added. In Lohan's case, a sober coach could potentially accompany her to her home, to movie sets, to press interviews and to her attorney's office as she's negotiating upcoming projects. He'd keep an eye on her and make sure she's steering clear of people who've led her astray in the past.
And if there's a slipup? "I've used everything from 'Shut up!' to 'Do you want to become a person or remain a dope fiend?'" says Doug Caine, founder and president of Sober Champion, a sober coaching company that has offices in Los Angeles, New York and Chicago, among other cities. "I've asked, 'Is smoking crack the best way you can serve your children?' Every client requires a different motivating tool at a different time."
Tough love is central to sober coaching. "We don't do hand-holding or babysitting jobs," Caine says. "Coaches and clients develop an intense, bonded relationship. If you're not willing to do some work, if you won't go to any lengths to stay clean, you're going to have a tough time benefitting."
Working with an outsider who is not emotionally invested in an addict's case can be more helpful than turning to a friend or family member. "High-risk situations are not always predictable, and having someone there 24-7 is helpful," says William Zywiak, a research scientist with the Center for Alcohol and Addiction Studies at Brown University. But it's not for everyone, and should be complemented by other types of treatment, such as therapy sessions or support groups. "It's a poor fit for clients with a dual diagnosis, like a mental health issue," Zywiak says. "Coaches are experts on sobriety, not other conditions."
Coaching sessions follow no set curriculum. Unlike Alcoholics Anonymous sponsors, coaches are not confined to a 12-step program, and services are customized to fit clients' needs. Michelle Hirschman, a sober coach based in Santa Monica, Calif., provides 24-hour phone crisis support and meets with clients three times a week, typically for six months to two years. She helps clients learn to deal with free time by mapping out schedules with hour-by-hour activities. She also focuses on exercise, meal planning, career guidance, budgeting issues and ways to have sober fun.
But there's no evidence that sober coaching works. Studies of effectiveness don't exist. And the specialty has no formal structure or discipline – coaches are not overseen by a governing body, they are unregulated and there is no standardized or accepted training. Some coaches are recovering addicts drawing from their own struggles with addiction. Others are trained drug counselors, social workers or psychotherapists, or have worked at residential treatment centers. "Sober coaches don't necessarily have a sophisticated education – and because of the amount of money they're charging, one would expect some sophistication," says Westley Clark, director of the U.S. Department of Health and Human Services' Center for Substance Abuse Treatment. "It becomes a matter of what are you buying, what do you get?"
Before signing on with a coach, do a credentials check – supervised training, affiliation with public and private treatment programs and references. Ask the coach about his successes and failures, years in the field and experience with similar cases. If the coach has an addiction history himself, inquire about his own recovery process, and how long he's been sober. A well-qualified professional, Clark says, will be knowledgeable about the science of addiction – and about self-care, community resources, conflict resolution and crisis intervention. He will also be respectful of confidentiality and sensitive to cultural differences.
"Anytime you have an intense one-on-one relationship, it's a delicate situation," Clark says. "Between the money and that intensity, boundary issues can start to surface – a client is essentially buying his treatment provider. That's why we recommend this approach be combined with other recovery services, which can offer support and backup to both the coach and the client."
Updated on 08/27/2013: This story was originally published on Dec. 21, 2010.