Here’s our question-and-answer segment posed to our resident advocacy professional and Executive Editor, Joe Schrank. Joe’s been a social worker for 25 years. He’s also president Remedy Recovery and co-founder of The Fix. Our topic today: the Rehab Industrial Complex. The industry is broken and corrupt, so why do we keep sending people through the system? Joe’s helpful responses to our questions begin right below this bold paragraph.
Does the current rehab system actually work?
No. Every time I say that I get a chorus of Betty Ford alums and church basement dwellers telling me how it worked for them. It is true: the most important recovery is yours, unless you’re an ethical professional who has an obligation to look closely at the system.
There’s a foundation social work theory to which I often refer: “We help individuals out of a ditch but we must also look at the ditch.” Social workers in other areas of practice have always been interested in advocacy and policy. I’m a frustrated policy guy swimming in a corrupt pool, so it’s hard for me to find a seat at the cafeteria table. (Forgive me for mixing metaphors, I do that when I’m angry.) And, yes, I’m part of this industry, but I think we can do better. From a systemic analysis, rehab doesn’t work. Maybe the more specific thing would be to say in its current incarnation, it doesn’t work for enough people in need. Most rehabs in America are some form of faith-based cognitive restructuring with the goal of “total abstinence.” That’s successful 3-5% of the time. If cancer, hypertension, transplants, diabetes claimed an industry based on that success rate, what would we do? I’m guessing we’d want to improve outcomes.
Why do so many centers exist?
I believe there are so many because America marginalizes addicted people. Canada, Switzerland, Portugal, are all driven by science and treat addicted people like patients. The Philippines and Iran kill addicts. But rehab in America has become little more than AA indoctrination camp and AA is facilitated by other recovering people. Plus, the standard of care is shockingly low. State licensure varies, but sometimes you just need to hang a sign out front and a few empty beds and the Bill Wilson catalogue and, presto, you can start treating drunks and addicts. The Substance Abuse and Mental Health Services Agency (SAMSHA) reports “at least 23 million Americans in need of services with no greater than 10% receiving any.” So we have thousands of facilities in America but we barely scratch the surface of actually providing treatment to 90% who need it. Something is wrong there.
What should be fixed about the industry?
America needs to have a giant open dialogue about drug policy which would include treatment. America says “addiction is a disease” but it incarcerates people for having it. America has an absurd fantasy that “total abstinence” is the solution for all people in need. It would take a while to stop the locomotive and push it in another direction, but I truly believe it can be done. We need the resolve to do it. Maybe the opioid crisis will be the portal into treating substance misusers as patients. In the meantime, we need to up the standard of care and put it in the plans of doctors and credentialed social workers.
Speaking of fixes, you started The Fix, right? That other recovery site that everyone reads. I’ve heard that the original mission of that site had become compromised. Let’s hear your version.
Part of The Fix was supposed to scrutinize the $45 billion rehab industrial complex. At first the rehab business didn’t get us at all. I had one CEO of a rehab center call me and demand changes to his review. I explained “I didn’t say it, your consumers did” but he didn’t get it. The trouble began when the investor got itchy and wanted to see revenue and insisted we sell ads to rehabs. I was devastated and pissed. To me, The Fix was a tool to correct wrongs in the rehab business, not promote falsehoods. To me right now The Fix is just a love letter to rehab. I understand the investor needed to fund the project and there was easy money to be made if we got in bed with the very industry we were criticizing, but… come on. I think there’s an advertising market out there for recovery people: jeans, coffee, meditation retreats, exercise equipment, energy drinks, whatever. But selling people more rehab is just mean.
Right. What if rehab doesn’t work for an individual? They’re not failures. Yet, there’s a system in place that almost caters to repeat customers.
This is the biggest paradigm shift needed: The providers are failing, not the individual. AA and rehabs are both bad at disclosing outcome metrics. Most who relapse after a failed treatment program are deemed “not ready” or “unwilling,” but I’m certain that the system is the bigger part of the problem.
Joe Schrank is Executive Editor of The Small Bow. If you’ve got a suggestion for what we should ask Joe next, please email us here.