Here’s a link to a NYT article that touches on a particularly distressing issue. I have often felt disgusted that drug rehab and treatment centers rely on misleading advertising (fake news?) to make huge profits off desperate people. And then send them back to an isolated existence without the tools they need to maintain some kind of control. If you read the article, which I encourage you to do, you’ll see that “Treatment providers, 
in some cases, have been willing to pay $70 per ad click.” Do you realize how much money they’re making off ads in order to justify that kind of payout?
Although most addicts quit without formal treatment, (sometimes called natural recovery) it’s clear that some people do need professional help. And it’s not news (for people in our community) that most drug/alcohol 
rehabs are disasters: charging exorbitant fees for putting the “Disease” marquee above their front door, along with a picture of a white-coated doctor smiling down from their website, yet shuffling people off to 12-step meetings as their primary treatment modality.
There is so much that goes wrong in conventional rehabs: the inappropriate dosing or refusal to provide opiate substitution for those in need, the lack of individual therapy with an 
experienced therapist, the use of shaming and other coercive techniques, the abysmal lack of clear guidelines for aftercare, and the fake news claiming that 12-
step techniques (and group “discussions”) somehow count as evidence-based treatment. Not to mention the almost total absence of unbiased program evaluation.
I won’t go on. Maia Szalavitz has written volumes (e.g., here) on these abuses, and Anne Fletcher’s book, Inside Rehab, also exposes much that’s gone wrong. I just caught this story today thanks to my cousin Karen (thanks, Karen!) and I’m pleased to share some good news: the profit-driven quackery dressed up as the solution to addiction in America (and elsewhere) is finally being spotted — and nailed — by healthcare advocates, legal specialists, journalists and media decision-makers. And that’s a pretty good start.
Here’s an excerpt from the article:
Google Sets Limits on Addiction Treatment Ads, Citing Safety
By MICHAEL CORKERYSeptember 14, 2017
As drug addiction soars in the United States, a booming business of rehab centers has sprung up to treat the problem. And when drug addicts and their families search for help, they often turn to Google.
But prosecutors and health advocates have warned that many online searches are leading addicts to click on ads for rehab centers that are unfit to help them or, in some cases, endangering their lives.
This week, Google acknowledged the problem — and started restricting ads that come up when someone searches for addiction treatment on its site. “We found a number of misleading experiences among rehabilitation treatment centers that led to our decision,” Google spokeswoman Elisa Greene said in a statement on Thursday.
Google has taken similar steps to restrict advertisements only a few times before. Last year it limited ads for payday lenders, and in the past it created a verification system for locksmiths to prevent fraud.
……In this case, the restrictions will limit a popular marketing tool in the $35 billion addiction treatment business, affecting thousands of small-time operators.
“This is a bold move by one of the world’s biggest companies, saying people’s lives are more important than profit,” said Greg Williams, co-founder of Facing Addiction, a nonprofit group that is an advocate for people struggling with addiction.
Informed by unparalleled neuroscientific insight and written with his usual flare, Marc Lewis’s The Biology of Desire effectively refutes the medical view of addiction as a brain disease. A bracing and informative corrective to the muddle that now characterizes public and professional discourse on this topic.” —Gabor Maté, M.D., author of In The Realm of Hungry Ghosts: Close Encounters With Addiction
The documentary “The Business of Recovery” addresses this too. It’s a shame we need to worry about ostensibly altruistic enterprises that end up exploiting the vulnerable for a buck. My fantasy wish would be for some kind of self-screening/pre-screening procedure to offer a reasonably prioritized list of options from the vast array of potential “treatment” modalities that have demonstrated efficacy. To empower people to explore what intuitively feels like it will work best for them. “Treatment” in quotes because it never has been about treatment. It’s about personal development.
I agree completely. Options of any sort would be great. But ideally, options among diverse treatment approaches. Addiction is so individual…help has to be individual too.
