Still, he said that a couple of weeks before entering the Pasadena Recovery Center, he attempted to get a head start on his sobriety and was four days clean when VH1 producers approached him with a request. "They asked to get some footage of me using, and I said, 'I haven't been using,'" he recalled. "They said, 'We really have to get footage of you using.' Anyway, I was easily talked into showing them."
"The show's producers would never ask anyone to use...PERIOD," said Scott Acord, vice president of VH1 Communications, in an e-mail.
Pinsky, a board-certified internist, addiction medicine specialist and television and radio personality who hosts "Celebrity Rehab," declined to participate in this story. But Jeff Olde, VH1's executive vice president of original programming and production, defended the ethics of "Celebrity Rehab."
"You're dealing with addicts first and foremost, so whatever it takes to get them into treatment — treatment is a good place," said Olde. "I feel very comfortable saying we're a show that actually helps people."
Indeed, a number of those who graduated from the rehab program featured this season said they are celebrating nearly half a year of sobriety.
Dickinson put it plainly: "Dr. Drew saved my life."
"I needed to get some help kicking these prescription meds — Ambien and Xanax — and the show went along for the ride," Dickinson said. She is comforted that her struggle is "helping millions of women watch the transformation."
It's unclear, however, what effect "Celebrity Rehab" has on its audience, which has dropped about 37% from Season 1, when the program averaged 1.65 million viewers per episode, according to Nielsen.
Despite the decline, the show remains a pop culture touchstone. Watching other people's addictions is addictive — especially when those people thrive on attention and will go to extreme lengths to get it. Even some in the industry, like filmmaker Judd Apatow, have been sucked into the phenomenon. "Why bother writing when nothing I write will ever be as good as Celebrity Rehab?" he wrote on his Twitter page in December. "I need a drug habit so I can get life help from Dr. Drew."
Pinsky himself is a polarizing figure. He recently signed on to host his own prime-time show on HLN and has been lauded as an example of "TV giving itself a moral center."
But some industry figures, like Promises' Sack, question whether Pinsky's attraction to the spotlight could cloud his good intentions. "It's not that Dr. Pinsky doesn't know how to treat people. It's that when you create this context of paying people to participate, it doesn't work," argued Sack.
Garrett said that before "Celebrity Rehab," he too questioned how "legit" Pinsky was but now believes he's "100% the real deal."
Other "Celebrity Rehab" alum, like actor Jeff Conaway, have more mixed feelings about the show.
Conaway, best known for his roles in the movie "Grease" and the sitcom "Taxi," was an imposing presence on the show's first season. After undergoing back surgery, Conaway said he developed an addiction to cocaine and pain pills, and as he attempted to quit those drugs on the program, he threw tantrums, shouted and blacked out.
He now says he ramped up his antics for the cameras.
"We all knew we were on TV. I think everybody, like myself, made choices. Sometimes we would go a little bit further than maybe we normally would," said the actor, who also appeared on the program's second season. "You can't help it. There are cameras sitting in front of your face, and we're paid to be dramatic. That's what we do."
Conaway said the show's producers frequently requested he "give them drama." He played along, until the end of the first season.
"I was in so much pain, I thought, 'When I get out of here, I'm going back on pain pills,'" he said. Show executives urged him to stay on the program. "The producer said, 'Can't you just lie? Can't you just not talk?'" he recalled. "I don't think producers ever have actors' best interest at heart. Their first allegiance is to the show."
VH1's Acord said that if "producers asked him to stay, they wanted him to continue to work on his sobriety for as long as possible."
Dan Partland, executive producer of "Intervention," said he understands why viewers are intrigued by "Celebrity Rehab" but ultimately feels "the conceit of the show is counterproductive to the ultimate outcome of the clients."
"You put the audience in the uncomfortable position of perversely hoping for failure, because those are the most dramatic moments," he said.
"Intervention" also has its critics, who charge that misleading addicts into an intervention is unethical.
"Listen, any time you're bringing cameras in the real world and aiming at disempowered people, exploitation is gonna come up. But we're very careful to only pursue stories where people are really interested in participating," Partland insisted.