Drug rehab statistics show that the percentage of those who will relapse after a period of recovery ranges from 40 to 60%. These recurrence rates are similar to those of chronic illnesses like hypertension and diabetes. People spend a lot of money and effort on treatment, so why is drug rehab so frequently unsuccessful?
Addiction is commonly known as relapsing disease. This might explain why over 85% of patients with drug use disorders relapse and return to use within a year of treatment. Studies show that at least two-thirds of recovering individuals relapse within weeks to months of starting treatment.
The aim of substance use treatment is to help individuals achieve lasting abstinence and return them to productive functioning in the community, family, and workplace. According to research that monitors patients for extended periods, a majority of those who enroll and remain in treatment quit abusing substances, reduce criminal activity, and enhance their social, occupational, and psychological functioning. But the treatment outcome bases on:
“Relapse rates for patients treated for drug abuse are similar to those for people treated for chronic illnesses like asthma and high blood pressure.”
Relapse to drug use doesn’t mean that treatment has failed. The chronic nature of substance dependence means that relapse can be part of the healing process for some patients. When someone returns to drug use after a period of abstinence, he or she needs to speak with their caregiver to resume, modify, or try other treatment options.
Ending drug use is a huge milestone, but it’s just a part of a long and complex recovery process. Individuals still need to overcome many challenges. Relapse occurs when one gets stuck along the way. They’re faced with a challenge but are unable or unwilling to confront it. So, they turn to inappropriate coping mechanisms as a way to deal with their inner turmoil and dissatisfaction. Unfortunately, this only leads them right back to substance abuse.
Reputable drug rehabs offer remarkable help to people in need. The training, therapies, support, and supervision included in these treatment programs aid individuals in depths of substance dependence find new way of living. But the National Institute of Health states addiction is a chronic condition that requires ongoing care. For that reason, more than 50% of those who pass through drug or alcohol rehabs need multiple rounds of therapy to attain a form of recovery that lasts. But even so, not all of these individuals emerge successful in their fight against addiction.
This begs the question, why is the drug rehab so frequently unsuccessful?
Completing substance abuse treatment doesn’t guarantee sobriety. After leaving rehab centers, patients usually go back to environments where they abused drugs. Some places, people, or things can spark memories of drug use, and trigger urges that cause relapse.
Different aspects can increase the chances of relapse, including:
Triggers include anything from sensations, feelings, or thoughts to relationships and situations that cause the recovering patient to use after a period of abstinence. Holiday parties involving social drinking, exposure to drug-related objects, walking through drinking joints, or hanging around friends who are still using are examples of triggers that can cause a relapse. Unfortunately, recovering patients are consistently exposed to these triggers, making it hard to abstain.
Substance abuse treatment doesn’t end at the rehab facility. Recovering patients should continue with further treatment as specified in their relapse prevention plan. Rehab may stop the urge momentarily, but taking the right steps ensures long-term recovery. After-care services like 12-step, support groups, and other prevention programs arms individuals with coping skills that are essential to staying sober. A strong support system from friends, family members, recovery coaches, and peers can also encourage one to soldier on. But many patients don’t get this assistance, so they end up sliding back to their old habits.
Other internal and external factors like fatigue, physical pain, depression, self-pity, dishonesty, and unemployment can cause an individual to relapse. Researchers from one study discovered that risky drinking is common among the unemployed and that unemployment is a risk factor to drug use. Pity parties – when one feels sad, they can no longer hang with friends at bars or events -- can spark thoughts and eventually cause a relapse.
Just because a patient accepts to enroll in a rehab center doesn’t mean they’re all for the idea (or ready for that matter). There are different things that one can do to undermine their recovery process. For instance, one can join a program with no sense of commitment to life after addiction. Although therapists may use cognitive behavioral therapy among other treatment modalities to address such a problem, it takes dedication and desire to get better on the patient’s side to succeed in treatment.
The same applies to patients who won’t share their insights during group therapies or ones who mock others in the counseling sessions. These individuals often have unresolved issues and disrupt meetings, which are essential in addiction treatment. Patients who don’t listen or are adamant about opening up aren’t able to take advantage of the healing and usually return to using soon after treatment.
The addiction rehab industry is packed with false claims and unsubstantiated care. As we’ve mentioned earlier, a significant percentage of recovering patients resumes drinking shortly after treatment. Research also shows many individuals who pass through rehabilitation wind up with a greater sense of personal failure and despair. This could be because of one or a combination of the following reasons:
With so many factors contributing to addiction, creating a standard treatment approach that works for everyone is impossible. The National Institute on Drug Abuse details the principles that rehab centers should use to individualize care for each patient. But still, most patients only pass through a short detox period, followed by a series of lectures, 12-step, and group therapy. Generalized treatment isn’t effective in addressing the mental, physical and emotional needs of each client.
