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EXCLUSIVE: New documentary assails questionable ethics in addiction treatment industry

April 21, 2015
by Gary A. Enos, Editor
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An individual in long-term recovery who worked in the treatment field teamed up in 2011 with a filmmaker with no previous exposure to the subject of addiction to examine the practices of the treatment industry. The result of their work, a documentary that will have its official premiere April 26 at a film festival in California, paints an altogether unflattering picture, arguing that the nation's substance use problems have worsened at the same time as the field's revenues have soared.

The Business of Recovery,” which received a preview showing in March at the Phoenix Film Festival and will be featured twice next week at the Newport Beach Film Festival, features interviews with treatment center executives, research experts, and addicts and their family members who sought to navigate what they often saw as an uncaring and money-driven treatment system. Producer Greg Horvath says he started working on the film four years ago with director Adam Finberg because “I started to question a lot of what we do. You can only see it so many times not working.”

Some of the family members who appear in the documentary say their loved ones endured numerous frustrating treatment experiences from many providers. Susan Colasurdo, whose young adult son Michael died of a heroin overdose three months after he was interviewed for the documentary, said in the film in reference to the facilities her son had visited, “Not one of them has done anything different from the others.” Being left in the dark about what their expenses were paying for is a frequently cited complaint among the family members interviewed for the film.

The documentary reserves some of its strongest criticism for 12-Step approaches to treatment, citing that while a 1998 national sample of private facilities found that 90% based their treatment on a 12-Step model, only around 5 to 10% of patients are substantially helped by this approach (the latter figure is stated in the film by retired Harvard Medical School professor and 12-Step critic Lance Dodes, MD).

Prescription for improvement

While Horvath and Finberg tell Addiction Professional that the film does not set out to offer a solution to shortcomings in the field (they say they prefer to let viewers judge what they see), the documentary does offer hints to some alternative strategies. Presented by interviewed sources such as Dodes; addiction medicine specialist Stuart Finkelstein, MD; University of New Mexico emeritus professor and Motivational Interviewing (MI) expert William Miller, PhD, and SMART Recovery and Practical Recovery president Tom Horvath, PhD (no relation to the film's producer), these suggestions include:

  • More of a strict science-based approach to treatment. Miller says in the movie that some addiction field leaders will call a treatment “evidence-based” if just one study shows a basis for it—even if dozens of other studies call the approach into question. Greg Horvath says too much of what happens in addiction treatment is based on “passion and belief,” adding, “We don't treat cancer that way.”

  • A commitment by government to regulate the industry more closely if it will not police itself better. The film offers sharp criticism of sober home operators in this regard, with Michael Colasurdo saying “They're not so sober” and acknowledging that one home where he stayed conducted no drug testing and routinely allowed residents to leave the premises on evenings and weekends.

  • Stronger education and credentialing requirements for clinicians. Dee-Dee Stout, a consultant and counseling professional, admits in the film that the fact that she herself started working with addicted patients after she had just nine months of sobriety and no educational background in the field amounts to a “scary thought.”

  • Clinical services that are less heavy on educational lectures and coercion and look more at the factors that motivate individual patients.

  • A more systematic approach to measuring the success of treatment, moving away from efforts that rely solely on patient self-report. “I don't understand how an industry that has never defined what success means can be allowed to cite success rates,” says Greg Horvath.

Tom Horvath tells Addiction Professional that the movie is “upsetting,” adding, “It is a reminder of the abuses in the substance abuse treatment industry that I have been aware of for so long that I have been desensitized to them.” He says, “Fundamentally it's an appeal to ethics and science.”

The producers compare increasing death rates from drug overdoses to declining death rates from cancer, stating that the latter field's work is paying off for patients because it is governed by science. The film also cites statistics on climbing revenues in the addiction treatment industry, and lists the high salaries of some nonprofit facility executives.

The filmmakers say they are currently planning next steps following the Newport Beach event, as they have received numerous requests to screen the documentary and also are looking to reach a distribution deal.

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Comments

I've been in this field for some time and it has pained me to see how badly managed centers are, how good clinicians leave due to frustration, hostile work environments, and being put down by mediocre staff. I know of one center where the director was sleeping with the patients, was investigated, had his license revoked, and then went right back to his unethical behavior and was able to keep his rehab center open. I had a supervisor who had fraudulently obtained his license, got caught, but the hospital never sanctioned him or relieved him of his duties. Friends and associates similarly share horror stories like this, and we all wonder what we are doing in such a profession. Money over humaneness or compassion; no national standards of care; burn out rates are some of the highest in any field; and mediocrity is becoming the preferred norm over skill, talent and knowledge.
I applaud Horvath and Finberg for having the courage to expose our underbelly. It's about time!

www.compasisonatebeginning.org

I have to disagree with the previous post. I work at a long term residential treatment center, and am in the process of attaining a private D&A facility license in my state, as well as my LPC. The ethical standards and the staff credentials at my full time job are very appropriate as will be in my private practice. As a whole however, I see facilities in my state that have people in recovery doing counseling with very little, if any formal training in counseling or psychology. I think we do ourselves a disservice in that sense.

It seems some facilities think being in recovery is enough-with that I strongly disagree. I certainly do not agree with the "money over humanness or compassion". Again at my full time job, we've taken people in that did not even have medicaid. We still gave them a bed and treatment.

