The ongoing issues of ethical and quality treatment within the addiction treatment field are no secret anymore. Media stories like the report on Last Week Tonight with John Oliver and the numerous stories covering the terrible escapes of Kenny Chapman in South Florida are just some of the high-level, well-known ones but throughout the country, unethical, immoral and illegal practices continue to thrive without necessary government or law enforcement oversight or a media spotlight. While many addiction treatment centers offer high quality, evidence-based treatment in a responsible, ethical manner, many others continue to operate under a cloud of darkness, unethically, immorally and sometimes even illegally. Patient brokering, urine scams, insurance fraud, and just overall shoddy care continue to occur and individuals suffering from addiction and family members seeking help in crisis for a loved one continue to get taken advantage of while many within the industry charged to help those in need continue to profit off and exploit a vulnerable, stigmatized population.
There is no one answer, single solution, or overall cure-all for what ails the addiction treatment field. Many people have opinions but just like addiction, the issues within the addiction treatment field are complex and confusing, the solutions are not often black and white and often even those within the industry have differing or opposing opinions on what potential solutions are or should look like. There is no quick fix or easy answer. There is, however, one overarching theme that needs to take hold within the field to better the options and the choices given to those individuals, families, and communities as they seek help through the field of addiction treatment: Transparency.
The need for transparency within addiction treatment is greater than ever. This includes transparency within the industry between organizations and professionals as well as the transparency from the industry towards the consumer. Millions of people never receive the treatment they desperately need and many more are overwhelmed and confused when seeking help. More individuals and families lack necessary trust in the addiction treatment field due to being duped by facilities, patient brokered or due to being admitted into a clinically inappropriate facility and then left to fend for themselves once the treatment center couldn’t adequately treat the patient’s clinical issues. It is vital that we as an industry understand and begin to act within the principle of transparency as an industry, a business, and a clinical provider. For too long the industry has operated outside the scope and oversight of other health care fields and the growing opioid crisis and addiction epidemic has allowed further substandard practices to continue since communities and local governments frantically search for answers to dying constituents, broken families, ravaged communities, a faltering workforce and rising crime.
Initially, it’s important to understand some of the practices and issues that continue to occur in the addiction treatment space that correctly have people questioning the legitimacy, effectiveness, ethical compass and overall practices of the field. Here are just some of the more blatant and egregious issues:
- Patient Brokering (treatment facilities buying and selling patients)
- Drug testing (a necessary practice in treatment, but one that is often abused in terms of frequency and overbilling practices)
- Predatory online marketing practices (this can include several different situations, including treatment centers buying leads through third-party websites, third party websites that act objective but only send patients to facilities that have paid for leads, treatment center-owned websites that look unaffiliated but are meant to filter patients to a specific center, patient-brokering websites, or treatment centers stealing the contact information of other facilities online to reroute calls)
- Lack of information on a treatment center website (this could be when a facility doesn’t list their staff or the actual levels of care they provide or a treatment center attempting to look like something it’s not)
- Understaffed facilities (many treatment centers offer small or part-time clinical staff, little to no medical staff or small clinical staff in relation to a larger marketing or outreach staff)
- Inappropriate clinical admissions or a “Heads-in-Beds” mentality (many facilities will admit clinically inappropriate patients or will present or promote themselves as a higher level of care than they are licensed for or clinically able to serve, such as an IOP with a recovery house presenting as a residential facility)
- Enticements (Examples can be forgiveness of insurance deductibles or paying for transportation to treatment or other “gifts” in exchange for a patient admitting to a rehab)
- Fake “scholarships” (not actual scholarships that many non-profit facilities have that can be used to supplement those that cannot afford treatment or a scholarship where a facility will simply offer free treatment based on a patient’s inability to pay, but rather a treatment center claiming to offer a scholarship and then signing up a patient for an insurance policy under false information and billing that insurance)
- Untrained interventionists that present as independent and objective but really take kickbacks from treatment centers for referrals
These are just some of the more egregious offenses that take place within the addiction treatment field. Although there is no way to completely get rid of bad actors in the field and not one black and white solution, there are already some ways that individuals, families and consumers can try to vet programs. Obviously, first and foremost a program should be licensed by the state it is located within to operate and treat patients. However, there are some additional ways.
