ADDICTION TREATMENT: THE BUSINESS OF RECOVERY
Addiction in America is at an all time high. There are nearly 70,000 deaths due to overdosing in America on a yearly basis, and the numbers are on a steady rise.
Alcohol and drugs, have become such an ingrained part of our culture, it is nearly impossible to find a teenager that has not experimented with some substance by the age of 15. As a society we are unprepared and frankly, uneducated about what this rising “drug culture” represents, not only for us as a nation but at an individual and deeply personal level.
Most of us still avoid acknowledging that addiction has somehow touched us, or someone we know. It is like a cancer, that is slowly spreading, which we all choose to ignore, sweep under the rug and minimize. Until, it kills us or someone that we know and we realize that we can not hide from the truth any longer.
This cancer has become so “normalized” that most of us don’t even think twice when our co-worker drinks themselves to obliteration, our friend pulls out a bag of cocaine or we hear that another person we went to high school with has died from an overdose.
It almost seems like these experiences have become part of our everyday culture. Recently, I stumbled upon a book called “The Naked Mind,” by Annie Grace, which has completely changed my perspective and relationship with alcohol.
I never realized until reading this book how deeply instilled in our unconscious mind it is that drinking is “good” for us… When in reality it is poison. Yet, when we turn down a drink or order water at a restaurant, we are met with stares of confusion, questions and assumptions.
It’s almost like NOT drinking is unacceptable.
With so many blind spots around drugs and alcohol, we are often not aware of the amount of marketing, money and manipulation goes into the industry. We are SOLD the message that substances will make us happier, healthier and more attractive. We are TOLD that using is “cool” and will make experiences better.
We never stop to think about the reasons behind the messages: profit, personal gain, capitalism, exploitation. Altering our bodies and minds has become one the greatest business opportunities, and we didn’t even realize it.
Not only is an entire industry (underground and not) dedicated to making us ADDICTED in the first place… There is also a whole other industry designed to “treat” those that can no longer manage their lives because substances are now in-control of them.
The funny thing? The very industry that is designed to HELP addicts, is also dependent on addiction being an issue. A treatment center can’t exist without clients…. Right?
In my experience working in the field, it has shocked me how broken the system is. Honestly, we really don’t understand addiction. There has not been much research done on it. We don’t know what treatments are the most effective, lasting and evidence based. Very few medical professionals specialize or even know how to treat an addict.
Yet, there are treatment centers all over the nation that cost hundreds of thousands of dollars per month. Some even claiming a cure in 30-90 days.
How did this happen?
Well, to be honest- I didn’t really understand the extent of the issue. But when I realized what has been happening, I felt shocked, angry and more motivated then ever to educate people about what is actually going on.
Let’s Break It Down:
1. Eating disorder and mental health treatment centers are highly regulated by medical boards due to the high acuity and risk of potential harm/death of patients.
2. There is a lack of research and understanding about Addiction, because of this it has not been classified at the same acuity. Therefore, not regulated or held to the same standards that eating disorder and mental health clinics are.
3. When Obama passed the Substance Abuse and Affordable Care Act in 2014, it went into effect immediately. (Love Obama), but this was a huge issue- because it created a need for substance abuse treatment… BEFORE we actually had any rules, standards, regulation or research available for standard of care.
4. Business men quickly realized that insurance now had to pay for treatment of addiction. All you needed was: a house, staff and a license with the state.
5. There was a lack of treatment centers and high demand/market that emerged from the Affordable Care Act.
6. Treatment centers started popping up all over the country claiming to “cure addiction” and making a whole lot of promises to addicts and their families. Most of these treatment centers being founded and owned by individuals who are NOT medical professionals, licensed or at all informed about clinical standards of care.
7. Issues like unethical billing, fraud, client brokering, negligence of care, in-house labs, became the “norm” in the industry.
8. Regulation Boards, such as, (JCO) started trying to create a “standard” to manage the issue. However, accreditation and audits are often sporadic. Treatment centers put their best foot forward, when inspected or assessed and then don’t maintain those standards post accreditation or inspection.
9. Insurance companies started to catch on and start cracking down, limiting payment and approval for care.
10. Treatment owners start to panic and quality of care goes down even more because they now are not as profitable due to insurance not paying as much and denying coverage.
11. Lack of accountability and regulation by medical boards leads to continued patterns of unethical behavior, manipulation and business decisions that do not actually benefit the client or meet standard of care. (e.g. lack of aftercare planning, re-admitting clients, keeping clients that are not an appropriate fit for the treatment center).
