A lack of national standards and less than optimal oversight of many inpatient, opioid addiction rehabilitation programs is raising questions about the level of services, personnel, and quality of care many patients are receiving. On the other end of the spectrum, however, are programs dedicated to guiding patients on the road to recovery.
The CDC estimates that 114 people die a day because of drugs, and 6,748 will visit hospital emergency rooms for treatment. A survey conducted by the HHS Substance Abuse and Mental Health Services Administration (SAMHSA) finds, however, that as many as 90% of people who most need drug rehab do not receive it.
Treatment approaches run the gamut from abstinence, detox, and 12-step programs, to comprehensive programs embracing a combination of group and individual psychological therapy, medication-assisted treatment (MAT), treating co-occurring conditions, and social services. The variety of programs and discrepancies in quality not only breeds skeptics of the addiction rehab industry, but also opens the door for scammers.
Where is the money going?
Private insurers are spending millions on opioid addiction treatment—up 1,000% between 2010 and 2015 to $721 million, according to Fair Health—prompted by President George W. Bush’s 2008 parity law requiring most group health plans to provide more generous coverage for treatment of mental illnesses. The 2010 ACA cemented coverage even further.
Today, there are more than 14,000 specialty addiction treatment programs in the United States, according to SAMHSA’s National Survey of Substance Abuse Treatment Services.
“What programs are offered is pretty much up to a rehab facility,” says Carolyn Coker Ross, MD, author, speaker, and consultant in the treatment of addictions, eating disorders, and obesity in La Jolla, California. “While there are some governing organizations ([the Joint Commission] and CARF), they do not dictate what is offered. And the level of treatment providers varies immensely.”
“Often times, poor rehab programs offer nice amenities in a scenic location, but lack the appropriate clinical care,” says Lisa Blanchard, vice president, clinical services, Spectrum Health Systems, which provides addiction treatment services, including inpatient detoxification, residential rehabilitation, medication-assisted treatment, outpatient counseling, and peer recovery support. “They have great mattresses, HD TVs, and horseback riding, but these programs usually suffer from inadequate staffing combined with a lack of clear recovery programming.
“Conversely, good programs have a clear clinical vision and are accommodating, hold clients accountable to expectations, are friendly and inviting with strong customer service, and have strong values and commitment to each client’s recovery,” she says. “The staff should be knowledgeable, well-educated, and compassionate. Good programs also have strong aftercare and family engagement components, as both of these are vital to sustaining recovery.”
Blanchard says that facilities newer to the market are usually backed by venture capitalists looking to make a financial boom in lieu of providing appropriate care. “Nationally, there has been an increase of these ‘destination facilities,’ usually in Florida or California but could be found anywhere,” she says.
Marvin Ventrell, executor director of the National Association of Addiction Treatment Providers, agrees with Blanchard. “Because of industry growth and an increased ability to profit, private investors are putting money into new centers or buying them. They are in it for the ROI, which doesn’t usually equate with quality care.”
Until recently, says Scott Olson, CEO, Pathway Healthcare, there were really only two kinds of treatment for opioid addiction: methodone clinics, mostly for those on Medicaid; and residential programs, inpatient rehab clinics often for the very wealthy. Headquartered in Dallas, Pathway provides addiction treatment and recovery clinics. They combine MAT, using buprenorphine and naloxone, along with behavioral therapy.
What bothers Olson is a philosophy deployed by some rehab centers—recovering or ex-addicts helping patients, which makes no sense to him. “If a person’s life is in chaos, how can he or she help someone else?” he asks. “We can’t afford to promote poor care.”
Caron Treatment Centers, based in Wernersville, Pennsylvania, offers a multidisciplinary approach to address the co-occurring disorders often associated with substance use. It incorporates various treatment modalities, such as cognitive behavioral therapy (CBT) and dialectical behavioral therapy (DBT), psychological testing, medical evaluations, and 12-step integration.
Doug Tieman, president/CEO, says Caron endorses the utilization of MAT—primarily Vivitrol (naltrexone extended release) or Suboxone (buprenorphine and naloxone)—but not methadone, and stresses that MAT alone is not a panacea.
Narcan (naloxone) rounds out the list of other available medications under MAT for opioid addiction.
“Medication must be used as a supportive tool and managed by a qualified healthcare professional in collaboration with treatment specialists as part of a comprehensive therapeutic program,” Tieman says. “We identify patients for whom we think MAT will be a good fit and educate all patients about the disease concept of addiction and the importance of implementing evidence-based practices to sustain a meaningful and healthy recovery.”