That’s why there needs to be guidance, nurturing, and education at an early age so the resources and options are accessible when needed. So everyone isn’t standing around with their hands in the air going “What the f—” when their teenager develops a heroin habit. Nobody seems to want to look at it till it’s too late because of the contrived stigma that continues to drive the cycle of ignorance.
Hello Marc, My name is Jan Winhall and I am a therapist who works with addiction. I wanted to let you and your readers know about a telesummit that is on next weekend called The Radical Recovery Summit. Myself, along with Nicki Meyers, Gabor Mate, Tommy Rosen and others are speaking about alternative forms of therapy for healing addiction. Your work is wonderful, and I encouraged listeners to read your books. I hope you will listen and we can all share our thoughts about the great work being done. My hope is that we can all continue to connect and promote non pathologizing and trauma informed for ways of healing.
http://kilobycenter.com/radical-recovery-summit/
For those of you interested in new, holistic, progressive (non-disease-oriented), mindfulness-related approaches to recovery, this appears to be a treasure chest of diverse thinkers, speakers, and doers. I’ve listened to some of the clips on this site, and the views I’ve heard seem insightful and possibly very productive.
I’m hesitant to endorse the event fully since the costs aren’t clearly presented up front. But there does seem to be a 48-hour window of free access, so if you’re interested, don’t wait to check it out.
Odd-It does not seem like it is a real-time-live symposium, but a collection of pre-recorded interviews.
I think you’re right, Carlton.
Rehab marketing is now paramount due to the new laws directly affecting Florida. These laws indirectly affect the entire US. If you don’t get your marketing in check, you will be out of business within the next 12 months. Now, with the Google restrictions, many treatment centers are scrambling with their marketing efforts. They have survived with limited marketing knowledge and experience, however now they must understand, track, and wisely invest in a heathy marketing mix. Behavioral Helth Network Resources warns drug and alcohol treatment centers to get their addiction treatment marketing in check, and check their SEO. The organic rankings, and Google maps listings will be the Google juice. BHNR explains in this article https://www.behavioralhealthnetworkresources.com/uncategorized/rehab-marketing-practices/.
Thanks, Charles. This is really informative. And nice to get more good news.
Mark, Behavioral Health Network Resources has educating addiction treatment industry CEO’s and Executives on ethical rehab marketing practices for over two years with 13 conferences focusing on this topic. The education is paramount to survive the changes on the business and marketing side of our industry. California is about two years behind Florida and currently has started legislation on patient brokering and ethical web marketing practices. BHNR is going to providing our Ethical Marketing Practices (EMP2018) conference in California starting in late June early July of 2018. Here is what our conferences look like https://www.behavioralhealthnetworkresources.com/events/emp-ethical-marketing-practices-addiction-conference-2018/. It could help us and the community greatly if you would be so kind to have a post for these essential Executive trainings. Thank you for being an advocate for ethical marketing.
Aside from the dubious evidence base for 12 step, its free and everywhere and it’s an absolute disgrace that any provider, private or public sector, is allowed to base more than a fraction of its “intervention” on it. Outside of the lucrative private treatment sector, Commissioners of local services need to check what’s really being delivered (preached) by staff in groups and individual work with clients. It will so often be 12 step. And why is the taxpayer stumping up for that? The issue also lies in the recruitment of recovery workers who are in recovery themselves and aren’t required to undergo any additional training besides their own lived experience and some time as a volunteer first. This is in large part because pay is so poor in the “psychosocial recovery” sector that the chances of recruiting and retaining anyone who understands, let alone can practice, empirically supported therapies, is slim.
Sorry I went on a tangent from private rehab but the principle is the same – why pay for 12-step. Rich or poor in private or public services deserve more.
The industry of treatment recruits well meaning early recovery folks, to do their bidding at the lowest wages possible, which in turn raises their profits. The public agencies, constantly send grant bids in order to pay their staff, and the goal isn’t the client, it is the grant reporting. Now, MAT is here to save the day. The giant guilt ridden, pharm driven treatment program to undo the long ignored over prescribing, and the increasing use of heroin in a segment of society was long believed immuned to such tragedy. We are a disconnected society. Where is that treatment? Unless there is money to be made, unlikely.
