I also was able to connect with Gary Tennis, the President of The National Alliance for Model State Drug Laws (NAMSDL), to be able to ask regarding intricacies of treatment from the law making side of things. Very insightful conversation.
Again, paralleling my career, the next major accreditor I came across in my work history was JCAHO, renamed The Joint Commission. I reached out and was fortunate enough to connect with Julia Finken the Executive Director of Behavioral Health Care for The Joint Commission.
Granted, the questions, and responses had to go through their marketing/media team; still insightful nonetheless.
So, in parallel with my work experience, the first accreditor I chose to have a conversation with was CARF. Was fortunate enough to connect with Michael Johnson, the Managing Director of Behavioral Health at CARF. We discussed CARF's role in treatment accreditation, and even had the opportunity to directly inquire regarding CARF and its role in a facility actively under investigation or under scrutiny for fraud that was accredited by them.
After much contemplation, deliberation, and further strategic thought; I decided it would be integral to have a full perspective image on this industry by inviting members of accreditation along with organizations that influence law makers to gain a better understanding from their vantage; further to be able to present to the public.
Continuing with this theme, I wanted to bring on one of my mentors who has been in the field of addiction and recovery for the past 20 years serving the greater Philadelphia area to gain insight on what he has seen, as far as the trajectory of "treatment models."
For more information on Dr. Frank and his practice:
From how I was raised, and what I have learned along the way, it's always important to identify those that came before you. If you have not already, please consider viewing The Business of Recovery:
First interview was with the producer of the film Greg Horvath:
Prior to relaying additional insights to my now biased perspective; it's important that we all consider the following:
1. Why are these facilities so vastly unregulated?
2. How are these facilities able to maintain licensure?
3. How are these facilities able to establish, maintain, and pursue with accreditors like JCAHO, CARF, Shatterproof even when limelight is shown on them?
4. Who is watching the watcher?
5. Where does the corruption go?
6. Does it get political?
7. Are privatized jails pushing lobbyists to then communicate with congress on treatment?
8. Are the Sackler's pushing for lobbyists, jails and treatment as well?
9. What is the end game here?
10. Is anyone looking at the cost/benefit here, or doing any analysis on the cost of treatment, vs the cost of an inmate; further comparing and contrasting the revenue cycles of a treatment center vs a private jail?
In a series of audio interviews that were conducted over the last 3-5 years, we will interview folks from various realms to try to gain some more insight. These interviews, were originally part of an anonymous podcast, provoked more inquiries, which provoked more interviews. The cycle went on and on....
It’s amazing to me to witness people become so infatuated with their incoming salary. That Façade of wealth followed by addiction to all that brings, Often ends up illuminating a devilish side that create nothing but Evil genius continuing the maddening cycle deceit lies and corruption fraud Solely to keep the momentum going keeping true to being 100% mindless to the physical emotional and mental bankruptcy created within society
Often these addiction treatment center publicize that they act as a microcosm of the world and actuality they simultaneously create a microcosm within a microcosm of devilish greed
Let us process.
Another extremely wholesome idea. Let’s look a little deeper to see what we find.
Most of our jails are privately owned. Even in the ones that aren’t, we are in an era where most jails are max capacity, over crowded and lacking resources.
The notion of treatment as opposed to incarceration is a notion that should have been implemented decades ago for all non violent first time offenses featuring drug charges.
What we are seeing now is money from these jails being passed back and forth from attorneys to marketers of treatment facilities. Why no one talks about it? Well that’s not lucrative.
Random non profit companies being created by said marketers validate the “genuineness” of what is to occur. The marketer boasts how they virtuously want to help, represent a treatment facility, and coerce the judicial system to reduce sentencing allowing for the individual to go to treatment as opposed to jail.
The marketer then funds for an insurance policy for said individual, via the non profit they own. The individual comes to treatment, marketer makes their commission, facility begins billing for services. It’s a win win win win win..... right?
Treatment as opposed to incarceration is a beautiful thing conceptually on paper. What most don't realize is that most of the people involved in treatment DO NOT CARE about treating. There's a lot of profit in the system of treatment that we really need to take a hard look at. Additionally we must spend time evaluating "evidence based" modalities.
Efficacy can not be measured in simple surveys over the phone, nor by in house biased statistical analysis. Additionally, supervisory bodies need to be evaluated and neutralized. There currently exists a positive skew on treatment centers, their accrediting bodies, and the silent investors involved. It is it's own paradigm of monetary gain on the backs of those suffering.