The intensity of detox varies depending on the type of substance abused, length of use, etc. When a patient doesn’t get enough detox, it means he or she may still have the toxic build-up in their body. This will predispose them to cravings or flashbacks that may act as a trigger. Sadly, run-of-the-mill detox programs don’t consider this and leave their patients not fully detoxified.
Substance addiction often co-occurs with mental illness or other conditions. The Substance Abuse and Mental Health Services Administration revealed that there were about 9.2 million people who experienced both mental health and substance abuse disorders in the US in 2018. Combining strategies from fields of addiction and psychiatry treatment is a great way to ensure long term sobriety, according to SAMHSA. When the dual diagnosis isn’t taken into consideration, then the patient is highly likely to suffer a mental relapse and end up using the substance again.
Some rehab centers – particularly the luxury ones – go above and beyond to make the lives of their patients comfortable. They offer vast services like ocean therapy (riding a yacht), equine therapy (tending to or riding a horse), aquatic aerobics, fitness training, qigong therapy, work assignments, leisure skill groups, among other services along with other care programs. While these are great, there’s no scientific evidence of their effectiveness in substance abuse treatment. These services are great differentiators, but none of these rehabs monitors patient outcomes, despite promising quality results. These are just some of the reasons that drug rehab is so frequently unsuccessful, depending on how you look at things.
As we outlined in part 1 of this series, body brokering has been made illegal at the Federal level with the passage of the 2018 SUPPORT act. However, this bill contains an unfortunate loophole. This allows drug rehab centers to continue to use body brokering to recruit new patients into their facilities.
The 2018 SUPPORT for Patients and Communities Act allows for “certain payments to bona fide employees and independent contractors”. In this sense, eliminating kickbacks to just anyone off the street, like the drug rehab bounty hunters who were looking for kids and young adults with insurance coverage. Now the same people that brokered patients who were struggling with addiction, can become hired, (on salary) from a drug rehabilitation clinic. As long as they aren’t paid per head, there is technically not a “kickback” taking place. This is what is keeping much of the practice of body brokering alive and well in today’s drug rehabilitation industry.
As mentioned earlier, some of these “recruiters” are even licensed insurance agents and can sign you up for insurance if you don’t have coverage. Let me remind you that many of these people are not in the game to truly help people overcome their addiction. Maybe most of them really think that’s what they are doing. Maybe they think they are helping others, but when motivated by money and greed, the consequences of their actions can be deadly. Remember that to these businesses, relapse is much more profitable than sobriety and recovery.
This was a comment from a post on a private Facebook group. And yes, you read that right… A recruiter, who took a young woman out of state to a rehab facility, got her involved in the relapse to rehab shuffle, went to her funeral and did the same thing to others. This person ended up recruiting 5 more young addicts. Is this not madness yet? Why aren’t the insurance companies doing anything about this?
That’s a great question, that doesn’t have an answer yet. While some groups have organized, creating websites concerning ethics in addiction treatment, I can tell you that there definitely are ethical addiction treatment providers out there. I should know, I work with a handful of them.
When substance abuse treatment is provided with the best intentions, treatment does work. It can help people turn their lives around, but recruiters can be very persuasive with illegal inducements to re-enter treatment. This is a system that encourages people to inflict self-harm, relapsing just to restart their insurance coverage.
This happens all the time, someone who is in recovery goes to a 12 step meeting as a method of continuing aftercare upon the completion of their drug rehabilitation program. Many addicts graduate the treatment program and begin staying at sober living homes. Or, they relapse and enter the drug rehab shuffle at the beginning again, going through detox, inpatient rehab then on to a sober living home. Sometimes this cycle repeats indefinitely.
Some unscrupulous marketers will attend 12 step meetings regularly and try to talk people into either relapsing for treatment or entering their sober living home. Since they are bona fide employees of the company, technically, their work doesn’t produce a “kickback”. Many recruiters are paid salary because that’s just how you get around the law.
Since I don’t personally know any rehab recruiters, I can only assume that they have monthly quotas to meet. A certain number of heads to fill the beds at the rehab facility, otherwise, they’d be fired for not producing results. With the average client bringing in roughly $800 per day, the stakes are high. So, how does the $35 billion dollar a year addiction treatment industry keep growing for its investors? By finding more and more people who need treatment.
With drug addiction rates and drug overdose deaths skyrocketing in the United States, the market is definitely there. Drug rehab has even (inadvertently) created its own lifestyle around their existence.