As a sober woman, who accepted early in my adult life that alcohol not only increased my pain and suffering, alcohol created more. AA was there to help me find a life sober, and to increase my knowledge of my own human condition. The treatment industry has long billed for what is freely there.
Yes Mungo, treatment industry is quite dubious, and lucrative.
You two, Mungyo and Helen, have obviously been around the block. Thanks for the astute analysis of the underlying contradictions. Anne Fletcher has written much that’s critical of the 12-step approach, especially as practiced at treatment centers (e.g., not grass roots, not free). In this interesting article she tries to disentangle our distorted perceptions by identifying common myths. It’s not “pro” or “con” — just informative.
I have it to comment. I am an addict in recovery. I have a therapist. LCSW. I pay $3 per visit. I have more than addiction. Generalized Anxiety, depression. My therapist points it all to AA and NA. The anxiety goes way back before I started drugs. 3 treatment facility’s. In and out of AA. NA. Was a RN. License revoked. Felonies are now 8 yrs old. Unable to get employment. Corporate level does background check and I’m turned away. These are minimum wage jobs! AA can’t help that, hasn’t helped anxiety. Frankly the discussions of alcohol and drugs make the craving come back. It was gone when I walked in!
That is such an awful story. I think I emailed you to express that. All I can say is that the US is more punitive of people struggling with or past addiction than any other country in the Western world. It’s insane that you can’t get work because of an old conviction. Of course AA can’t help with that — that’s not their territory. But that the discussions are triggering…well that’s something that a skilled facilitator should be able to help with. So they are failing you as well.
It seems wherever we find an absence of rationality or skill what we get is blame and retribution to fill the vacuum.
Marc, I’m very glad that you are posting this, it is so important to highlight all of the many aspects of the treatment industry that need attention. (probably shouldn’t get me started, actually). I was so glad that the affordable care act included the mandate for addiction treatment. I have been equally disturbed, though, by the for-profit industry that has grown as a result. What should be an opportunity for many to get the help they need has been usurped as an opportunity for unskilled treatment center owners to rake in insurance money. I live in the heart of it in Southern California, there are an estimated 200 sober-living homes in my small beach town, alone, each affiliated with a local IOP. And while some provide legitimate treatment, many are simply erected as businesses, profiting primarily from the money they get from their urine analysis insurance reimbursement. Admittedly, not all are malicious in their intent, often they are started by well-meaning recovering people who legitimately believe that 12-step involvement is all that is needed for all with addiction problems (which I don’t agree with, of course), but there are certainly many predacious businesses and an absolute torrent of fraudulent behavior throughout. Lastly, the fraudulent insurance practices are also making it almost impossible for the legitimate places to get clients, since few will voluntarily attend a center where they will be expected to pay their insurance deductible when they can choose to attend one that doesn’t. The industry needs regulation as badly as our health-care system does.
Hi Eric. Cliffside Malibu epitomizes some of these abuses… Maybe “abuses” is too strong a word, especially as outright lying by powerful players becomes increasingly normative. But check out this “expose/” of Cliffside Malibu. It’s a great little piece of video reporting, Lance Dodes is featured as a commentator, and it will make your skin crawl if you haven’t seen the likes of it before. And thanks to Vice for getting right in there and telling it like it is.
Marc, more great journalism by VICE. I love those guys. Unfortunately, I have seen the likes of this, I live in the middle of it all. I know two people (both are not part of the problem, I assure you) that worked at Morningside Recovery Center which is where the boy with the eating disorder died. For a while I was being offered program directorships almost weekly from these sorts of places. I previously mentioned that I have had heroin addicted clients that have fed their habit by taking turns referring each other to centers that give kickbacks here (southern CA) and in Florida. (Incidentally, California rehabs are known for paying thousands per referral and Florida, only hundreds). People from some of the more predatory rehabs actually send workers into 12-step meetings and offer treatment to those struggling to find housing and require that they relapse (if they aren’t already using), to qualify. Both the referred and the person who finds them get kickbacks, of course. Another unrelated practice that I see is that clients in most of these places are immediately put on three our four psychotropic medications (never opiate maintenance) which helps to justify that insurance companies continue paying for longterm IOP treatment. (Obviously, medications can be prescribed legitimately, but I don’t see what is happening as responsible prescribing practices).
