Dark Practices in the Addiction Treatment Industry: Q&A with a Treatment Placement Specialist

For over 30 years, Robbin O’Neill-Gregory has dedicated her personal and professional life to learning, embodying, and applying strategies to help recovering individuals and their families. She currently is the Managing Director at Recovery Fusion, which provides independent recovery support services.

Recently Robbin published a piece on her blog called “Heads in Beds: Why Addiction Treatment Facilities Place Cash Over Care” describing unethical practices of the addiction treatment industry. Using screenshots from Facebook group conversations with professionals in the field, the piece paints a shocking picture of the dark side of the addiction treatment industry. We invited Robbin to share more about this piece and her experiences in the field.

I want to talk about your piece “Heads in Beds.” Can you give some backstory about why you decided to write this?

Robbin: I think that treatment has done an amazing marketing job at giving people the illusion that treatment is a be-all end-all cure. People often go away to 30-day residential programs knowing nothing about what specific services they will receive. They just know treatment means, “I’m going away to a program and I’m going to come back healed.” There’s just this pervasive understanding or belief that that’s how treatment works. People aren’t given multiple options because 80% of all treatment centers are based in traditional methods. If you have cancer, when you look for treatment, they give you extensive options for which path you’d like to choose. Why aren’t we doing the same for people in recovery when their lives are truly at risk?

Here in Santa Barbara, we have limited treatment places and they are predominantly, except for one, all based in traditional methods. Up until recently, I usually worked individually, client-to-client. Then I became part of some treatment teams out of the area and in doing so, I witnessed some situations involving treatment centers doing unethical practices.

And so when I wrote “Heads in Beds,” a lot of it had to do with my frustration. “Heads in Beds” is an actual term in the industry. It comes from the idea that when you have a facility with open beds, every day a bed is open is lost revenue. So you’ve got to get “heads in beds.” It's an ugly term.

And it's really hard when you receive a client that's been to four or five treatment centers they look at you like you're another one of “those people.” You're racing against the clock to build trust with the client and the family.

One young woman that worked with me actually cursed at me and called me names when she met me. That's what I was up against. She wouldn't give me the time of day. I really had to just stay calm and meet her where she was and tell her I understood her frustration. It took months. And that’s hard when you have a family who wants instant results.

I think it’s important to educate people. There's no magic cure for treatment. Assessment is essential—it must be the first step. If you call a center and they merely ask you your name, date of birth and drug of choice, you know that something is wrong. And “guarantees of success” are false advertising. There’s the saying that you can throw a life preserver out to somebody, but there's no guarantee they're going to take it. But I don’t think people understand that you also have people in other boats with questionable intentions going, “We'll save you, we'll save you.”

Another part of writing the story was that I had to find the courage to actually speak up. The industry is so pervasive and the mainstream has been so quiet about the practices with the general public.

In your piece you mention quite a few unethical practices that you’ve encountered. What are some of the most egregious of these practices?

Robbin: Some practices you see are centers billing urine tests to insurance companies for anywhere from $1,500 to $17,000 a piece. Others poach clients, where they pay people to go in and literally convince people to go to another center. Some find and pay people to use their social security and their name, giving them a fake address to buy insurance and get them into the facility. I mean, really dark things.

People will spend any amount of money and treatment centers that are unethical know that. When you have a kid that’s in trouble, parents will spend anything. People looking for help are in an incredibly vulnerable situation. They're dependent upon what catches their eye or what they click first.

The way people find treatment is they literally Google “addiction home” or “addiction treatment.” Nine times out of ten, who they find is a matter of who can buy the most advertising on the web. And so you have these centers such as “American Addiction Centers,” who spend hundreds of thousands of dollars a month on Google AdWords to get top placement.

And when families make a call, they're usually calling into a call center affiliated with a particular treatment company. There are behavioral health companies that have multitudes of treatment centers across the United States. They think that they're calling a local place, but the company could be located anywhere. The job of the person on the other end of the line is to get their information and find a place for them within that network. The people on the phone are highly trained in “catching,” literally “catching” this person and putting them in a treatment center.

I mean you could argue that, hey, at least the person doesn’t drugs and alcohol their system and they're somewhere getting help. But, it's pretty much a toss up whether or not it will take for them, whether or not it will lead to long term recovery. So, there's no wonder that our rates for recovery are so pathetic. They’re horrible.

Aren’t these practices illegal? Why do they occur?

Robbin: It gets down to money. You have very savvy people in the recovery arena, especially places like sober livings, who just lease out a house, call it “sober living” and put into place a few policies and practices. For those who are manipulative or savvy enough to work on the darker side of the business, there are always loopholes in business. Here you have honestly the underbelly of the world.

The FBI has gone in and raided most of the places in Florida. Now it’s happening in Orange County. So, there is change happening but unfortunately there's so much of the bad business practices that it really has to be “buyer beware.”

What needs to happen to make these kind of unethical practices stop?

Robbin: I think the solution really is, is having unbiased independent treatment placement people working in collaboration with centers where they're placing clients. They're staying in contact with them from initiation on through to maintenance coming back out to the other side and developing that relationship. These placement specialists should not own a treatment center or a residential or a sober-living. They can build relationships but definitely should not own them if they're going to do placements.

I think there should be more oversight from each county for sober livings. I mean, I’ve seen sober livings where you've got 20 women using one bathroom. Terrible stuff. So those aren’t sober livings, they’re flophouses.

Really, there's a lot we can be doing. And you know, we have JCAHO accreditation with treatment centers, but you still can't truly understand someone's business unless you are there. I’ll go out to places with JCAHO accreditation and certain elements that I think will be a good fit for a client, but then you get in there and they do not deliver what they advertise.

So, at the very least, having an advocate for families to help navigate the process is really, really important. It’s also important to make sure that you have a team of people who are staying transparent with each other during the treatment process.

What is your hope for the future of care for people dealing with addiction?

Robbin: I think it’s hard to help people reconstruct a new reality since people resort to addictions to escape reality because reality is intolerable. Treatment truly just the beginning of recovery and we have to view it as such. It helps a person stabilize so that they can start their journey. We need to do better to create a continuum of care, from initiation through aftercare.

And when you break it all down, time and time again I have found that people essentially have a broken connection to life or to somebody around them. I think that the answer is that we have to be kinder to one another. I think we've been doing things wrong. When someone is lost, we often do this treatment of “tough love.” I think there's a very real difference between a loving bond and severing enabling behavior. And I think that we can do both at the same time with people who are lost.

So, it’s not going to be some magic pill—a specific modality or a single scientific, evidence-based treatment. I think the answer is plain and simple. Much like what I think this life is about, we need to ask ourselves, how well do we love?

What else would you like add that I haven’t asked?

Robbin: I want to make sure that in all this darkness that people know that there are people that are really doing great work out there. Tireless, extraordinary work. We are talking about the darkness in this industry right now because it does a disservice to the kind-hearted, knowledgeable people out there that are doing great work.

If you're looking for treatment for yourself or a loved one, read this helpful list of questions to ask from the makers of the film The Business of Recovery.

Evo is an outpatient addiction treatment program that respects where you are and where you want to go. Clients set goals that work for them, whether they include complete abstinence or moderation. Evo sees success as lasting change in the client’s life, including physical health, movement towards personal goals, and their sense of connection and purpose. Evo’s program integrates psychotherapy, psychiatry, life coaching and somatic therapy. Learn more about Evo’s program.