The Business of Recovery – A Delicate Balance

The Universe has a real sense of humor.  Last week, I participated in an Ethics Panel in San Diego, with a focus on referrals in the treatment industry.  That doesn’t seem very odd so far, right?  Wait for it…

I’m not in private practice anymore, so I don’t make a lot of referrals these days, but because of my 20+ years in the industry, I often have colleagues reach out to me for recommendations.  Last week, for example, a New York colleague asked me to recommend a treatment center here in California for a client of hers and I passed on the name of a center because I like the work they do.  I received a thank you text from the center’s marketing representative, which is pretty standard procedure (which I appreciated).

When I opened my mail on Monday, there was a $150 gift card from said treatment center thanking me.  I’ll admit that I let myself fantasize for a moment about what that $150 could buy, and then I stopped myself and checked in with my moral compass and the choice was quite clear.  What’s the difference between a gift card and a check?  Nothing, if you ask me, which is why I’m mailing the gift card back to the marketing rep and have let him know that my #ethics don’t allow me to take cash or gifts in exchange for a referral.  And frankly, unless they change their policy, I will not refer to that center again because if they sent $150 to me, then they’re probably sending it to everyone.

There are many problems in the treatment industry including the reality that there are kickbacks and payment for referrals; that many treatment centers are deriving a great deal of their profits from drug testing multiple times a week at very high costs; that the lack of structure and monitoring in aftercare isn’t working well and the recidivism rate is sky-rocketing; that on many treatment center websites, they claim to offer certain services that they don’t actually provide; that multiple treatment centers have been caught red-handed re-routing treatment center calls to their own call centers, and then defend it as okay, saying it’s not illegal…the list goes on and on.  And I haven’t even touched on the lack of regulation in the sober living industry, but that’s a topic for another blog.

My impetus for working in this business emerged out of my own recovery process and my desire to help other addicts/alcoholics and their family members not suffer the same consequences of addiction that I had.  That was true for most of my colleagues at the time.  But the times, they are a changin’.  What has happened to our ethics?  When did we lose our moral compass?  My sense is that this trend started when the large conglomerates began buying up treatment centers and venture capitalism entered the picture.  It was the start of treatment becoming more about the business – ie, money – than about helping people, and the result is, frankly, a mess.

Addicts/alcoholics and their family members are at their most vulerable and frightened when exploring options for treatment, and between the pretty websites and the sales pitch on the end of a call center phone, what’s going on is nothing short of predatory.  So how do we change it?

Let’s start by educating the consumer.  I’ve told family members to ask things like, “How much do you (the treatment center) charge for urine tests?” If it’s more than $150 max (other than in extraordinary cases), then they’re ripping you off, so hang up and call somewhere else.  “How often do you drug test?”  If it’s more than a few times during the entire course of primary treatment, then the center is telling you their treatment doesn’t work…if it did, they wouldn’t have to test so often.  Hang up and call somewhere else.  “How do you involve the family in treatment?”  If they don’t offer an intensive family program, or a weekly family group if you live locally, then I would look elsewhere because it means the center isn’t addressing the systemic nature of the dis-ease that has invaded your family nor are they involving everyone in the long-term recovery process.

I also educate consumers to ask about detox, especially if their loved one is an opiate addict.  Many treatment centers are pushing ongoing medication management, such as Suboxone or Vivitrol, rather than using it solely for short term tapering and detoxing.   To me, there’s not much difference between that and a methadone clinic, and being on opiate agonists/antagonists can have multiple long-term consequences, just like methadone. Yes, the opiate epidemic is frightening, but being on medication long-term is not a solution:  it just creates a different problem.

The other important thing that those of us in this industry can do is to start at home:  practice ethically.  Period.  Full stop.  Refuse the gift card or the kickback; be honest about what’s on your website, put aside your fear of economic insecurity and trust the process – that if you practice ethically, the universe and your colleagues (me for one) will support you and refer to you BECAUSE that’s what you’re doing.  We also can’t be afraid to speak up and speak out in our industry by calling out our colleagues that we know are not practicing ethically, by not referring to treatment centers that have shady practices and to SUPPORT centers that are putting the clients and their families ahead of making money.  It’s really simple:  do the right thing.

For many of us in this business, we grew up in dysfunctional homes where we learned to ignore the elephant in the middle of the room.  Well, Ladies and Gentlemen, what we have here is a a 3-ring circus, and all of us are culpable if we don’t participate in changing it.  This is my attempt to do just that, and to inspire you to do the same.

Yes, for many of us, this is the business we’re in, but there’s a balance.  Yes, I can make a living helping others, but the bottom line is that I can’t make my livelihood at the expense of someone else’s life.  My recovery requires that I practice principles in ALL my affairs, not just when it’s convenient.