Eric. This is really ghastly. I didn’t know about the kickbacks, though the VICE piece sure implies a number of shady practices. And sending workers to get 12-steppers to relapse and then admit them….is…should be punishable by prison terms.
I know there are legitimate, well-intentioned treatment centers out there, but it’s distressing to view them as a small minority.
Marc,
I spoke with someone last week who had been in the treatment bubble in Florida for the previous couple of years. While in one sober-living/IOP program, he was offered $300 by the owner of the Sober-living home to go to a detox center that he had no medical (or other) reason to attend. He would have received his $300 and the owner would, no doubt, have received a much higher kickback. The insurance companies would be footing the bill for all these kickbacks and the unnecessary detox bill. While I have no love for insurance companies here in the US, it’s astounding how much fraud has infiltrated the treatment industry while it sits unregulated. And this is one of many stories this person told that he saw first hand.
http://www.nationalgeographic.com/magazine/2017/09/the-addicted-brain/
I agree, and I work in a rehab. Here in Australia there has been a troubling tendency over recent years to force treatment upon people. This initially from justice circles using the theory that drugs cause crime but now also from welfare angles where talk of forcing drug using unemployed people to treatment is gaining momentum. And from where I sit I know that the last thing I can do is do anything about forcing a person to change even if I believed drug use is causative and not a symptom. In my view this is false imprisonment with many court diversions occurring even before a person is convicted of a crime yet because its about drug users the society says nothing. And yes when they come to my service we send them to AA, at least now voluntarily rather than as a mandatory part of our program. My concern here is that we are socially constructing addiction, especially in the young who we label without any real evidence as addicts and send them on the life long path to ‘recovery’, a path that only in my experience gets worse as the self fulfilling prophecies that 12 Step emphasise become ‘real’. And pushes to send to rehab younger and younger people will only produce an entire generation of confused young people, or worse. One solution to this is to clear the water in rehabs and legalise drugs thus leaving that 2-3% of drug users who will still need help to be able to go to the few well resourced rehabs that would be left once the real extent of the problem emerges. This forced treatment only suits the rehab industry and there is little opposition to mandating coming from that industry at present and nothing about drug law reform to indicate this ‘industry’ really has the clients true welfare at heart.
Excellent points, Terry. Forcing people into treatment, especially by the courts, is a many-headed beast. Sally Satel has cogently argued for a contingency management approach, stressing that light (but mandated) punishments (balanced by rewards) are not only ethical but effective. Here’s a good example of her argument. But there’s clearly a down side. I wrote a post on “drug courts” a while back….I could see a glimmer of hope, yet my overall reaction was a sort of revulsion. Forcing people into treatment encourages them to function like children, and that’s completely wrong-headed.
I pretty much agree with you about legalization, though I still vacillate. Despite the potential hazards, it’s hard to imagine anything worse than the present system. And some European countries have shown that controlled legal access can be safe and effective.
Judges are being unfairly attacked for ‘practicing’ medicine by mandating Vivitrol. I am a national speaker for the drugs courts and go around the country training judges and treatment providers on treatment options. There was a very biased article in our local paper – The St Louis Post Dispatch and I wrote an op-ed article in response. I was pleasantly surprised to see it published. Here is the link.
http://www.stltoday.com/opinion/columnists/the-conundrum-in-treating-opioid-addiction/article_69bea5da-737d-5a4e-8ea8-6b6ffc196c96.html
Blame the insidious business model for the present mess. Where are the investigative reporters and ‘experts’ who passionately write on just about every subject except exposing the business model!
