Drug Rehab

‘Rehab Racket’: Excessive Prices Of Addiction Remedy And Questions Over Efficacy – WBUR


Editor's Note: In this lesson, topics of drug addiction that some listeners may find annoying or offensive are discussed.

If you or anyone you know lives with addiction and depression, there are resources for help. Visit the website of the Drug Abuse and Mental Health Administration or call the hotline at 1-800-662-HELP (4357). Also, visit the American Society of Addiction Medicine or the American Academy of Addiction Psychiatry for a list of qualified physicians by postal code or state.

The high cost of addiction treatment. Is it a rehab bat? We ask the investigating vox reporter.


German Lopez Chief Correspondent for Vox. He is working on a series on the American addiction treatment industry titled "The Rehab Racket". (@germanrlopez)

Christina Delos Reyes Co-director of Addiction Recovery Services and director of the Addiction Psychiatry Fellowship at Cleveland Medical Center, University Hospitals. Professor of Psychiatry at the Medical Faculty of Case Western Reserve University.

Job interview highlights

the USA

German Lopez : "I have with Kimberly Blake's family spoken. And she and her husband spent at least $ 110,000 on addiction treatment. And her son is still overdosed and dead. And one of the facilities they would go to – so there was "New Found Life" or the "[Little] Creek Lodge" in Pennsylvania in California. And these places, they would go to them, and they would seem as if they were good at first. They would promise all these beautiful things. The decor seemed nice at times. However, they would find that these places only performed a 12-step treatment. And for Sean, for whatever reason, that simply did not work out.

"And I have heard the story now, over and over again, as part of this coverage.Where, when someone goes to these facilities, they really try to recover and when they say to the person," Look, this approach just does not work for me. "People say," Wow, maybe you're just not ready for treatment. "Or, even if they're trying to find something else, they just do not have the training or that Expertise to actually guide them, whether they need cognitive-behavioral therapy or medication or anything else – really, they'll focus so much on this 12-step approach that everything else will fall by the wayside, and that's exactly what it seems in this case He would go to those places, he would do it 12-step dominant focus, it just would not work for him, and ultimately, actually When I asked for medications – or what Medi was offered to him cations – they would be cut off quickly, or they would be stigmatized, or he would be prevented from staying with them. And in time he simply did not get better. And finally overdosed and died. "

What is the regulatory structure – if any – around these addiction treatment centers?

Lopez: "You have to retreat first and find out how this treatment system came about. And addiction was long considered not a disease, but a disease. That began to change in recent years. But in this context, where it was not considered a disease, this 12-step model was the model launched in the US – where addiction was started. So we're talking about Anonymous Alcoholics, Anonymous Narcotics. And the system somehow grew out of these community groups – I would call them – that's the way it goes. This 12-step approach. And it's based on a lot of addiction treatment in the US. Sometimes it's called the Minnesota model, where you go to a place for 28 days. It is mainly based on the 12 steps. And you go through this.

"And that's exactly how the addiction treatment system has grown, and as a result, governments – whether federal, state, or local – have really only caught up and, most of all, when we get into the opioid epidemic, they've tried But the industry … first and foremost, it's different from other places in the healthcare industry – where you have this model, where you can find research, prove that this treatment works, and then hospitals begin to apply it. It's the other way around here, where people made the most of this model – the 12-step model – because the healthcare system would not take it seriously or seriously, and then regulators come and try to make sure that Therefore, the big thing here is that, in some cases, there really are not that many regulations, I mean, in some cases These facilities do not have a single doctor or nurse in the staff. And that's not even required by law. Because honestly nobody really watched. Until, I think, this opiate epidemic really started.

The ideal addiction treatment situation

Christina: "In an ideal situation, a person would receive a combination of biological, psychological and social interventions. And so among the biological interventions would be drugs such as buprenorphine, methadone or naltrexone. Psychological interventions would include things like cognitive behavior counseling or motivational interviewing or other types of conversational therapies. Among the psychosocial interventions would be the creation of a sober network with 12-step programs and similar programs. "

Why do only a few treatment centers combine biological, psychological and social interventions?

Christina: "I think there are a number of reasons, and that's quite complex. Part of it is historical, as Mr Lopez has suggested. … In America, treatment centers were created that were separate from the medical system. And so, as he said, there are many treatment centers where no doctor is employed. And the sub-specialty "addiction medicine" as well as the sub-specialty "Addiction Psychiatry" are actually only available since the early 90s. So this is a relatively new area – or an under-specialization – in American medicine. So, I think that's it. I also think that the opioid addiction has a lot of stigma besides the historical thing. Historically, people have not thought that this could be treated by a doctor or a medicine. Until this changes, finding treatment centers that are willing to do all three things will be difficult.