12. This creates a chronic relapse pattern, because if we are being honest… Most treatment centers don’t set clients up for success, and long term sobriety for a few different reasons: 1. The lack of research and regulation actually means that most centers don’t really offer evidence based quality care. 2. The business wouldn’t be profitable if all the clients stayed sober.
There are so many reasons that I felt the need to write this post, break it down and educate people on what is going on.
First and foremost, I am really passionate about working with addicts. They are some of the most talented, intelligent, creative and intuitive clients that I have worked with. Despite the cultural stigma we still have around addiction, there are way too many amazing people that have lost their lives to this disease.
Secondly, I do not understand how medical facilities are owned and run by businessmen with no education, medical backgrounds or licenses. They have nothing to loose. If they “fuck-up,” they don’t have a professional license on the line, which they have spent thousands of dollars, years, sweat and tears to earn. They just get walk away! Some even start a new treatment center by simply “re-branding.”
Sometimes they get thrown in prison, but that is not always the case.
Imagine going to a hospital for help after being shot, walking out and having someone waiting outside to shoot you again- all so that the hospital can make some money off of your insurance plan.
That is exactly what happens at some treatment centers. A good amount of treatment centers have no aftercare planning, which ultimately sets clients up to fail from the moment the complete the program.
Treatment centers, in my opinion, should be run and owned by licensed clinical staff, who have the appropriate training and skills on how to do things ethically. They also should be highly regulated and held to the same standards that hospital and other medical facilities are.
Thirdly, there often are a disproportionate amount of decisions made by the business team or administrative staff, clinical issues such as, (e.g. length of stay, level of care, referrals, if the client can work or not, going back to their home state, etc.)
These decisions are clinical and should be determined collaboratively with the client and their treatment team. NOT by the business owner, program director or non-clinical staff. It is out of their scope of practice and in any other medical facility, there is no way in hell that would EVER fly. (e.g. Imagine the clerk at your doctor’s office telling you what medications to take or what cancer treatment is best for you). Would you trust her over you doctor? Probably not.
Lastly, it is our responsibly as healthcare providers to speak up about ethical/legal issues regarding standard of care and competency. If we don’t speak up, we are just as bad as the people making the unethical decisions.
As John Stuart Mill famously says, “A person may cause evil to others not only by his actions but by his inaction, and in either case he is justly accountable to them for the injury.”
Being a recovering people pleaser myself, I understand how hard it can be to have confrontational, conversations and conflict.
However, I have observed is that it is common for clinical team members to avoid, ignore or be left out of decisions made on the “business side,” that directly impact client care.
As caretakers, healers and helpers- Radical Candor does not come naturally to us. Nevertheless, when we don’t step-up and advocate for our clients, their rights to quality care and don’t fulfill our duty maintain our professional standards, we not only devalue ourselves, our profession but also put ourselves at risk for loosing our license!
I personally, would rather speak up, for the client and follow my ethical/legal guidelines, get fired from a place that is not providing quality care and piss a few people off, then loose my license. The reality is, no one likes to have difficult conversations, call people out or point out flaws in the system.
Yet, it is necessary.
If your boss or the owner of the treatment center is not willing to have difficult conversations, own up to their mistakes or hear how they can improve the program- they are probably not running the place for anything more then profit. They probably aren’t even actively involved or aware. Everyone, including clients can feel when someone cares personally vs. cares about profit.
Owners who truly care, are willing to hear feedback (even negative feedback) because they are more concerned about doing the RIGHT thing, then LOOKING good or making an extra buck. When someone cares, they don’t getting defensive or justify decisions that clearly are not made in the benefit of the client, they are willing to listen to feedback from clients, staff (both clinical and floor), admit when things are wrong and make changes to better meet their needs. They spend time with the staff and clients and get know them, they are informed about what is happening at the ground level.
In short, they are involved.
That being said, I want to end this post on a more positive note. There ARE good treatment centers out there that truly help people get sober and move on with their lives. I am passionate about this because I think it is important that clients, families and providers all know about these things and what to look for.
I recorded a podcast awhile back that gives some tips on how to choose a treatment center and what questions to ask to make sure you are entering a quality program, you can check that out here:
Do your research, educate yourself and ask the questions that need to be asked, whether you are a client or a provider looking to work at treatment center. Demand straight forwards answers and evidence that shows the quality of the services provided. Good programs will back up everything they say, shitty programs will blow smoke up your ass with empty promises. Trust your gut instinct.
Do not settle or take it lightly, it truly is a matter of life or death.
Also, check out John Oliver’s recent segment to learn more: here