Hi Marc
Unfortunately I would go much further than confining these observations to the, mainly residential, rehab/treatment industry. In my humble opinion and through years of observation, I see pretty much everything about substance misuse and mental health getting progressively worse. A whole attitude of narcissism, arrogance and sociopathy have taken over and the snake oil salesmen leading it seem to have all the cards. Huge amounts of money are being spent on the latest popular political whim, making some people very rich, creating careers and empires but probably making life increasingly difficult for those poor people, both workers and service users, who inevitably become victims. These days it has become much more important to appear good, statistically and aesthetically, than it is to actually do good and we are much the worse for it. Inordinate and obscene amounts of resources are spent documenting shit, number crunching and polishing the places people work out of. All this is done at the expense of the things we know work like meeting people where they are, developing a therapeutic connection and building a therapeutic relationship. It’s now become much more important to demonstrate statistics about how many detoxes, including OST, that you’ve completed than it is to subjectively demonstrate how service users have improved the quality of their life.
A couple of blogs ago you asked me to report on the progress of a service you know I was involved with. I have been very reluctant to do this because of all of the above. My heart is filled with sadness because I hear from the wounded warriors left behind or I attend their funerals.
Omigod, Peter, that is so depressing. I wish I could lift you out of there and take you…where? Well, the Netherlands and several other European countries certainly don’t sound like they’re descending into the pits of hell as quickly as the UK seems to be.
I understand your points, of course, and they all ring true…and worse, from my point of view, the self-serving, self-camouflaging trends you describe are as rife in the US as in the UK. If you want to laugh instead of cry, look at the video link I inserted in a comment just above (my reply to Eric). It’s a Vice documentary in which the head of a very expensive rehab consortium based in California is being interviewed, along with comments by Lance Dodes. Anyway, the guy is a second Trump in that he says the most ludicrous things, shoving his foot in his mouth with nearly every word… and the good news is that the exposure these guys are getting as rip-off artists might finally stop them…as per the theme of this week’s post.
As for the treatment experiment I asked about (should it remain unnamed?)….I had a feeling things weren’t going too well since you’ve been reluctant to talk about it. We’ll have a chance to talk in more detail ex blogus (I just made that up: would it count as a Latin phrase?) and I’ve still got unanswered emails of yours I want to get back to. Keep up the good fight, man! Things keep changing….
While I’m trying to cheer you up, I’ve been in touch with Bruce Alexander. He sent me a 37-page update/summary of his whole model of addiction, and it’s excellent — eminently readable and certainly powerful. Of course the model itself doesn’t paint such a rosy picture of the world. Sigh….
Hey Marc
Many thanks for sharing the Bruce Alexander paper, I too love the guy. Everything in his paper really chimes with my own experience. I am sick to fucking death of the “official line” and all the charlatans standing behind its bankrupt facade. Thank god there are people out there like Bruce, Maia, Matt and your good self, otherwise I think I’d be rapidly pulling the insane card out. I remember many years go whilst doing training to become a mental health nurse. We were discussing delusion and a definition stuck in my head for some reason. Delusion, a false belief that isn’t in keeping with the society or culture the person is from. Won’t respond to any amount of reason. Sounds remarkably familiar.
Peter, maybe you and other stout-hearted men (and women) need to get out of the trenches for a while. There is progress happening at many fronts in the war on the war on drugs. For example, Canada is legalizing cannabis this year. That’s bound to send reverberations around the world. And both opiate substitution and naloxone/naltrexone are becoming more easily available in N. America at least, so people don’t have to go to the streets or simply OD. The Swiss model of providing clinical heroin and letting addicts wean themselves out of sheer boredom is being tried in half a dozen European countries and Canada as well. Heroin addiction has gone down to almost zero in the Netherlands in people under 40…from a much higher percentage 20 years ago. Many programs in Europe are dedicated to getting addicts into the work force. And it’s working.
I know these are not full-out solutions, especially not of the “therapeutic” sort that you crave. But they do show that people in various parts of the world are rethinking drug policies, generally decriminalizing, and trying out treatment options that would have been sneered at a decade or two ago. All I’m saying is that there is light in some places. But not at the bottom of the trenches where the problems are most intractable. Maybe you need to come up for air.