Many drug rehabilitation centers around the US are rapacious. Most business entities are. It’s the nature of capitalism after all. That’s how jobs are created, so our economy keeps growing and moving forward. In healthcare enterprises, this frequently creates an incentive for putting profits above the needs of people. Unfortunately, this is precisely what happened to the addiction treatment industry, in a very short amount of time.
New patients to drug rehabilitation centers typically enter treatment, because they want to get better. In places like Florida and California, (where most of the nation’s rehab centers are located) the need to find new patients became urgent. Body brokers and rehab recruiters began offering inducements to people from out of state that needed treatment. They would buy the airline ticket or arrange travel to their rehab facility, completely free to the patient.
At first, this seems like a wonderful opportunity for the patient - to finally have access to treatment. It also offers them a chance to escape their daily routine, so they can focus on recovery. This is all fine and dandy until their insurance coverage runs out. Many of these patients get kicked out of rehab, onto the streets, with no money and no return ticket home. Many become homeless and begin to use drugs again. They know if they go out and get high, they can become eligible for treatment again, and thus, the rehab shuffle begins.
For many young adults in the US, rehab has become an alternative to homelessness. Rehab is also an alternative to working some shitty fast-food job, where you barely scrape together enough money every month to eat and pay for rent. Economic opportunity for young people in this generation isn’t the same as it was for their parents. Rent is astronomically high right now. College tuition has increased by an average of 234% since 1990. Hell, even if you go to college, it is still hard to find a decent paying job.
It seems that the odds are not stacked in your favor. With the lack of economic opportunities for today’s youth, it’s no wonder why so many of them end up depressed while turning to drugs and alcohol to self-medicate their inherent feeling of hopelessness.
Once a kid enters a drug rehab facility, seeing how easy it can be, it’s hard for them not to crave the ease of being institutionalized. Body brokering exasperates that desire for many young adults, offering them "the easy life" through inpatient rehab. This is where all of your basic life’s needs are met, while your parent’s insurance policy covers the bill. That is until your benefits run-out, or you turn 26 and are kicked off of your parent’s insurance plan. Sadly, a lot of young adults find themselves in this situation: homeless, unable to find a job, and addicted to drugs. It’s undeniable that this relapse-to-rehab-shuffle has greatly contributed to the growing homeless populations in many American cities.
You can read part 3 of our expose' here:
In case you’ve been living under a rock, or are one of the lucky FEW people in the United States who hasn’t been impacted by the opioid epidemic, or drug overdose crisis in some way, you may not have come across the term “body-brokering” before. Body brokering, by large part has been used to keep the addiction treatment industry afloat. Many drug rehabilitation centers still use body brokers, or "drug rehab recruiters" to fill their beds with patients. This is how the addiction treatment industry makes money, of course, and there’s absolutely nothing wrong with that, right?
Sadly, making money off of health care services in the United States has its definite share of adverse side-effects. These negative effects occur often within the addiction treatment industry, especially when access to treatment can quite literally mean life or death for the patient. The sad, ugly secret in the drug rehab industry, is that it’s more profitable to have people relapse than it is to actually help them get clean. This fact has helped foster much of the greed that is currently thriving in the rehabilitation industry while giving it a bad name.
While there certainly are reputable addiction treatment centers operating in every community across the nation, the bad actors seem to be getting the most media attention. Drug rehabilitation clinics who actually do a good job, are forced to compete with a thriving industry of crooks who are not out to help people. They just want your insurance money. The practice of body brokering has tainted the public’s perception of the addiction treatment industry as a whole.
Hundreds of stories from various local and mainstream media outlets have brought attention to the practice of body-brokering. Perhaps the first national attention to body brokers came out with the “Florida Shuffle” stories that began surfacing after the passage of 2010’s Affordable Care Act. The ACA, or “Obamacare” mandated that any health insurance plan must cover substance abuse treatment and mental health services as one of the ten “essential health benefits”. This has opened up the doors to, what some call “the wild west” of addiction treatment.
It’s literally “anything goes” in today's addiction treatment industry. Thousands of different treatment options across all 50 states. All with very little oversight or regulation within the industry. This leaves the consumer, the addicts, the people that need the most help, in the dark about which program will best suit their individual needs. Not only which one offers the best treatment, but also, which one isn’t just pilfering money from the health insurance company while offering little, to no actual treatment services at all.
To keep people coming in with health insurance plans, many individual treatment centers would pay kickbacks to people known as body brokers, for the “referral” of the patient. These are patients who’s insurance can pay the rehab facility upwards of $20,000 per month, or even more for inpatient treatment and related services. As such, the kickback became a lucrative enterprise for someone who knew their local drug scene.
