If you’re even reading this, there’s probably a good chance that you or somebody near to you is struggling with an addiction to drugs or alcohol. In the midst of all the mayhem that comes along with substance abuse, finding the light at the end of the tunnel can seem impossible. Often times the road is unclear, as the subtle lines between offering love and enabling, supporting or destroying become even more blurred. As the addiction progresses, emotions of both the user and the loved ones become ever-stronger, making the capacity for strong decision making even harder. That’s what I’d like to help you with.
First of all, you should never try to take responsibility for the treatment of the addicted individual. It is a serious ailment that requires serious professional treatment. Unfortunately, not all treatment is created equal. In the enormous boom of rehabilitation facilities that have sprouted over the last couple of years, many do offer truly exceptional treatment, but not all. As with any business, integrity can be easily disposed at the promise of a few extra dollars. Over time, certain practices have become increasingly prevalent, bringing an air of notoriety and distrust to the treatment industry as a whole. Remember though, there are facilities and programs that still do great work! Moving forward, I’d like to bring light to a few of these schemes so that you can better know what to look for when choosing an option that is best for you. I’ll conclude with a few critical questions that can help you weed out the winners.
So that being said, let’s take a look at some of the perils of the industry. Here’s some of the hot-phrases that have made headlines lately:
“Junkie Hunter.” “Body Broker.” “Kickbacks.” “Insurance Fraud.” Sounds like the resume of an aspiring gang recruit, huh? Topics like human trafficking, drug dealing and fraudulent business models are usually reserved for conversation about the darker folds of mankind; New York mobsters or Mexican drug cartels. These characteristics call to the imagination vivid images of shady black market transactions in abandoned warehouses, strong-armed extortions of local businesses and elaborate strategies to avoid legal recourse at all costs. But what if I told you these people were here to help? Would you trust them with your kids? How about your spouse? I hate to say it, but maybe you already have. As the death toll of addiction has reached over 70,000 in 2018 alone, the demand for acute, intensive treatment has skyrocketed. Here’s why—the treatment industry is emotional by nature. Pair that with the inherent urgency involved in the cessation of drug addiction, as well as the overall lack of regulations, and the potential for abuse is born. Before going any further, I’d like to preface by explicitly saying NOT ALL TREATMENT IS BAD! Despite the growing number of “revolving door” rehabs that have sprouted up across the country, there is no shortage of honest and proficient centers aimed towards long term recovery. That said, let’s take a look at some of the unsavory practices that have evolved with the advent of insurance-funded “luxury rehabs”.
These referral services, commonly marketed as “rehab placement” companies, are the ground soldier equivalents of the treatment hierarchy. Their business model is simple—bring patients (customers) to contracted facilities. Having negotiated a deal with a select few centers, usually at a set dollar amount per patient, they offer their “free” services to the public, promising to find the best “fit” to accommodate your loved one. Claiming comprehensive knowledge of cutting edge treatment and an extensive network of facilities, they prey on the most vulnerable target of all—your heart.
Not surprisingly, most people are poorly versed in the world of recovery. Why should they be? So when a friendly voice picks up the phone on the other end of your google query, asking questions that will bear no weight on their ultimate decision, but assuring you that they know “just the place”, you breathe the first deep breath you have taken in months, maybe years. Finally, somebody is on your side. Think again. Your call and your life boils down to little more than a paycheck, a small incentive to fill beds. Dare I call them kickbacks….
And here’s the real kicker, you’re worth a lot more if you relapse.
Why settle for one referral fee when you can play the perpetual good guy? If that treatment didn’t work, “Well that‘s just the nature of the disease. I can get you into another fantastic treatment tomorrow. What kind of insurance did you have, again?” This process goes on, unmitigated by anything or anyone until you finally become privy to the game or die. These are the unfortunate circumstances for so many seeking help from the grips of addiction.
“Body brokering“ or ”patient pushing“ is the ugly(er) cousin of rehab placement. Although similar in concept, the world of body-brokering transcends even the most basic ethical and moral standards that one would hope for in such an emotionally charged arena. Nearly all of this patient brokering is done under the table or through convoluted, semi-legal contracts, arbitrated by individuals loosely affiliated to the facilities they are referring to. (You can learn more about this specific practice and the steps California is take to fight it, here).
To better understand this, you’d first have to know a little bit about how insurance-subsidized treatment operates. Depending on the circumstances of each individual, or more importantly the diagnostic status, insurance companies will cover varying levels of treatment. Starting with the most intensive care, or detoxification, all the way through residential, intensive outpatient and outpatient, insurance aims to cover as little as possible. In other words, as soon as they deem you eligible for lower levels of care, they will drop your coverage. Eventually, no matter the level of preparedness an individual displays for long-term sobriety, insurance cuts short and they are on the streets once again.
But of course, there’s a loophole. It’s kind of the name of the game.
Given the relatively short period of time that insurance has extensively covered addiction, the parameters of “proper treatment” remain loosely defined. Many insurance policies, PPO’s (Preferred Provider Organizations) being the golden goose, will cover treatment numerous times within a fiscal year so long as the individual meets a single requisite—they currently have a substance in their system. No sufficient fear of relapse, mental instability, or strained extraneous circumstance can necessitate addictions treatment. Only relapse. And luckily, that‘s what addicts and alcoholics to best.
