Let’s Not Throw the Baby Out With the Bathwater!
by Thomas G. Beley, PhD, LCSW
There has been an enormous amount of negative publicity regarding substance use treatment facilities and so called “sober homes” in the south Florida area. So much so that the integrity of the entire treatment industry has been under scrutiny. And perhaps so it should be. Given the accounts of fraudulent billing, “patient brokering,” and human trafficking occurring, it is disheartening to know that we continue to live in a society where vulnerable groups of people are preyed upon for monetary gain. There is a definite need to take a closer look at what is actually going on. However, let’s not let the emotional sensationalism of these news stories cloud the facts and issues of what is really going on.
Our nation is currently under siege by a problem that has been a long standing health issue that seemingly continues to be the “step child” of our healthcare system despite the fact that it is one of the leading contributing causes of death in our country. Addiction has become a menace to our society. Illegal drug use, legalized drug use, prescription medications, and alcohol have infiltrated all segments of our population. While pharmaceutical companies have well intentionally figured out ways to introduce an assortment of new medications to combat the side effects of prescribed opioid medications, deaths from opioid overdoses have become the number one cause of accidental deaths in the United States outnumbering car accidents.
The problem of addiction is not going away and, unfortunately, it is only going to get worse. The fact is that we need treatment centers and we need “sober” homes. They have been a main stay for people suffering from the scourge of alcohol and drug addiction for decades. What we do not want to do is to scare people away from getting the help they need. Let’s not forget that there are many established quality treatment centers and “sober” homes throughout the nation.
One of the problems that legitimate treatment centers have encountered is the limitation that insurance companies have placed on them in providing effective treatment. Treatment is often cut short by insurers, often citing “there is no medical necessity” in favor of a less intensive program meaning they are often discharged from the facility without really getting the full care that is needed. As a result, there has been a proliferation of these “less intensive” treatment programs which is where the insurance loophole begins to expand. Many of these “less intensive” programs are ineffective at best because of a lack of credentialed professionals running them, or they have been established with the sole purpose of milking the insurance companies of benefits.
A problem is occurring that many of these well-established treatment facilities and “sober homes,” historically known as halfway and three-quarter houses, are being overshadowed by these bogus; make shift facilities that have taken advantage of the insurance loophole. Make no mistake, some of these places have little interest in providing the necessary help needed to address those suffering from an addictive disorder. The primary goal is to make money. Their sole purpose is to prey on a vulnerable population, many of the victims are young adults in their early twenties with little or no life skills who are still on their parents’ insurance. Many of these individuals have been in the throes of their addiction for years and have little choice. Either they and the family do not know any better or they simply feel resigned to play along within a deficient system.
Many of these victims are offered easy money to recruit other patients to live in a so-called “sober home” who will often have connections with a so-called “treatment” facility. In many instances, there is an established unethical relationship of “brokering” whereby there is an exchange of money for patients between the “sober” home and the “treatment” facility. Each supplying the other with a steady stream of “insured” bodies. Patients are actually encouraged to go out and recruit other patients from other “sober” homes and treatment facilities in exchange for money, free room and board, or both. In some instances, the owner of the “sober” home also owns the “treatment” facility.
Many people leaving a bona fide treatment facility will need a halfway or three-quarter house for support and a transition back into sober living. However, a legitimate half-way or three-quarter house, now often referred to as a “sober home,” will be just that, a place where people can live and receive the necessary support and structure to transition back to a normal life. The halfway and three-quarter house has been an integral part of recovery since addiction was recognized as a medical condition decades ago. The concept of the halfway and three-quarter house is basic. The person pays rent for a safe, structured place to live with other recovering people. The concept being a person can engage in life responsibilities such as work or school and return to a supportive setting until such time the person can live independently.
However, for some, the concept of the halfway and three-quarter house has morphed into the so-called “sober home” where clients are more or less forced to participate in a “less intense” treatment program in exchange for free room and board. While in theory this sounds like a very reasonable proposition, the reality is we have vulnerable people being “brokered” into, at best, untenable and ineffective facilities. Many of these individuals do not need “less intense” treatment, what they need is guidance and direction in developing life skills and purpose, which is often a part of more intensive treatment
Families are also enticed by these facilities with the promise of not needing to pay rent for their loved one to live in such a “sober home.” The catch is their son or daughter will have to participate in a highly ineffective “less intense treatment program” which is usually compromised of other patients who have no desire to recover or are simply just trying to get by; to survive playing what now amounts to a very deadly game of so-called “recovery.” Life for some of these individuals has become not trying to recover as much as trying to negotiate a better “treatment” deal. They bounce from one treatment program to another, from one “sober home” to another, with no real direction of getting back on track with their life.
Legitimate treatment centers often encounter prospective patients and families negotiating treatment terms because they have been offered free plane fairs, waived co-payments and deductibles, free room and board post treatment, and other enticements by these questionable treatment facilities. Somewhere along the line, treatment for a deadly disease has become more like purchasing a car. People, unfortunately, have been seduced into looking for the better deal rather than effective treatment that is going to save a life.