Many drug rehab recruiters are recovering addicts themselves. Their personal experience with addiction can actually be beneficial to the business. They typically know where to go, where the drug activity is taking place and they know how to sell the idea of treatment to someone, even if they don’t necessarily want to quit using drugs. They tell them it’ll be like a vacation. Instead of living on the streets, you’ll have a bed and warm meals for the next month or two.
Some drug rehab recruiters even offer to pay out of state airline travel, then they’ll give you cash, groceries, cigarettes, cell phones and a free place to stay. Some even brag about having ties to the music and film industry in Southern California, to lure in new clients. All they had to do was go down to skid row, find a person who was using drugs and either had or was eligible for a decent health insurance policy.
Some body brokers would even offer to pay the insurance coverage costs for the first month, so they could get them into a rehab center. I’ve even heard of some rehab recruiters being licensed to sell insurance in California. Talk about doubling-down on your profit margin, right? Once they get a patient into a treatment facility, the money just starts pouring in. The extent to which the opportunities for greed and corruption have been covered extensively, by numerous news outlets and blogs. For those who are unaware, the rehab shuffle has become the reason so many people have died, trying to get treatment.
Body brokers have been reported to pay cash to prospective recruits, in order for them to buy drugs. In some instances, body brokers would even provide the drugs to patients themselves, so they could relapse, test dirty on a UA and their insurance would start over. They’d put them up in a motel for a night or a weekend, tell them to have fun (while relapsing) and they’d be back later to take them to a detox facility.
Certainly, some people got treatment, stayed clean and that was the end of their rehab story. They recovered, but a large number of clients end-up repeating this process. Go to rehab, get clean, relapse, go to rehab, relapse again, etcetera…
The big problem here is that many people would relapse once and then die from a drug overdose. This happens far too often, because people don’t realize that they had developed a tolerance to the drugs over the course of their addiction. They get clean at rehab for 30 or 60 days and when they relapse, they think they can use the same amount of the substance as they did before. Without the tolerance their body had built up, the dose can be too much for the person to handle. They overdose and die, and that’s the unfortunate end to their story.
Stories like these have sadly become the definition of the Florida shuffle, or what I prefer to call, the “rehab shuffle.” I call it this because the problem is not exclusively limited to drug rehabilitation facilities in the State of Florida. Other states like Arizona and California have dealt with this problem to a similar degree. When you have a city, like Los Angeles with over 1,000 different addiction treatment centers operating currently, competition for new clients can be fierce. Business owners get desperate, ethics and morals are ignored. All the while, vulnerable and fragile human lives are at stake.
On October 24th, 2018, President Donald J. Trump signed the SUPPORT for Patients and Communities Act into law. This was a massive set of over 120 different bills from congress, aimed at fighting the opioid epidemic. An important part of this legislation, (in regards to body brokering) was the “Eliminating Kickbacks in Recovery Act (see 18 U.S.C. §220). This act was aimed directly at the substance abuse treatment industry, its employees and private, third-party body brokers.
This bill extended the federal anti-kickback statute (AKS) [see: 42 U.S.C. 1320a-7b(b)] to regulate private clinical treatment facilities, laboratories, or sober living homes. The original AKS statute prohibits any exchange of remuneration (anything of value) for referrals to services, payable by a federal program, like Medicare or Medicaid. Now, with the passage of the SUPPORT Act, anti-kickback laws can apply to programs paid for by private insurance, but only those in the drug rehabilitation field.
The stiff, $200,000 dollar fine and the possibility of up to 10 years in prison for providing or receiving a financial incentive for referring patients to a drug treatment facility should have solved the problem, right? Actually, because this law was directly aimed at ending the practice of body-brokering in the drug rehabilitation industry, it seems everyone thinks that patient brokers are now a thing of the past. This statement couldn’t be farther from the truth, as we explain why in part 2 of our “Drug Rehab Recruiters” series.
This the third installment of our ongoing look into the drug rehabilitation industry in the United States and the continued use of body-brokering through "drug rehab recruiters".
You can read part 1 here:
And Part 2 here:
Some call themselves “addiction placement specialists,” or “marketers,” while others are “drug rehab recruiters”. In the healthcare industry, patient brokers are often referred to as “runners,” “steerers” and “cappers.” There is no regulatory code of ethics to abide by this profession. While some of these recruiters may operate on their own personal ethics, legitimately wanting to help others by getting them into treatment, others perform the job with undeniably questionable morals.