Marc, so glad to hear that you are in touch with Bruce Alexander. I think that his book, The Globilization of Addiction, is one of the most important works out there on the subject. He really tells the whole story. I love hearing that you guys are in contact. (Is it possible to see the 37-page paper you speak of yet)?
To all readers. I sent Eric a copy of Bruce Alexander’s delightfully succinct recap — how he sees addiction as a social problem fueled by societal fragmentation. I found a direct link to the article. Here it is!
You might also want to explore the Bruce Alexander website, especially “Newest articles and speeches”. Bruce is very active in getting his ideas out and he is the grand master when it comes to a societal analysis of addiction.
I begin by a link to a very insightful article in the NEJM.
http://www.nejm.org/doi/full/10.1056/NEJMp1706492
Physicians by and large shun the treatment of addictive disorders because they have told that addictions is an ‘incurable or ‘untreatable’ ‘disease’. Physicians are trained to ‘cure’, Since treatment of addictive disorders is outside of medicine, a business model prevails.Patients are subject to all sorts of exploitation. Most of the residential programs have little or no medical involvement and patients sent back home with little or no protection from ever-present cues and triggers that could lead to relapse. Only a tiny fraction of patients are sent back home on buprenorphine or Vivitrol. Each relapse is a potential new patient!
Outpatient treatment is also overwhelmingly based on the business model. Patients are told they need life-long Opioid Substitution Treatment (OST) and this is the’ gold standard’, yet patient are hard-pressed to find affordable treatment. Once again, a business model dominates the delivery of methadone and buprenorphine. The majority of the methadone clinics are self-pay and do not accept insurance. Less than five percent of US physicians have obtained the DEA waiver to prescribe buprenorphine and it is not unusual for patients to pay out of pocket for the doctor’s visit. As a result less than ten percent of the 23 million patients impacted by drugs and alcohol receive medical treatment. Imagine, if AIDS/HIV patients had to go thru this!
Sadly, there is a vested interest in maintaining the status quo because any change will upend the business model. We have known for the longest time that OST is effective when the access or supply of legal and illegal opioids are curtailed. Indeed, it is growing and getting more potent. Legalization is not the answer. Let’s start by removing the meaningless restrictions on buprenorphine make treatment more accessible.
Hi Percy. What a succinct and revealing analysis….and how depressing. It does seem that the US and the UK are the two low points in the Western world when it comes to creative and humane treatment. (see my reply to Peter, above) I’m amazed that the restrictions on OST prescribing authority have remained so firmly in place to this day. Is there any light at the end of the tunnel?
Dear Marc,
Thanks for your kind words. The US landscape is very different and what worked in Portugal or Switzerland is unlikely to work in the US. To begin with, the US consumes 80% of the world’s legal opioids and we have a 1600 miles border with Mexico and 90% of the heroin comes through the legal border crossings.
Any change to the present OST treatment structure is going to be met with vehement opposition because it will disrupt the business model.Here is a link to an article I wrote in the local paper when the editorial unfairly attacked judges for ‘prescribing’ Vivitrol.
http://www.stltoday.com/opinion/columnists/the-conundrum-in-treating-opioid-addiction/article_69bea5da-737d-5a4e-8ea8-6b6ffc196c96.html
A couple of years ago I wrote an article in The Fix on why OST should not last a lifetime and you can guess the reaction I received. Here is the link.
https://www.thefix.com/content/opioid-addiction-treatment-should-not-last-lifetime-percy-menzies
There is no light at the end of the tunnel because the end has been sealed shut by the business model of OST. Easing the restrictions will weaken the model and negatively impact the bottom line.
We just received the mortality figures for 2016. They are shocking! 64,000. We are are going to fight the epidemic with widespread distribution of naloxone (Narcan), crippling restrictions to OST and attacks on naltrexone and Vivitrol?