- Membership in the National Association of Addiction Treatment Professionals (NAATP.) This is by no means and end all be all in terms of ethical practicing treatment providers, but NAATP does have a Code of Ethics and has taken recent steps to remove some organizations that are not abiding by or acting within that code. Making sure a treatment center is a NAATP member is a good start although, again, not a foolproof way to ensure upstanding ethical operations.
- Clear listing online of staff and levels of care. A treatment center should always have its staff listed on its website, with their experience, licensure and/or certifications. Furthermore, there should be a clear understanding of the level of care. Listen to your gut. If a facility lists only two or three therapists, what could the clinical quality or oversight actually be on a day-to-day basis? Also, question a facility that employs more marketing and outreach representatives than clinical/medical staff for the same reason.
- Let’s be clear: A facility accredited by The Joint Commission or CARF in no way speaks to their ethical or business practices. These accrediting bodies serve to hold a program to a high level in terms of policies and procedures and patient safety. They DO NOT look at many or most of the issues we are discussing here. However, a program that is NOT accredited by a national accrediting body is one way to immediately dismiss a program simply due to lack of outside oversight.
- This is referring to both online testimonials or the experience of professionals and alumni patients and families. If you read a testimonial online and it seems too good to be true, it probably is or if online testimonials seem very basic or general, there is a good chance they aren’t real. Also, ask the treatment center if they have any alumni or alumni families that you could speak to in order to learn about their experiences. And if you are seeking treatment at a facility locally, speak to therapists or other professionals in the area. They should have some experience with that center.
- VISIT THE FACILITY! We cannot stress this enough. We understand seeking addiction treatment often occurs in a crisis, after years of anxiety and fear by the family. We also understand the window of opportunity or willingness for the potential patient is short. However, it is vital to make the most appropriate treatment placement decision rather than the quickest or easiest one. When an individual agrees to seek treatment often the family wants them to admit as soon as possible. This certainly makes sense but making uninformed decisions during a crisis is not the best way to make sure your loved one admits to the most clinically appropriate facility. Do not make a decision simply based on a Google search, a quick look at a treatment center’s website and a phone call with a nice admissions person. You would certainly not decide on where to send a loved one with any other complex, chronic, potentially fatal disease in this manner. Ask questions. And visit the program. Meet the clinicians, the doctors, the management, the ownership. Feel comfortable with the people that will be directly treating you or your loved one. See the facilities firsthand. Ask questions about the clinical philosophy, daily schedule, and clinical program. Ask why a facility does what it does, why it does things in a certain manner, how will this help to achieve the best possible recovery outcome and then listen to your gut. Any facility operating above board, with a moral and ethical compass and an evidence-based clinical approach will be happy to invite you in and speak with you at length about their program. They will not try to intensify the crisis and tell you to put your loved one on a plane to send them across the country or tell you “trust me” when you have not yet developed that trust. They will welcome you into the process, to meet them, to learn about the treatment program and experience and support you in making an informed decision.
Transparency is key when it comes to addiction treatment and it is the responsibility of addiction treatment providers to demand transparency of ourselves, our programs and each other. It is a responsibility of addiction treatment providers to make sure that those seeking help are given honest, appropriate options when seeking help in a crisis. It is the responsibility of addiction treatment providers to be transparent with those seeking help if they cannot help or are not the appropriate fit and then work with those seeking treatment to find them the appropriate help that would best fit their needs. Operating in the shadows allows for more unethical, illegal and immoral practices and it is the responsibility of those good actors in the addiction treatment space to demand transparency of ourselves and of each other to support a field where those seeking help for themselves or a loved one can trust they will not be preyed upon or taken advantage of and rather find the life-saving, life-enriching addiction treatment they desperately need.
If you or someone you know needs help for addiction or dual diagnosis issues, please give us a call. Maryland Addiction Recovery Center offers the most comprehensive dual diagnosis addiction treatment in the Mid-Atlantic area. If we aren’t the best fit for you or your loved one, we will take the necessary time to work with you to find a treatment center or provider that better fits your needs. Please give us a call at (410) 773-0500 or email our team at firstname.lastname@example.org. For more information on all of our drug addiction, alcohol addiction and co-occurring disorder services and recovery resources, please visit our website at www.marylandaddictionrecovery.com.