When the intention is to make money for a drug rehab facility, all morals and ethics can easily be thrown out the window. When someone has a kid who’s about to die from a drug overdose, the family will often resort to any means necessary to get their loved one into a treatment program. They’re desperate and vulnerable. Many recruiters realize this and take advantage of the urgency in their circumstances.
Abandoning all rationality when faced with a dangerous situation happens all too often. Sometimes people won’t even research a rehabilitation facility before they choose to spend tens of thousands of dollars there. The internet is littered with stories of parents, spouses, family members, and friends who were naïve at this point in their lives. They thought all treatment was the same, they didn’t know an entire sub-group of ‘bad actors’ had popped-up to swindle them. They didn’t know their loved one could die, while actually trying to get treatment for their addiction.
Some individuals who legitimately want their recovery from addiction to be successful, end up getting swept up into this rehab/sober home/relapse/back to rehab shuffle. Yet, others undeniably know exactly what’s going on and they’re just along for the ride. In far too many cases, navigating the rehab shuffle has essentially become a way for them to get a free ride in life.
Typically, your insurance will cover everything at the rehab then you’ll move on to the sober living home. The sober living arrangement has long been a great source for referrals to the addiction treatment industry. Some drug rehab companies even own their own network of sober living homes. While some of these can and do help people recover from their addictions, others operate a kind of relapse mill where, (in rare, yet not uncommon instances) they encourage their residents to relapse. Some sober living homes are known as flop-houses, where drug activity is well-known and intentionally ignored. Once the residents relapse, they can go back to rehab, for free and the company makes money, hand over fist. All of this is just lining the pockets of the bad actors in the rehab industry, at great cost to the American health care system and sometimes costing people their lives.
Now you see that this problem hasn’t gone away with the passage of new laws, what is the next step? How do we resolve this crisis? How do we separate the good treatment providers from the swindlers? These are all fantastic questions that need urgent action.
What is legal does not necessarily mean it is moral. Much of the patient brokering practice is a market response to the high supply/low demand for addiction treatment. Maybe creating a world in which drug use isn’t glamorized on full display is one way to start. We see the need for access to treatment services any time you visit low-income, poverty-stricken areas of major American cities. Addressing the root causes of poverty, mental illness and substance abuse is never a bad place to start.
The demand for treatment is there, the need is there, so why is it hard for addiction treatment programs to keep their doors open? I would argue that the sheer toxicity of greed that has run rampant is largely to blame. The nefarious practices of body brokers, rehab recruiters, and insurance fraudsters have given a bad reputation to the entire substance abuse treatment industry. It’s no wonder that the internet is filled with stories of parents who lost their children due to a drug overdose death, while they were away, supposedly getting treatment for their addiction.
The people who enter treatment, with no intention of recovering also make it harder for people who actually want to quit using drugs or alcohol to get the help they need. Think of all the wasted time, money, and resources that go into the rehab shuffle. Many times the pursuit of profits blinds the world to the legitimate needs of people who need help the most.
Treatment specialists, drug rehab clinicians, even drug rehab owners and operators have come forward to speak out against the unethical practices of others in the treatment industry. It’s not just parents and family members of lost loved ones. Though most internet forums spend a lot of time just pointing fingers at bad-actors in the industry, some have come up with more constructive ways of dealing with the problem from the inside out.
Valid Resource is a marketing and advertising firm from Lake Forest, California that focuses its efforts exclusively on reputable addiction treatment establishments. They run the marketing aspects of evidence-based, ethical drug rehab locations all across the United States. They understand that no one addict is the same and everyone should have an individualized treatment program formulated by medical professionals, to meet their unique needs.
Ethics in Treatment is a website where patients can go to report abuses and unethical or illegal activities within the treatment industry. The stated intent of the website is to: “identify and avoid bad-doers in the space of addiction treatment.” The resources & Reporting tab on the website lists all laws regarding the drug rehabilitation industry and agencies to report abuses too, when applicable.
A regional ethics commission in the Washington D.C. area called the DMV-PLA (DC, Maryland, Virginia Professional Liaison’s Association) is an agency of mental health and substance abuse treatment professionals who abide by a strict code of ethics. Their stated primary purpose is: “to provide support, encouragement, mentorship, education, and networking opportunities for our members while continuing to foster a collaborative and transparent atmosphere.”
Ultimately, when it comes to unethical practices in the addiction treatment industry, good people need to come together to fix the problem. No one governmental agency, politician, marketing firm, or group of concerned parents is going to fix all the complex, nuanced issues facing the addiction treatment industry. The time to demand change is now, it is urgent and it is not going to go away on its own.