Then, in the middle of the last decade, the metastasizing of gossip sites, tabloid shows, reality TV and celebrity overdoses put addiction, Pinsky’s longtime specialty, at the center of the culture. Alarmed by the tabloids’ portrayal of addiction as yet another indulgence of the rich and famous, he decided to stage a media intervention on this latest misunderstood health crisis. Working with independent producers, he approached VH1 with a proposal for a subversively authentic reality show, in which such common action-inducing tricks as sleep deprivation and free shots of liquor would be unnecessary. Instead, it would follow actual substance-abusing celebrities (as defined by cable) through an actual detox in actual rehab. “It all stemmed from Drew,” says Jeff Olde, VH1’s executive vice president of original programming and production.

Using the decade’s most derided TV genre to combat its most high-profile illness required a mix of showbiz savvy and bona fide credentials few but its host could provide. “Dr. Drew is one of a relatively small number of psychiatric professionals who is both credible and 100 percent TV-friendly,” says Michael Hirschorn, the former head of original programming at VH1 who gave the green light to “Rehab” in 2007 (and for whom I worked at Spin in the late ’90s). “And he was willing to take all of the risks on himself, to say, ‘I’m gonna guarantee that this will be a legitimate and nonexploitative process.’ ”

In 2008, “Celebrity Rehab” made its debut, with a cast of derailed actors, porn stars, pro wrestlers and reality-TV veterans. It was an immediate hit, prompting two more seasons and the spinoffs “Sober House” and “Sex Rehab With Dr. Drew.” The show didn’t shy away from the tropes of train-wreck TV — the sobbing and fighting, the seizures and vomiting — but it still staked a claim to therapeutic value. While Pinsky’s methods were mainstream, his gentle confrontations with addicts in denial often provided the cat-and-mouse tension of a “Law and Order” cross-examination. In an inspired cultural mash-up, “Celebrity Rehab With Dr. Drew” aligned reality TV’s need for conflict and meltdowns with recovery’s need for honesty, humility and group support. And it pre-empted charges of intrusive voyeurism by appropriating the dictum “You’re as sick as your secrets.” With reality gimmicks like emo-rock cues, dramatic cutaways and chronologically remixed story lines, the show created dependable redemption arcs for its characters that helped distract the audience from the fact that the biggest celebrity on “Celebrity Rehab” was Dr. Drew.

Pinsky soon became the national face of addiction medicine, acquiring a mystique distinct from any other celebrity physician’s. To the general public, “he’s sort of the god of 12 Step,” says Duncan Roy, the 49-year-old British writer-director and patient on the new “Sex Rehab With Dr. Drew.” Roy’s wit and maturity made him an unusual patient for a Dr. Drew show, and he would later write an article questioning Pinsky’s expertise with sex addiction. But shortly after “Sex Rehab” was shown, Roy joined Pinsky on a TV news program and found himself humbled by the doctor’s mastery. “Sitting next to him,” Roy says, he saw that “he has an enormous power. I mean, I’m used to being interviewed but — God.”

Capitalizing on what many saw as his genius for explaining America’s psyche to itself, Pinsky began to focus on what he considered a bigger opponent, the disease that lay beneath them all: a toxic new form of narcissism, stoked by the media. In his latest book, “The Mirror Effect: How Celebrity Narcissism Is Seducing America,” he diagnoses today’s obsession with fame as a potential public health issue. The book incorporates a 2006 study conducted by Pinsky and his co-author, S. Mark Young, in which they subjected 200 celebrities to a standard psychological test, the Narcissism Personality Inventory, and found that celebrities were 17 percent more narcissistic than the average person, reality-TV stars being worst of all. Narcissistic celebrities aren’t exactly news, but this newer variety, according to Pinsky, is. It has been bred for years by casting directors screening for what are known as “Cluster B” personalities, those prone to histrionics, aggression, hypersexuality, drug abuse — and auditioning for reality-TV shows. This emerging strain of supernarcissism, Pinsky says, turns especially virulent in the world of social media, where young people, who are chasing an increasingly accessible kind of fame, begin to mirror the increasingly pathological behavior of their idols. According to Pinsky, our fascination with these newer narcissistic role models may seem a mere guilty pleasure, but, he argues, it is a reflection of the deep, primal chord they strike within us, the desire to emulate and then destroy our icons. It’s a kind of envious compulsion that tabloids have fed for decades and that new media now intensify with fast, cheap dopamine-blasting hits at the click of a remote.

This, says Pinsky, is the real sickness, the American addiction. So just as the intrepid epidemiologist flies to ebola-infested Yambuku, Pinsky has come to meet the monster where it lives. At least that’s the pitch. “Sometimes I think the patient I’m treating is the culture,” he told me. But the addiction model of celebrity comes with its own baggage, especially in a patient population prone to the subtle thought distortions of a brain under the influence. If, as Pinsky and Young write in “The Mirror Effect,” “nothing demonstrates a celebrity’s basic drive for attention more powerfully than a willingness to check one’s dignity at the door, week after week, in front of millions of viewers,” such a perspective casts a strange light on a program that gives these same people high doses of their drug of choice, week after week, in front of millions of viewers. Addicts are known for the prodigious logic they supply for patently irrational behavior; if the sickness of the culture is contagious, Pinsky, too, is at risk, and his mode of clinical outreach is potentially exploitation in denial.

Image From top: With Adam Carolla, ”Loveline,” 1998. With Rodney King, Steven Adler and Jeff Conaway, “Celebrity Rehab With Dr. Drew,” 2008. With Jill Vermeire, a therapist and his counterpart on “Sex Rehab With Dr. Drew,” 2009. Credit... From top: Jeff Kravitz/Film Magic, via Getty Images; VH-1 (2

On the eighth day of “Celebrity Rehab” treatment, the new cast met with alumni from previous seasons, among them Rodney King, star of what might be coldly described as the most momentous reality-TV clip in history. Seeing King chatting with celebs of utterly featherweight significance prompted me to put a few commonly asked questions to Pinsky. Doesn’t luring cast members with promises of money and exposure cast doubt on their commitment to sobriety? And doesn’t broadcasting amid other hormone-and-booze-soaked reality shows undermine the show’s supposedly dead-serious message? Pinsky had ready replies to both.