The Business of Treatment

Twenty-three million Americans have a substance-use disorder. In other words, more than one out of every 15 adults in this country is addicted to drugs, alcohol or some combination of the two.  They are friends, wives, fathers, sons, daughters and colleagues dealing daily with an often undiagnosed and deadly chronic disease.

In addition to the physical, social and emotional repercussions for so many addicts, there are major financial costs to the U.S. economy.

According to the National Institute on Drug Abuse (NIDA), abuse of alcohol and illicit drugs costs our nation more than $700 billion annually in costs related to crime, lost work productivity and health care. While the addiction and mental health industry may not be able to cure every addict who comes in for treatment, the positive work done for many in the addicted population is vital from both an economic and social standpoint.

The addiction recovery industry is primarily made up of dedicated and caring therapists, nurses, doctors and case managers whose sole purpose is to help those in need and save lives. Working in an addiction treatment center is not easy. The path to wellness is trying and, in turn, so are the jobs of the treatment center staff. They are there because they care about every individual suffering from addiction. They care about making broken people better and helping them return to their families, friends and jobs.

The addiction treatment industry has been hit with some bad press due to a handful of bad actors. These stories paint a grim picture of the addiction recovery industry. However, most people who work in addiction and mental health services are there for the right reasons and to effect positive social change in the midst of major drug and alcohol epidemics. They are there to make as much of a difference in each life as possible, and we need them and the addiction recovery industry to help the millions of Americans who are suffering from addiction. Demonizing an entire industry due to a few bad actors not only doesn’t help, it hurts – and makes it more difficult for people to access good treatment.

While most rehabilitation providers are well-intentioned, it’s important to know how to avoid the bad ones. The primary differentiators for high quality, ethical, patient-centered treatment centers revolve around the concept of “practicing what you preach.”  Every addiction recovery center will say they provide patient-centered care, use evidence-based practices, provide trauma-informed treatment, and so on, and most do those things really well. Sadly, the ones that don't often say those things too.

Here are a few ways to identify a high-quality treatment center that is practicing what they preach:

• They have a state license and national accreditation. In the most basic sense, reputable patient-centered care can only exist in a state licensed and nationally accredited facility (JCAHO (more rigorous) or CARF accreditation). This means every facility that an organization runs, from their clinical centers to the sober homes and even their vehicles, must meet the standards of a national accrediting organization. By being Joint Commission accredited, recovery centers are held to standards of safety, quality improvement, basic quality of care, and accurate documentation.
• Clinicians are fully licensed and certified in the subspecialty areas that they practice. Ideally, clinicians will have master’s degrees as an LCSW or LPC, in addition to CAC certification or LAC licensure. Most addicts have co-occurring mental health or trauma issues that must also be treated, so it’s important that there is daily treatment beyond the 12-step process being done by qualified professionals to help individuals treat the underlying drivers of addiction.
• Ask to visit the facility or at least better understand what the program looks like on a daily or weekly basis. Viable programs will offer varying types of individual and group therapies, depending on the person’s particular diagnosis. They will also offer a phased approach over the course of multiple months that help the patient build positive life skills and habits in a sober environment.
• When in doubt, ask an impartial private practitioner, ideally one who is board certified in addiction medicine (ASAM certified) which treatment centers they recommend. They can often provide more guidance and direction.  One place to search and find one is through the American Board of Preventative Medicine’s website.

As a family looking for help for a loved one or a company trying to support a once-valuable employee, it can be difficult to determine the good treatment centers from those that misrepresent their level of care. Here are a few questions to ask to guide your search for high-quality, ethical treatment:

1. Did the treatment center sign you up on an insurance policy or tell you which insurance policy to get? Did they pay your premium every month you were in treatment? Did they fly you out to treatment? This is all widely considered unethical and a very negative sign.
2. What is the bed count and licensed staff-to-patient ratio? Ratios below 12:1 in residential treatment and 15:1 in outpatient treatment indicate better individualized care.
3. Does the facility have a medical director on staff? Are the doctors associated with the program certified by the American Society of Addiction Medicine?
4. Does the treatment center and its clinicians have the licensing and certification explained above? 
5. Does the center offer a variety of therapies and skilled therapists who can address trauma, mental health, or medical history that may have led to the addiction? Are those professionals certified and trained in the specific modalities they’re using?
6. Is the program transparent about why they’re doing what they’re doing or do they just tell you that they’re the professionals and to do what they say? If the latter, run away!
7. Does the program offer different treatment and therapy options to fit different needs? Every program should have a primary track, but do they provide additional services for other needs that are specific to the individual?
8. Does the program offer any form of case management to assist you with your legal, professional, medical/dental, or other non-therapeutic needs? In addition to digging into the above topics and questions, watch out for the following warning signs:
9. Generic advertisements and websites that don’t detail the types of treatments provided and facilities for patients. These sites and ads are often fishing for clients which they then broker to addiction treatment centers across the country. Promising 100 percent success, not sharing the facility’s actual name and using actors wearing doctor outfits are common tells that something is afoot.
2. Offers for anything free: Any time there is an offer to pay for travel, an offer for a “free bed,” or cash offers (no, I’m not kidding) you are likely dealing with a shady operation.
3. Treatment centers that don’t ask for patient background, medical history, or references from past professionals should be a red flag as they can’t know if their services are the right services for an individual’s needs without this information.

As an industry, we need to do a better job of providing impartial, effective guidance and transparency for those who need it. It is our duty to help people find and get the ethical, quality care they need in order to rebuild their lives. The vast majority of the addiction and mental health services industry is comprised of hard working and mission-driven professionals who recognize the social need and are working tirelessly to help each individual. With more than 65,000 people dying of overdoses each year in our country, these professionals and the reputable treatment centers for which they work will be instrumental in our fight against the addiction epidemic in our country.

Ethan Castro is the executive officer of AspenRidge Recovery, an addiction treatment center with locations in Lakewood and Fort Collins.