So what does this have to do with body brokering?
Imagine your son or daughter has just left residential inpatient treatment. Under the best of circumstances they’ve been there for 60 days, but standard coverage is 30 for most policies. Even those with the most rudimentary knowledge of recovery know that that amount of time barely scratches the surface. The trauma is fresh. The withdrawals have subsided, but the obsession is alive and well. Intense discomfort calls out for familiar vices and the prospect of long-term sobriety is daunting. They’re approached by a confident, young individual, with an offer they can’t turn down: two thousand dollars—to get high…
There’s a catch though, they have to go back to rehab. And that two thousand dollars? Well that’s a small price to pay for the five thousand dollar kick back paid out from the facility. The cost of business, if you will.
And if those numbers seem a little high, consider the fact that a 28-day inpatient rehab can cost anywhere from $6,000-60,000, usually somewhere in the middle. While this whole thing may seem a little extreme, it is not the cautionary tales of conspiracy theorists purporting anomalous incidents to anyone who will listen. This sickening practice has become so prevalent it has earned itself a suitably horrifying moniker: “junkie hunting”. Don’t believe me? Type it on google.
Okay, so the process of getting IN to treatment is riddled with corruption, but how about the treatment itself? Well these are no pillars of integrity either. In fact, the most fundamental requisite expected from these facilities, being complete insulation from drugs and alcohol, is not a guarantee. These sober livings and rehabs, which are being shut down in droves in Florida and areas of Southern California, are commonly referred to as “flop houses” by those in the know.
Again, the business model is simple, but slightly different based on the designated purpose of the facility. In the case of inpatient rehabilitation, insurance grants coverage for a couple of days at a time based on the services rendered. The more “comprehensive”, the more that can be billed to insurance. This includes everything from drug testing to therapy, medication management, acupuncture and everything in between. Every couple of days the patient is up for re-evaluation, at which point the liaison to the insurance company formulates a list of diagnostic codes that hopefully ensure further coverage.
Ultimately, this is a fairly standard practice in any medical insurance billing. Make no mistake, there are wonderful treatment centers that bill insurance and offer spectacular services, but the system is incredibly easy to manipulate!
After all, what really dictates good treatment??
More on that later.
Services equal money. Whether they are necessary can be of little importance to the care provider. In fact, sometimes the facilities can truly care less if the services were rendered at all! Take for instance the ever-growing list of rehabs indicted in Florida for millions in insurance fraud. This tactic is by no means a rare occurrence.
And then there is the true “flop house”. A sober living which accepts the rent of its patrons and could truly care less if they are sober at all. This is one of the most harrowing and widespread forms of heartless treatment profiteering. The world has no shortage of addicts and alcoholics with no interest in pursuing sobriety. It is the nature of the ailment. Many times, these individuals find themselves in a bind, threatened with the loss of shelter or family if they don’t choose a path of recovery. Luckily for those, sober livings will take them in and turn cheek, gladly accepting rent from those financially responsible whilst facilitating the same behaviors they have been paid to prevent.
What Should I Do?!
As I’ve stressed from the beginning, there is no shortage of quality treatment, but in the boom of the opiate crisis they have become harder to find in an ocean of questionable businesses. So what do I do?
First of all, do your own research!!
Even if the recommendation comes from a trusted addictions therapist, always ask your own questions. Legitimate operations should have no trouble whatsoever answering even the most scrutinizing inquiries. Here’s some of the things you may want to ask?
“How long have you been operating?”
This question is incredibly important as to the overall credibility of the facility. In the boom of the addiction crisis, the market has over-saturated with short-sighted entrepreneurs looking to make a quick buck. If they’re not engaged in questionable activities, these places often go belly-up as a result of inadequate knowledge in the field of addiction treatment. Longevity speaks volumes. If people have been coming back this long, there’s probably good reason.
“How is your alumni community?”
If long term sobriety is the goal, it should only make sense to ask what happens to all of the people who’ve been treated in the past. If the prior residents are nowhere to be found, that‘s probably a bad sign. Recovery involves consistent community and nearly all strong treatment programs will try and facilitate that in some form or another. After all, the real testament is what happens after your loved one leaves. An alumni presence can really be synonymous with success.
“How long is your program?”
Long story short, recovery doesn’t happen in a month. The 28 day model is based not substantiated in medicine, but rooted in tradition from an industry born many years ago and never reconsidered despite an immense rate of failure. If you’d care to do your own research on the history of 28 day programs, feel free, but believe me when I tell you the number is arbitrary. Those who remain abstinent from substances for over a year have a nearly 50% better chance of achieving long term sobriety. This work takes time.
“Why does your program work?”
Don’t settle for convoluted explanations about cutting edge therapies veiled in the allure of amenities. A good program knows why it work. Period.
While these are some of the questions I believe to be pertinent, follow your heart. Consider your own personal experience and ask how the program really fits. Addiction is complex and one size does not fit all. If something feels wrong, it probably is. Do not be afraid to be critical. This is life or death.