The Politics of Addiction
How is it that the treatment industry for substance use disorders has become increasingly more suspect of unethical practices over the years? The answer is a very simple one, neglect. Neglect at all levels of our society except one and that is the criminal element.
Regardless of how much research that has been conducted over the years, and there has been a plethora of research in better understanding addiction, it seems to be still falling on deaf ears. People continue to turn a blind eye to the fact that substance use disorders and addiction is one of leading health hazards and causes of death in our country.
Despite the fact that it has long been recognized as a medical condition requiring medical and professional interventions, there continues to be the stigma of the ‘addicted’ person suffering from a lack of will power, fortitude, and discipline. Research has clearly demonstrated that this is not the case. There are neurobiological and behavioral underpinnings to this disease that have impacted key areas of the brain including a person’s genetic make-up. What is even more important regarding this research, which has been around for decades, is that there are effective interventions and treatment approaches that can be utilized. The old adage of relapse being a part of recovery is simply not true anymore. Unfortunately, this research seems to be slow in reaching our treatment industry forcing many people suffering from addiction to be treated with antiquated and ineffective approaches.
What compounds this malaise even further is the fact that the insurance industry and the pharmaceutical industry seem to have little incentive for change making it difficult for legitimate treatment facilities to do their job effectively. These facilities are often limited in the amount of treatment they can provide and are often in a battle with the insurance companies to prove medical necessity for further treatment. Even when medical necessity is proven, insurance companies are reluctant to authorize further treatment, in part because of the abuses that tend to occur across the board in our healthcare-insurance paradigm, but also because they are tired of paying for treatments that are seemingly ineffective.
Insurance companies are fighting back. Why should they pay for another intensive treatment when that person has been through a similar “treatment” four or five times previously? As a result, the insurance industry has relied on the premise that treatment needs to be provided on a shorter-term basis and in a less restrictive setting. As a result, there has been a proliferation of these less intensive programs that have focused on relapse containment, which is not necessarily a negative goal, but they are extremely limited when it comes to addressing the coping and life skills necessary to live a more productive and meaningful life.
The insurance industry has also relied on the pharmaceutical industry’s propensity to develop better maintenance medications. These medications, creating a multi-billion dollar windfall of their own, are geared more toward reducing symptoms and maintaining the person so they do not decompensate any further, not necessarily getting the person back on track with their life. The goal of stabilization and maintenance is not enough. People with addiction issues need a treatment program that will address the neurobiological, psychological, and behavioral aspects of this illness.
All of this creates a vacuum of need for the person suffering from an addictive disorder. As such, they are left vulnerable with little or no options to choose. They are preyed upon by the opportunists whose only intent is financial gain subjugating these individuals to less than supportive living conditions and participation in ineffective programs that will only lead to relapse, hospitalization, or worse, death.
Yes, the reality is there does need to be a crackdown on these unethical and fraudulent “sober homes” and ineffective “treatment” facilities. However, what is going to happen after that? Let’s not throw the baby out with the bathwater. The problem is not with the fact that there are unscrupulous people out there ready to take advantage of a faulty system. This happens in any organization or industry where there is a faulty system in place. The real problem is that there is not enough attention being paid to the real issue, the disease of addiction and the need for more effective treatment.
The problem of addiction needs to be the focus of our attention. Last year alone there were over 52,000 deadly opiate overdoses in the United States outnumbering that of car fatalities. Add in another 88,000 alcohol related deaths and the number of deaths from addictive substances becomes staggering. This is close to the equivalent of a passenger 747 jumbo jet airliner crashing every day for a year. This does not even include the deaths of other addictive legal and illegal substances. It is estimated that the use of addictive substances costs our nation $740 billion dollars annually. Let us not lose focus on the true issue.
Let’s also not lose sight of the fact that there are a number of well-established and effective treatment centers and “sober homes” throughout the country that have been in operation for years. These are facilities that are committed to working with a population that have long been neglected and now preyed upon. These are the facilities that need to be recognized and supported.
Established treatment programs will be staffed with credentialed licensed professionals. The facility is also usually certified or is in the process of getting certified by an external credentialing organization such as the Joint Commission or the Commission on the Accreditation of Rehabilitation Facilities (CARF). The facilities will have established levels of care with clear clinical guidelines as to treatment philosophy and outcome. Involvement with the person’s family and support system will also be an integral part of the program. Transparency and openness for others to see the work they are doing is tantamount to their efficacy and success.
The credible sober home will also have the same transparency and openness. The facility will usually have structured ground rules and 24-hour supervision. The main goal being a time limited supportive living environment geared toward assisting the recovering person getting back into the mainstream of life and personal direction. Most important, it will not have any affiliations with insurance or with a treatment facility. A credible sober home may be endorsed by a number of treatment facilities but they will operate independently and separately of those treatment facilities.
The bottom line is that there is effective and meaningful treatment out there. It is just a matter of finding those places. It is going to take a concerted effort of accountability at multiple levels to address all the problems at hand with addiction. There is no one entity to blame. Lawmakers, healthcare professionals, treatment programs, the insurance industry, and families are all going to need to take a closer look at what they can do to address the problem of addiction.