In a recent blog post, I cautioned about a particular program and rehab, Narconon, which is actually a front for the church of Scientology, obviously choosing a name that sounds like a 12-step program as a lure. But at least they actually do something (indoctrinate people in their cult).
As we’ve known, but as John Oliver has highlighted in a way that only he can, a much more prevalent abuse of vulnerable individuals, families, and health insurance premium payers is that the country is chock full of facilities calling themselves rehabs (and also sober residential programs) which offer either minimal help or actually do harm. Responding to outreach/marketing from these enterprises is perhaps not so different from replying to email from Nigerian princes in need of a loan.
In the late 1980s, with the advent of managed care, health insurance, which had previously covered inpatient rehab treatment for virtually anyone with a drug or alcohol problem, dramatically cut back. In most Massachusetts-based plans, only detox was covered (the typically brief process of physically withdrawing someone safely from an addictive substance), and even that only if the person showed signs or history of withdrawal symptoms. With some exceptions, “rehab” (usually a month-long program beyond detox with a heavy schedule of educational and therapy groups as well as peer support meetings and medical oversight) was available only to those with money. (At present, a month-long self-pay stay at a nice rehab can easily cost over $60,000.) Instead, most plans were covering up to a few weeks of intensive outpatient treatment followed by regular (weekly) outpatient therapy/counseling. Fortunately for everyone, self-help groups are much more available and supportive, requiring no expense or managed care approval.
With the advent of the frightening opioid crisis (itself largely an outgrowth of medical overprescribing encouraged by pharmaceutic companies), and the astounding number of deaths by overdose, some health insurance plans have begun covering rehab stays again. With that increase in available money, we have seen a new surge of activity by profit-driven crooks. The Boston Globe recently ran a series on how some Massachusetts-based individuals have recruited addicts to fly to Florida, which seems to be the current ground zero for ersatz treatment, where rehabs and residential programs make big profits on services including frequent urine tests and further enhance business by fostering recurrent relapses. (Relapse is a common feature of addiction in any case, but ostensibly most treatment facilities seek to prevent it.)
John Oliver notes that the term “rehab” itself is not controlled. (The same is true for “therapist” – you, blog reader, can bill yourself as a therapist or a rehab tomorrow if you’d like to.) And that many of these places are not offering so-called evidence-based treatments. I’m afraid I have to add that even those that say they are doing evidence-based treatments may not be replicating them in the way they were done in the original studies. In addition, even treatments that have been certified as evidence-based (based on questionably meaningful outcomes) may not be relevant to real-life needs of real individuals. And, on the other hand, some treatments that no one has managed to get certified may actually be quite useful.
To my mind, in evaluating a rehab, you’d want to answer questions like these:
- Upon visiting the facility, does there seem to be a lot of treatment going on?
- Who are the staff, what are their credentials/training, and what is their history of providing care over time?
- What kinds of “reviews” have been forthcoming from former patients in the program being considered?
- To what extent does the advertising emphasize slickness and luxury (often not correlated with therapeutic mission)?
- Does the facility claim that it “cures” a condition that is known to be chronic, i.e., can go into remission but doesn’t go away.
- How long has this facility been in business and to what extent has it earned respect over time (especially if not recently bought out by another corporation)?
One advantage of consulting with actual addiction professionals who derive no profit from treatment facilities (e.g., at lawyer assistance programs) is that it can provide some more objective input and guidance.
Jeff Fortgang, PhD, LADC-I