The wild, wild West

Fraud and failure: A brief story about addiction treatment and the need for reform

Pine Ridge Reservation in South Dakota is home to the Oglala Lakota Sioux Tribe and covers approximately 2.1 million acres. This beautiful country has a rich cultural heritage and historical significance, particularly as the site of the tragic Wounded Knee Massacre. During my internship year, I was able to travel here doing some work on the reservation. It was an experience that shaped a lot of how I approached my take on mental health and addiction.

I remember doing some basic psych assessments, basically screening folks who might be at high risk, and was shocked to see how many people I talked to had experienced profound trauma and loss. Almost everyone that came in front of me had lost a loved one to alcohol, drugs, suicide, or a motor vehicle accident. It was tragic, to say the least, forever broke me out of the privileged therapy bubble I had been raised in as a clinician, and taught me how to truly begin to put community first in all our attempts to redesign solutions to massive problems.

This past week I listened with horror as NPR reported on a story in Arizona where fake drug and alcohol treatment centers targeted Native Americans for treatment. These fraudulent facilities lured patients in as a way to exploit the state's Medicaid system - basically get paid to do nothing. Yup, that’s right, these centers didn’t provide any real services. One victim, Carson Leslie, actually died while being transported by individuals posing as rehab staff.

There’s a serious lawsuit in the works, which you can read about in the NPR piece. The scam intensified during the pandemic due to loosened regulations, resulting in significant financial losses. Sadly, even in the face of these tragedies, proposed legislation to increase oversight and penalties has faced opposition all while Native American community members report ongoing recruitment into these fake treatment homes. It’s sickening.

The addiction treatment industry appears to be experiencing significant growth, with the market for rehab facilities projected to increase from USD 16.8 billion in 2023 to about USD 31.3 billion by 2032. This is a lot of dough, and no doubt this increase is due in part to the rise in substance abuse and perceived need. Dr. Jane Zhu, in an excellent paper published in JAMA Psychiatry, found that private equity owns 6 percent of mental health practices and 7 percent of addiction treatment facilities. While this may sound small, it’s actually a lot bigger deal when you consider that private equity is involved in about 60 percent of all deals since 2018. Oh, and don’t forget about private for-profit entities who run 42.5 percent of substance use disorder (SUD) facilities, 19 percent of mental health facilities, and 23 percent of combined SUD-mental health facilities.

One study looking at private equity acquisition on medical practices, found that practices who were acquired by private equity were also associated with increases in health care spending and utilization. Other studies have found significant concerns with private equity backed practices and the impact these acquisitions have on health quality and outcomes.

Lack of Regulation and Accountability

Not surprising, and like other facets of health care, the addiction treatment industry suffers a major lack of stringent regulation and oversight, allowing many rehab facilities to operate with minimal scrutiny. This can lead to varying standards of care, with some centers prioritizing profit over patient well-being. As a result, reports of inadequate treatment, unqualified staff, and fraudulent practices are common. Some facilities may overcharge, provide unnecessary treatments, or fail to deliver promised recovery outcomes.

Exploitation of Vulnerable Individuals

People seeking addiction treatment are often in a desperate state, making them easy targets for unscrupulous rehab centers. If you have been in this situation, you know how it feels - desperation and frustration are pretty common! You will take whatever you can get, and like many, may assume that because they are a clinic in the helping profession, they must be looking out for you! Some centers can exploit this vulnerability by using high-pressure sales tactics, misleading advertisements, and false success rates, drawing patients and their families into costly and ineffective programs. This exploitation can take a severe emotional and financial toll on individuals already struggling with addiction.

Need for Transparency

A constant theme for me in my work has been the ongoing push to have increased transparency for mental health, and the addiction treatment industry is no exception. It’s vital for us to ensure that individuals receive effective care and that precious resources are not wasted on substandard or harmful treatments. Examples of this include, but are not limited to:

• Facilities providing detailed information about their treatment methods and the evidence supporting their effectiveness.

• Transparency in the reporting of treatment outcomes and success rates, verified by independent bodies.

• Open and honest communication about treatment costs and any additional fees that person can expect to help prevent financial exploitation.

The Shatterproof Treatment Atlas is a valuable tool that can help individuals locate reputable treatment facilities, providing crucial information about treatment options, accreditation, and success rates. We need this type of tool for every state!

Calls for Accountability

Once we have transparency, it’s time to start holding people accountable! There are a number of ways to achieve this:

• Implementing and enforcing stricter regulations for rehab facilities, including regular inspections and mandatory outcome reporting.

• Strengthening laws to protect patients from fraud and abuse in the rehab industry.

• Educating the public about identifying reputable rehab facilities and avoiding potential pitfalls.

I realize that I am being quite harsh about addiction treatment facilities, and by all means, I am not trying to overgeneralize and say they are all bad. There are some good places out there. That being said, without addressing some of the issues I have laid out above, it’s really going to be hard to know and hard to help know how to recommend help for those who need it. With the rapid growth in this space, and the ongoing need for regulation and accountability, we run the risk of people getting hurt. We simply can’t have practices that exploit vulnerable communities.

Yes, there are highly effective treatments available, there’s just inconsistent implementation, organization, and oversight across states and communities. That’s where organizations like the American Society of Addiction Medicine (ASAM) and their ASAM Criteria come in. These criteria are a widely used set of evidence-based guidelines that help improve the quality of addiction treatment. Creating a more consistent standard of care is ever so useful in this space.

Friends, I could write two books on this topic and by no means consider myself an expert in the addiction space! It’s just impossible to exist in this world and not see these issues so up front and in your face. We just can’t have more stories like the one from NPR keep happening!