It is time we learn a lesson or two from the AIDS/HIV experience on treating patients humanely.
What is the process for getting an ad approved for a legitimate, hospital-based, medical detoxification facility?
What do you mean? The process on Google? I have no idea how they monitor these things.
I live in a place where rebabs are totally unregulated and highly profitable. They are run on the 12 step model and the people in the rehabs are sent to 12 step meetings.
Anyone can start one with no qualifications whatsoever. They charge thousands of dollars a month and have a relatively low cost base. I do not know if they help people. I doubt there are statistics.
Here’s the thing. There is so much money to be made and they are so profitable that I would not identify them. I may be physically harmed. I fear that.
I have changed my name for this post because I do not wish to be identified.
Enough said.
Thanks for being brave and sharing that with us, Jerry. Don’t worry, your email address is inaccessible in my password-protected website data base.
That just sounds unreal, like something from Black Mirror. Ever watch that? A fabulous British series identified as “near-future sci fi”…it’s excellent. But what you describe is hideous. So the “healers” are worse than the dealers. I wonder how long this can go on. Surely regulations will come along soon….as is beginning to happen in media restrictions, as per this week’s post.
Hi Marc
I will watch Black mirror. It sounds good. I am grateful that my email address is secured.
The “healers” have no qualifications except they may have some uneven abstinence and know the 12 step liturgy. I have met some of them and been shocked when I found out they were running rehabs.
Some of them do it as a side business to make extra money. All you need is a website and a sales pitch. It helps that this is an attractive place to visit. Rehab with a beach!
The people who run a rehab part time, as above, do not see that they are doing anything wrong. They have no qualifications but they feel they are doing no harm and making money on the side. It is under the radar but harm is done.
The serious money is in the rehabs where the owners run them as a full time money making business. These people are dead serious about their bottom line. They have cash flow and that cash flow must be protected.
Crucially, they chose to run these business in an unregulated place with no oversight. That was a strategic business decision and, from a business point of view, a profitable decision.
People come from all over the world with mental health problems. Some of it could be related to substance use but that is often tangential.
The various mental health problems are far beyond abstinence from substance use. They need intensive support and care over a long period which a 28 day program does not provide. Coupled with the 12 step dogma in these rehabs I fear for the people who go there. I have witnessed this first hand. I am not making it up.
The rehabs may have access to a few select doctors. But they are local doctors and money talks. Much is possible.
It is not uncommon for people in 12 step programs to have felonies in their past. This may also include criminal activity which has no convictions. A percentage will choose to go to unregulated places to leave behind their past.
It then becomes logical for them to start a rehab in the unregulated place. They have transformed their criminal history into an unregulated rehab that, on the surface, seems legit. It can be construed as a front, depending on how you look at it. And there is no oversight. Perfect.
How long can this go on? Good question, Marc. It will be a very long time before any regulation or oversight is established here. Business will be good for at least 20 years or more in my guess.
In the event of regulation or oversight coming to pass they will move on to another unregulated place. There are many fall backs to choose from.
I have witnessed all this first hand. I would not dare to ask them for statistics of success. I can guess their cash flow from how much they charge, their cost base and how many people are in the rehabs. It is easy math.
They also have programs to keep people on longer and thus extend their cash flow.
Lastly, I know of one person in this place who I believe is not mentally well. This person has a criminal background with felony convictions and charges upwards of $20,000 a month for one on one rebab. It is pure 12 step. Again, unregulated and no oversight.
There is so much money involved + criminal backgrounds in a place where, let us say, legal matters can be overcome. Hence my realistic fear of harm.
Where does all the money come from to pay for the people to come to these rehabs?
1) Wealthy desperate parents from regulated places.
2) Wealthy young people from money.
Both of the above groups have little experience or knowledge in this field. In some cases, parents outsource their troubled tween to these places as a way to get them away from the family. It seems worth the money to get them a long way away.
That said, I want to watch Black Mirror. I keep my head down.
