Eighteen Stints in Rehab Couldn’t Help Rob Reiner’s Son. Maybe Rehabs Themselves Are to Blame.

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Nick Reiner, the man arrested on Sunday for the alleged murder of his parents, beloved Hollywood director Rob Reiner and photographer Michele Singer Reiner, has been to rehab more than eighteen times since the age of 15. Since Reiner’s arrest, there have been countless headlines, everywhere from gossip magazines to the New York Times, describing his decadeslong struggle with addiction to substances including heroin, methamphetamine, and cocaine. A question at the root of this tragedy is why Reiner, despite his family’s resources, his access to the best addiction care, and his myriad rehab stays, was unable to receive mental health treatment that worked.

Reiner often preferred to be homeless rather than adhere to the strict rules most rehab facilities mandate. He also felt that residential treatment—the recommended course of action for severe addiction, according to the American Society of Addiction Medicine—was ineffective for him. As a physician who practices addiction medicine and treats patients like Reiner every day, I was not surprised by this. Many of my patients avoid at all costs rehab or “detox,” a type of inpatient treatment during which patients undergo withdrawal in a monitored environment, feeling that it robs them of their autonomy and is like being in jail or prison. And even when patients do spend the time and money to enter treatment, rehabs fail them.

I won’t imply that Reiner’s alleged murder of his parents would have been prevented if only he had received different care. But a high-profile tragedy like this one gives us the opportunity to interrogate what our addiction treatment system may be getting wrong.

In a 2016 podcast episode, Reiner recounted how he had hurled a rock through a window of a rehab facility in a desperate attempt to convince the staff that he needed more medication. Most people will interpret Reiner’s actions as “addict behavior,” but I see it another way: His withdrawal was likely being undertreated.

There is something gravely wrong with our addiction treatment industry. Residential addiction care accounts for more than a quarter of national spending on substance-use treatment. In 2024, 2.6 million people received addiction treatment in a rehab facility. Yet many rehabs operate as shadow organizations, exploiting their patients and imposing punitive, often humiliating rules. Centers across the country have been charged with a variety of offenses, from health care fraud and tax evasion to sexual misconduct and even patient deaths.

Problems exist across the spectrum of rehabs, from expensive, for-profit facilities to nonprofit ones: A 2017 investigation revealed that the two Massachusetts locations of Recovery Centers of America, a rehab chain that charges patients an average of $24,000 a month, was severely understaffed and did not even offer all patients basic counseling. More recently, RCA paid $2 million to settle a federal lawsuit that alleged that Maryland and Pennsylvania facilities billed Medicaid for patient services that were never received, alongside other charges. RCA outposts still made their way onto Newsweek’s 2025 list of the country’s top addiction treatment centers.

Over the course of my training, I’ve learned that evidence-based medical treatments are often not found within rehabs across the country. Rehabs rely largely on 12-step programming, like Narcotics Anonymous/Alcoholics Anonymous, a method that may be effective for some patients but alienate others, particularly those who are atheistic or use medications to address their cravings.

When I found out about the alleged murders, I immediately wondered whether Reiner had tried medications to address his substance use, particularly his heroin addiction. Medications for opioid use disorder are effective yet highly stigmatized, particularly in the treatment settings Reiner frequented most: rehab facilities. A 2020 survey reported that only about 30 percent of residential treatment facilities across the country offered medications for opioid use disorder like buprenorphine or methadone, gold-standard treatments that reduce mortality, cravings, and illicit opioid use.

Many rehabs and sober living homes view these pharmaceuticals as “substituting one drug for another,” preaching that patients can be truly sober only once they’re off medications entirely. People with substance use disorders cite the undertreatment of withdrawal symptoms and unaddressed pain—which methadone or buprenorphine can rapidly address—as a major driver of why they leave inpatient settings like hospitals or rehabs before they have completed treatment.

Every patient who struggles with addiction has different needs. A legacy of paternalism has characterized our approach to addiction treatment in the U.S. Although some patients do benefit from extended rehab stays, not every patient with a substance use disorder should immediately be sent to rehab as a first-line intervention. If a patient relapses or breaks a rule in a rehab facility, the knee-jerk impulse should not be to discharge them from the program. A philosophy of harm reduction should inform how we care for patients, and treatment plans must be individualized.

In my personal and professional life, I’ve witnessed loving parents like Rob and Michele Reiner who have spent countless hours and hundreds of thousands of dollars researching the best addiction treatment for their child only to find it not just ineffective but harmful. More often than not, punishing people with addiction and applying a one-size-fits-all approach to care perpetuates a patient’s sense of isolation. Addiction is a medical condition like any other—the facilities that claim to treat this disease need to not only fulfill the promise of “Do no harm.” They need to do better.

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