Caller Highlights

Kylie from Charleston, South Carolina: "My partner was addicted to intravenous heroin and cocaine over a year ago , He tried outpatient detoxification with suboxon and methadone prescribed to him. [He] these drugs were also abused. So we decided that we should try to find a facility that would let him go without medication through his detox. Fortunately, our insurance covered a hospital stay. But the conditions were just dirty – and her treatment was so spotty – that he finally left and came home where he left cold turkey. And fortunately, I was able to take time off and really give him the care I thought impossible.

Noel from Frederick, Maryland: ] "My brother was addicted to heroin. And we come from a middle-class family. When the family found out about this addiction, we searched for the best treatment money could buy. We found a facility outside the state. We dropped an interventionist and helped with the family intervention. And he agreed. He did not finish the treatment. He came home and tried it in an outpatient treatment center. That failed for him too. He said that he had driven in the same places he had heroin before, and it was just too difficult. And he was basically back in the same situation as before. So my husband and I, who lived in Vermont at the time, invited him to come and live with us. And he came out, he decided that he wanted to do it cold. He knew at the Detox Center that they had done it cold and without medication. So he knew what to expect. And when he was done, he started working part-time. But he says it really was just a total absence of any environment that reminded him where he had been before. And just to be part of a normal family situation. And I've always wondered if there could be a voluntary system like "Foster an Addict" that could be developed. Because it was so critical for him. But not everyone has someone living in a remote place.

From the Reading List

Vox : "She gave more than $ 110,000 from drug-detoxification. Her son is still dead. "-" Kim Blake has a folder full of papers in her house. Each document is another attempt to help her son Sean recover from a decade of drug addiction.

"Some papers are rehab certificates, one tells Sean that" you are no longer alone. "Some are letters from Sean describing his advances dating back to the late teens and years Write about how he's feeling better.

"And there are many, many bills, the bills, and the ones the Blakes paid for them. The total cost: $ 110,000.

"That is the minimum that Kim and her husband Tim, Sean's father, have estimatedly spent on addiction treatment. The Blakes also stated that they spent thousands on other treatments for which they no longer have bills or receipts. (Their insurance company also made additional payments.)

"During all this, the Blakes used up their retirement savings along with college funds for Sean and his younger brother.

" Kim told me Tears that there would have been a result that would have been worth anything: "If he had survived, we would have said it was well spent money. No question. "

" But none of the treatments failed. In August 2017, Sean died of an overdose of alcohol and fentanyl, a synthetic opioid. He was 27 years old. "

] Gallup :" Drug Abuse Meets Nearly Half of Americans "-" Almost half of US adults, 46%, have dealt with drug abuse issues in their family: 18% had only alcohol problems and 10% only had drug problems, while 18% experienced both.

"These results are based on combined data for 2018-2019 from Gallup's annual Consumer Surveys Survey, which was conducted every July. Overall, in the two surveys, 36% of Americans said drinking was a cause of problems in their family, and 28% cited the same for drug abuse.

or drug abuse was ever a problem in their family. The rate of reported problems is expected to increase with age as older Americans have more time to gain life experience, but that is not the case. "


Vox :" How do I find in the opinion of experts a good addiction treatment? "-" In search of drug withdrawal? It can be extremely difficult – and terribly expensive. In some cases, families spend years and thousands of dollars before they find a treatment that works.

"Michel Cote, whose two daughters are currently recovering from opioid and methic addiction, said his family needed 10 years and $ 200,000 to find a small clinic that eventually helped."

"I have to ap I did not think anything would work," said Cote, who lives in Silicon Valley. "I actually thought that this is probably hopeless and it's just a matter of Time is up for the big catastrophe, but we had to keep trying. "

" At Vox's drug dependence project, The Rehab Racket, I've contacted experts to find out how this one works Process for people looking for a treatment can get a little better.

"Experts emphasized, in particular, that patients should strive for as comprehensive and individualized treatments as possible. It is crucial not to be content with a consistent approach, even if it works for someone you know. Addiction is a complicated disease that varies from individual to individual, so different approaches can work better for different people. Programs should assess patients and adapt them to their needs. "