This weekend, John Oliver spent nearly 2o minutes describing several of the treatment industry’s biggest hustles.
Is this a sign of the times?
Maybe, but it’s not new.
In Recovery Rising, Bill White describes the business landscape in the 1980s:
The trend of private insurance companies paying for the treatment of alcoholism and subsequently other addictions unleashed an unprecedented wave of institutional profiteering. In addition to the proliferation of addiction treatment units in hospitals, private, free-standing treatment programs grew at record pace in the 1980s. It was a predator’s ball. People with little knowledge of addiction recovery entered the business of addiction treatment as an investment to make money and sucked every dollar possible out of these new businesses. The operational assessment philosophy was, “If you have the insurance, you have the disease.” The admonition to staff was, “If you can’t find it (substance use disorder diagnosis), you haven’t looked hard enough.” Inappropriate admissions and re-admissions, inappropriate lengths of stay, inadequate treatment, and insufficient post-treatment monitoring and support (the latter not reimbursed by insurance companies) were pervasive. It was only a question of time before it would all collapse. And when it did, it was once again those suffering from alcohol and other drug problems, their families, and local communities who were most injured.
In another paper, he described the scene at the beginning of the 20th century:
The field’s public reputation had been wounded by highly publicized breaches of ethical conduct. Newspaper exposés charged incompetence and fraud
in the field’s clinical and business practices. Allegations abounded of inadequate care, patient abuses, sleazy marketing practices, and the financial exploitation of patients and families. Muckraking investigations of the bottled addiction “cures” exposed products secretly loaded with alcohol, opium, morphine, and cocaine.
Bill ended that paper with the following thoughts:
We must both aggressively monitor the ecosystem within which we operate and take a more activist role within that ecosystem. We must get ourselves clinically and ethically re-centered. We must take a highly splintered field and find a way to speak with one voice. And we must rebirth a new generation of leaders who can carry our mission of serving the still suffering addict into the 21st century. If we fail to meet these challenges, we may be doomed to repeat an episode in history little known to today’s providers of addiction treatment. And that lack of knowledge is perhaps itself a source of great vulnerability. As the great comedic scholar Lily Tomlin once suggested, “Maybe if we listened, history wouldn’t keep repeating itself.”
Those words were written in 1999, after the field had collapsed from the 1980s boom. They are probably more important today than they were then.