It doesn't end there...
Let's begin, as the story typically does, with the client. More specifically the route at which the client becomes the broker:
It begins with a client. Client comes into treatment, typically via a predatory marketer/alumni from a specific treatment facility. Client comes in with marketer/alunmi, goes through the program, and eventually graduates the program. The day of graduation the owners of the center decide to hire this client and is now an employee with a constructed title Ie - alumni services rep, marketer, recovery specialist. This individual is responsible for monitoring graduating individuals from said program. As soon as he hears of someone relapsing he ropes them back into the same facility. This begins one aspect of the revolving door.
It begins with a client. Client comes into treatment, graduates the program. The day of graduation the owners of the center decide to hire this client and is now an employee with a constructed title Ie - alumni services rep, marketer, recovery specialist. This individual is responsible for monitoring graduating individuals from said program. As soon as he hears of someone relapsing he ropes them back into the same facility. This begins one aspect of the revolving door.
If said facility is at max capacity this is when the “head for head” concept comes from. The spawn of brokering exists here. The original client (alumni rep/marketer/recovery specialist) will continue monitoring graduates for relapse. They then will look at neighboring facilities or facilities a few states over ie - florida or California. This then begins the head for head transfers/trafficking of humans. The unwritten rule is if one facility sends one client , the receiving facility owes sending facility. That goes on and on with various facilities. Commission structure exists here. The rep sending clients in need, will get a base salary, and x amount of money based on clients sent/received. Typically the x amount is in a bonus structure.
Marketers will also get kick backs from the receiving facility. To me knowledge in the tri state area it was $500 per client.
In summary, marketers are profiting off of the clients via brokering to addiction centers across state lines. Modeling the treatment center they work for. ie - owners, private equity - no direct wholesome concern for positive efficacy - more focus on human capital. Repetitive motifs of profits over people.
Marketers and out reach servicing providers, even alumni of programs, will often make quotes on, and market, false efficacy studies. This can happen in person, or via the phone as call centers are typically created to enhance this process to generate more influx of clients to said treatment centers (cold calling).
Many facets here need to be extrapolated: firstly, the stigma of these efficacy studies. There are so many arenas where falsities are involved. Most treatment facilities will have their alumni and marketing staff, cold call former clients to check in at specific intervals of time. ie - 3 days, 5 days, 2 weeks, 1 month post discharge. These "efficacy studies" are done in order to gauge progress of the client via simple phone assessment with little to no cross-referencing. Questions like "are you still sober, are you going to meetings, how many meetings a week are you going to, do you have a sponsor, are you willing for us to be in touch with your sponsor, etc." are included. From this "data" alumni and marketers create percentages for longevity of sobriety. This is simply phase one of the falsity. The next phase is when the percentages are reviewed by the higher ups of the facility, owners, more often than not, will ask for alumni or other staff to apply "positive skews" to the data. Manipulating for a higher percentage that they can advertise and market. More often than not, the figure 80% efficacy, is often applied to and marketed on pamphlets and websites of these types of facilities. Accrediting organizations DO NOT do their due diligence, they simply sign off their stamp of approval.
Speaking on accreditation bodies; there are tow main accreditation bodies for substance abuse treatment: JCAHO and CARF. Both of which sit in the non profit sector and are renowned nationally for going to treatment centers, evaluating them, and granting them accreditation. New in the running is a for profit known as Shatterproof. Shatterproof is a private for profit variation of JCAHO and CARF.
In laymen's terms, having accreditation in this sector, at this stage, is pretty much paying a golf membership to say that a facility is part of an organization. JCAHO, CARF, and Shatterproof all have each facility that is accredited pay them a nominal fee annually, with Shatterproof being the most expensive of the three. This allots for the facility to then publicize their accreditation, which society will then see, and automatically assume esteem. What I have found is that even if the facility holds accreditation with JCAHO, CARF, potentially even Shatterproof, and are under investigation, these accreditation bodies do little to nothing in removing their accreditation.
Further up the chain, on another level and discuss state regulatory bodies like the department of drug and alcohol programming, have oversight on facilities, but typically only have their sights on facilities during the opening phase. Meaning, in order to get credentialed, most representatives from the state level will only come into the facility to see how it operates, and evaluates upon opening. Thereafter, there are minimal checks or follow ups.
For more details please feel free to listen to something I wrote up on my reflections and recorded: