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:
The relationship between the Clinical component and the Sober living component of the Florida Model of care:
The concept of the Florida model of care:
Scenario 2: one unit with sober living “relationships” in the area
Once the insurance has lapsed for one client, that client is sent to another facility to utilize benefits again. This then goes nationally; which many professionals in the field refer to as human trafficking. Brokers, paid Alumni of programs, will then do “head for head” deals with other treatment centers to fill “heads in beds”.
Sober: not affected by a substance. Not inebriated
Living: the pursuit of a lifestyle of the specified type.
Sober living, a term coined mirroring themselves with halfway houses. Individual all reside together, have ground rules, expectations, and channel an extension of treatment into the community. A sort of stepping stone from treatment to full independence.
A bill introduced prohibit drug and alcohol recovery houses throughout Pennsylvania from discriminating against people with a physical or mental disability, including substance abuse disorders.
Jails typically will send recent released individuals to halfway houses and a revolving door occurs as recent released get caught up in a myriad of issues, and go back to the same prison they were in.
Similarly, treatment facilities send their clientele to sober homes, some of which are unregulated, the concept of ‘rack and stack’ spawns more issues. Beds are filled. Rooms and houses are over capacity. Individuals relapse and sometimes overdose and die, if it’s caught the individual is sent back to the same treatment center. Kickbacks are just the tip of the ice bergs.
Jails currently over capacity, a new push for first time non violent offenders to seek treatment as opposed to incarceration; interesting as they are now hemorrhaging bodies. Privatized jails potentially buying out sober establishments, dipping funds into treatment. Capitalizing on all ends. At all angles.
Originally coined, as a destination spot due to the white sandy beaches, and crystal blue waters; Florida became a hot spot to offer "destination treatment." This was appealing on many fronts. Mainly, it was a marketing campaign based on the amenities that Florida has to offer. A secondary marketable campaign, was financing of the operation. From an insurance standpoint, the Florida Model of Treatment was a more affordable option that enraptured a middle ground that was never approached before. It was this space that exists between inpatient and residential care (both of which are quite costly - both to the individual and the insurer). Those that engaged with this model of treatment, would access Partial Hospitalization, Intensive Outpatient, and Outpatient levels of care. Clients would often cohabitate with one another in sober dwellings that mandated rent, and on paper would advertise for 24/7 monitoring.
Often market driven campaigns would advertise that this model of care is a hybridization of what exists, but really gives the client a first hand enmeshed supportive environment from which to learn how to live independently free from the use of substances. If there was a mishap or relapse along the way, treatment centers would promote that the relapse would be caught so as to prevent anything escalating further.
A heavy emphasis on peer supports, and peer interactions are very much engrained in the fabric of this model. Peers, most of whom would graduate a program, would then be hired by said program, to then monitor and later recruit current clients.
Marketers and professionals in support of this model would often focus on the pro's as follows:
1. Strong emphasis on peer interaction.
2. Lower cost
3. Reality based programming
4. Life skill integration
However, not enough attention is given to the con's:
1. Little to no regulation
2. No differentiation (good treatment vs bad treatment)
3. No accountability (often the bad treatment options proliferate)
4. Modalities often focus on Insurance driven treatment vs Treatment driven client centered approaches
5. The multitude of neglect the client will experience
So generally speaking, all detox is 100% medially monitored. Ambulatory detox is a detox in which clients will are at a facility being medically managed 3-5 hours a day. This is formidable as insurers cover this level of care, and there's less staffing needs. There is also not a need for the traditional inpatient detox state and medical licensure for the facility. This is an arena that evades a lot of overhead costs.
Specifically, staffing needs for a general ambulatory detox:
- 3 techs total that would work 7 days a week. They will do case management notes just like they would come from any other detox
- Weekends nursing staff to monitor urine drug screens
- Drivers to transport clients to and from the facility to sober dwellings
Schedule of an ambulatory detox on a typical day:
- Morning medication distribution
- Then have process groups
- (Case managers could serve as both tech and case manager and cover said groups)
Intensive Outpatient (IOP) is a caliber of programming that offers group therapy 3 hours per day 5 times per week. Often these group meetings are designed to be held in the evenings or mornings to accommodate for individuals that are working or are in school.
Minimal medical oversight is required at this level of care and most individuals participating have completed the stabilization process and are in the maintenance phase.
Individuals participating are expected to adhere to a schedule, and show engagement with 12 step programming.
Partial hospitalization (PHP) is a form of a structured program sitting in the realm of outpatient services that is viewed as an alternative (and less costly) to inpatient. It is a higher level of care than typical outpatient services but less intense than formalized inpatient.
This programming is offered throughout the day for 6-8 hours, but does not require oversight throughout the night. Clients seeking this level of care are often engaged in sober living with oversight throughout the community.
Things often not included in the cost of stay:
- Transportation to and from living environment to treatment environment
- Support groups
- Job Training
Inpatient care is typically where patients reside for different lengths of time depending on the set up of the program. On average, most facilities have their inpatient programs set up to support 30 days of care. Some facilities will offer longer stays depending on their program ie - some offer 60 day programs while others offer 90 days of care. Length of approval for programming typically is contingent on severity of addiction, co-occurring mental health conditions, and if there is history of being in care in the past.
Typically, inpatient facilities off offer a host or modalities, including but not limited to: family programs, family counseling, individual counseling, group counseling, medication monitoring, introduction to AA/NA meetings, introduction to working the steps (integration of the Treatment Research Institute (TRI) module system (developed by UPenn)).
Facilities provide unique sets of amenities and accommodations. Some will include shared rooms, cafeteria meals, recreational activities. Other higher echelon facilities will offer private suites, gourmet meals, and more specialized amenities.
Detox level of care typically happened in a three phase approach: Evaluation, stabilization, and entry.
Evaluation: in which medical and mental health providers assess medical and mental health issues. Doctors will issue medical screenings, blood tests, urine drug screens to assess medical condition. A full and thorough drug, medical, and psychiatric history will be evaluated.
Stabilization: the goal of stabilization is to limit harms to the patient. The medical doctor will assess and prescribed medications to assist in reducing withdrawal potentiation.
Entry: in this final phase the doctor will familiarize the patient to the treatment program, review expectations and the treatment process.
Detoxing from substances typically takes weeks or sometimes months to manage withdrawal complications depending on a number of factors:
Types of substances used
Duration of use
Severity of use
Method of use
Amount of use in one sitting
Mental health conditions