Thank you for the detailed update, Jerry. Very specific, interesting, and yes, concerning. I’m not surprised that most clients have complex overlapping problems that can’t possibly be dealt with in a 28-day program…especially one that is run by businessmen. And the reliance on 12-step groups is truly disgusting, given that the 12-step movement has always been deeply committed to free access. I am surprised that these places actually attract people internationally. I can well imagine the shifting settings, corresponding to gaps in the regulation landscape.
What strikes me most is that this sort of “business model” is almost identical to the evolution of small, independent cells selling heroin (more like a franchise than a cartel)….which I’ve learned about through the book “Dreamland” — an excellent resource on the evolution of heroin in the US.
Yes the business model is like an independent cell.
They charge the same or more than rehabs in the US, UK etc. but the average monthly salary of a local worker is less than $250.
They are therefore much more profitable than rehabs in the US UK etc.
I will see if I can get Dreamland. It sound great.
From this discussion I gather this: the intersection of 12 step dogma, medicine, rehabs, courts, social policy, medical insurance, and folklore etc. has given birth to “The Addict”. An extremely profitable person indeed.
Thanks Google and Marc 🙏 . The business model of addiction is appalling. The fact that Google and people like yourself opening conversations like this restores some hope of finding better ways forward.
online marketers use Google search terms to essentially hijack the good name and reputation of notable treatment providers only to route the caller to the highest bidder.” This is a bold step by google
Certainly a good move to limit all of this rehab exploitation. Link below for an in-depth exploration of the absurdity of rehabs in Applachia and elsewhere. Commodification and marketing define American life now. Absolutely everything is for sale, and there’s a sucker born every minute.
http://projects.huffingtonpost.com/dying-to-be-free-heroin-treatment
Hello Mark,
Thanks for sharing such an informative post.
Interesting front page article about the an American rehab giant in todays NY times:
The Rehab Giant, Under Attack
https://www.nytimes.com/interactive/2017/12/27/business/drug-addiction-rehab.html?hp&action=click&pgtype=Homepage&clickSource=story-heading&module=photo-spot-region®ion=top-news&WT.nav=top-news&_r=0
treating addiction and related mental health disorders for over 30 years. Our abstinence-based treatment model is rooted in the work of our co-founder, Dr. Gordon Bell, a pioneer in the treatment of addiction in Canada. Bellwood as an addiction treatment rehab centre is defined by our long-standing experience, combined with our commitment to excellent patient care.
Thanks.
Hi Marc,
I just listened to this radio interview on our national radio in New Zealand, with a Kiwi journalist who has been tracing links between Cambridge Analytica, social media microtargeting software, psychometric surveys, religious counselling and “care”, and the Trump election campaign. Targeting people with depression, marital problems etc., to try and get them into church congregations and then manipulate how they vote. The guy’s name is Brent Allpress, and the documentary “People You May Know” is coming out soon. The thing that made me think of you and your work, is when he said he found a link between opioid addiction treatment providers and the campaign against the legalizing of medical marijuana. He points out, and you well know, opioid addiction treatment is big business. He suggests that the opioid addiction treatment business is similar to the weight loss business, built on anticipated return customers. You will also know about the billionaire Sackler family and its company, Purdue Pharma, being named in lawsuits alleging their marketing tactics helped get a nation hooked on painkillers.
I had to listen to the interview a couple of times, to try and get my head around it. Some people think that COVID-19 is a conspiracy, but this stuff really is – it’s scary.
https://www.rnz.co.nz/national/programmes/ninetonoon/audio/2018767461/the-kiwi-researcher-exposing-the-links-between-the-religious-right-and-trump
Further to this comment Marc, the documentary “People You May Know” seems to be coming out this February 2021 in New Zealand where I am, on Sky channel, which you have to pay to view. I know somebody with IT skills who has managed to download a copy from somewhere, but I don’t have those skills.
Metrotone Media is the owner / maker of the documentary I think: https://metrotonemedia.com/2020/06/05/people-you-may-know-2. The trailer can be viewed at that website anyway. I have emailed Metrotone Media, to find out how I can view it.