While I would agree the 12-step programs work for a great many people, it is not one of my favorite approaches to addiction. I think there are other behaviors and thought changing issues that need to be addressed-at least in the time they are with me. If they want to attend meetings and go that route, good for them.

Elle - I respect your disagreement. It is admirable that you do give patients beds, but as you know that is not the norm. When long term treatment costs $25k and up for a month, one has to ask how people can afford care - especially when most centers don't take insurance. As you said, you do see facilities with counselors that do not have the requisite skills, which does a disservice to patients/clients.

I think we actually we agree on more points than not.

In my practice, our ethics, standards and credentials are way above the minimum required standards, and we all feel that the CASA Columbia University Report on "Addiction Medicine: Closing the Gap between Science and Practice" should be on every practitioners reading list, to name but a few.

I think a documentary that shines a light on the challenges that are faced in this industry is long overdue.

I post my name as I have no need to hide behind anything.

The addiction field as a whole does not operate as a facet of health care. Some do a very good job of actually caring for folks with integrity, high standards of care and as any regulated facility that provides care for human beings.

Patient brokering and the bottom line have fueled this industry. If you try to actually google a facility and then try to reach THAT facility... you have to go through a bunch of crap first. Usually some sort of marketing group has control. If you use online methods most facilities are redirected to whatever marketing company that is slinging that particular facilities.

They get a piece of pie to send client's to facilities. It seems that there are a handful of big marketing folks that put a lot of money into being the top dogs on google search lists.

The marketing folks send clients to whoever they are dealing with for the agreed upon price per person that admits and stays beyond a few days. Several thousands of dollars can be made on each clients. A lot of small facilities are being cut out of action and have little to no clients as a result of not being able to pay those fees to acquire clients or who are being bought up by the larger facilities.

LETS TALK ABOUT ASSESSING THESE CLIENTS. Admission and intake folks... not all but most are sales people. While they may have gotten sober themselves almost all of them lack a fundamental background health care education and experience. They are unable to accurately assess a client factions in not only the obvious addiction issues, but a medical background associated with age and medications outside of the addiction. They are also incapable of factoring complications that may arise during the detox.

Many a time I have been on the receiving end of a client who I know full well does not belong at the place I was working. Admissions refused to listen to concerns and made decisions to take the client on because of the money and disregard the need for a higher level of care.

It is beyond frustrating. Admissions lying to families and making promises that are counterproductive to caring for the client on a safe level or what can actually be delivered. Once they are in the door those folks don't care. They won't return calls to families... it sort of is a form of patient dumping..... drop the client on staff, collect the money and disappear.

People have been forced out of work because they would tell owners/admissions/those in charge "no this is not a good idea at all. Someone can get hurt"

Factor in staff that is not trained to a level that can recognize dangerous situation. It happens more than you think.

A lot of places hire folks who are newly sober because it is cheap or free labor. All the while the executives are collecting several thousands a year.

Just because someone got sober does not make them a good fit to care people. THEY LACK BOUNDARIES, UNDERSTANDING IN CARING FOR ANOTHER LIFE and perhaps mean well without knowing any different.

I always say that you don't see the guy who has an open femur fracture... healing and then trying to become an orthopedic surgeon without going to med school.

I can ramble endlessly about this. I have seen plenty of folks come along and make a crap ton of money all the while I make a so so living doing the right thing.

I run circles around most of these folks and have no problem calling it the way I see. That for sure alienates me from a large part of the industry. I am neither a sell out nor a narc. I am an advocate for every person who enters treatment. They are entitled to a safe place to try to recovery without worry of substandard care being marketed as cutting edge best in the industry but not really...

There are many who provide solid care who like me, do the right thing and provide a high level of care with integrity. Those are the folks that get shut of the public eye.

I am sure I have said enough to have even more in the industry mad at me. Good. I hope so. Because what you are doing is a joke. It is harmful. It is greedy. And people die.

What makes me an expert? Some who worked in emergency medicine since 1990 in acute care, flew as a flight medic for 6 years and been to treatment twice myself. I now work with and around and here and there in Addiction Medicine having detoxed some of the most difficult clients with the best doc in the business in my opinion. I have seen the industry... I weeped because it was and still is such a mess. HOT MESS made of money grubbing fools

PS anyone looking to hire someone like me.? Consulting is tough at times. If I were a trust fund it would be easy breezy

I was once told that if we knew what went on in the kitchen of most restaurants we would never eat there. The same is true with treatment. If we knew what was going on behind the scene of most treatment programs we would never send someone there.

Many rehabs are staffed by ill-trained and under educated staff. Many drug/alcohol counselors barely have a G.E.D. Clients are told that they must really WANT to stop using/drinking with no clear & logical treatment protocol in place to help them do so. Most addicts/alcoholics are suffering from a chemical imbalance such as depression, bipolar disorder, schizophrenia, etc. along with unresolved trauma. The recidivism rate is 98% for people who attend various drug/alcohol programs. This is shocking but true. I spoke to one drug/alcohol counselor and asked her how she knew that she was really helping her clients. She told me that after clients left she called them six months later and the majority told her that they were still clean/sober! She clearly had no proof but the word of her ex-clients. No one can really prove that 12-step programs are effective since it's a anonymous program that does not keep statistics on its members that can be verified. Most rehabs make exaggerated claims as to their success rate. I have seen clients go in and out of rehabs year after year. The county hires under educated and ill-trained employees because it's cheaper than hiring educated competent individuals. Unfortunately, you get what you pay for.