SPECIAL REPORT: Addiction treatment at an ethics crossroads

Addiction treatment providers may be getting a free ride when it comes to what they promise and what they deliver, and the Internet is giving them some extra fuel in terms of getting what they depend on: patients. But who is policing what is being promised on the Internet, as well as by the call centers interwoven into the marketing strategies of treatment providers? Who comes between the desperate family member looking for help right now and the treatment provider, to guarantee that the treatment is evidence-based, worth the money, and likely to produce a good outcome?

The answer: Right now, if the program is not a public program, nobody, at least not from a federal standpoint, and not in the two states—Florida and California—that we will take a closer look at later in this series.

Public programs—those paid for by taxpayer dollars such as the Substance Abuse Prevention and Treatment Block Grant, Medicaid, or Medicare—are more closely scrutinized than private programs, as this series will show. And treatment providers know it.

“In the public sector you have to be pretty accountable for those dollars,” says Mark Fontaine, executive director of the Florida Alcohol and Drug Abuse Association (FADAA), which represents treatment facilities in the state. “You get sanctioned if it’s not appropriate.” But for private programs, paid by insurance companies or increasingly by “self-pay” patients who go into debt to afford the treatment, there is no such accountability—not in Florida, not in California, and not in the federal government.

The “treatment locator” of the Substance Abuse and Mental Health Services Administration (SAMHSA) lists any program that is state-licensed. There are no ratings—SAMHSA depends on the states to do the monitoring.

The single state authorities (SSAs) in the states are responsible for monitoring treatment programs that receive federal block grant funding. Licensing authorities in states are responsible for making sure that programs adhere to licensing statutes.

The bottom line: Programs must not break laws. But as the top lawyer-physician in SAMHSA, H. Westley Clark, M.D., J.D., director of the Center for Substance Abuse Treatment (CSAT), told Addiction Professional in an interview for this series, “Just because something is legal doesn’t mean it’s ethical.”

Questionable practices

Here are the most common practices we heard about that are taking place in the addiction treatment industry, and that are considered unethical by leaders in the treatment industry and by government officials. Many of these practices, especially those involving kickbacks, are also illegal if performed by providers that are paid by taxpayer dollars:

·        Using call centers to share patient prospect information with and between treatment providers.

·        Paying bounties for referrals.

·        Giving large gifts to interventionists with whom a program works.

·        Claiming to take a patient’s insurance, when in fact the anticipated reimbursement is very low.

·        Paying kickbacks to labs that are overcharging insurance companies for drug tests performed on a facility’s patients.

·        Promising a cure.

·        Using nutrient supplements that are proprietary and billing the patient.

·        Using brain scans and other unproven treatments and billing the patient.

·        Internet marketing scams.

“Why are most of these practices occurring on the private side?” rhetorically asks Michael Cunningham, acting director of the California Department of Alcohol and Drug Programs (ADP), the SSA for the state. “I would surmise it’s because that’s where the dollars are.”

That leaves licensing, but licensing has its limits. In California, ADP’s Licensing and Certification Division conducts an initial site visit to review health and safety issues and program policies. Compliance reviews are conducted once within each two-year licensure period. If a complaint is received, ADP initiates an investigation. But ADP’s licensing division doesn’t give any advice to consumers. It is simply the licensing authority, with its mandate to follow.

Clearly there are many ethical and high-quality providers in the addiction treatment field. But at a time when addiction treatment is continually blasted by negative press and patients are saddled with stigma, it is equally clear that unethical providers—however legal their operations may be—can hurt the whole field.

As David Lisonbee, president and CEO of Twin Town Treatment Centers in Los Alamitos, Calif., observes, “We all get painted by the same brush.”