“The Business of Recovery”: Putting Profits Over People Hurts Public Health

The Business of Recovery, produced by Greg Horvath, April 2015

Filmmaker Adam Finberg’s The Business of Recovery makes a bold claim, arguing that the many purveyors of addiction treatment are doing little more than selling false hope to people who are desperate.

Whether a loved one is hooked on alcohol, barbiturates, heroin or crystal meth, the film presents addiction “specialists” as marketing a one-size-fits-all solution: the idea that 30, 60 or even 100 days away, coupled with attending 12-step meetings morning, noon and night, is all that is needed to cure their addicted friend or family member. Of course, some people do get and stay clean after attending an in-patient program, but as the many medical experts and researchers interviewed in The Business of Recovery attest, the vast majority – upward of 90 percent – do not, relapsing at some point in their sobriety.

Dr. Lance Dodes, author of The Sober Truth: Debunking the Bad Science Behind 12-Step Programs and the Rehab Industry and a professor at Harvard Medical School, argues that many of the foundational ideas about ending substance abuse are wrong. Take the notion of addiction as disease.

“The disease idea used to be useful to destigmatize addiction,” he says in the film. “It can help people feel better about themselves, but as a scientific idea, it has little merit … Addiction is a compulsion, a feeling of being trapped or helpless,” and unless those underlying feelings are addressed in intensive psychotherapy, relapse, he says, is more likely than not.

University of New Mexico Professor Emeritus William R. Miller, Ph.D., agrees with Dodes, adding that where the prevailing wisdom once dictated that there was nothing to do until the addict hit bottom; this too, has been proven false. “You can help people increase their readiness to change,” he says, “by finding in them that which wants to change.” Often, he adds, this happens during a moment of crisis, when the internal motivation to stop using is at its peak. But it is never easy, because people have to grapple with depression, anxiety, relationship problems, sexual trauma, physical abuse or bipolar disorder, and address the many complex and uncomfortable feelings that made getting high so appealing in the first place.

The 12-step model, developed in 1935 by alcoholic businessman Bill Wilson and alcoholic medical doctor Bob Smith, comes in for a harsh smackdown in The Business of Recovery, but Dodes concedes that the program is often misused.

“Attending AA was never supposed to be forced,” he says, “but now courts and the legal system mandate AA treatment. It’s not that AA is bad, but that we have to see it accurately.” It also should never be mandated; study after study, says Dodes, has shown that recovery works best when it is entered voluntarily.

Nonetheless, high-end treatment programs including the Betty Ford Center, the Hazelden Foundation, One80 and New Directions for Women are strict adherents of the AA model. In addition, the $34 billion – yes, that’s billion with a B – industry has taken AA, which anyone can attend without charge in their home communities, and incorporated meetings into fantastically beautiful settings that look more like elite spas for the ultra-rich than medical treatment centers. And it has paid off – handsomely. For example, 30 days in Betty Ford costs $53,000. Shockingly, according to the film, this is not an anomaly. Most in-patient rehab centers, we’re told, charge between $25,000 and $44,000 a month.

Parent Jeff Tanner speaks eloquently in the film about the exorbitant cost of treatment. Upon learning that his daughter Jenna had developed a drug addiction, Tanner says that he quickly contacted New Directions for Women. Staff at the highly touted center assured him that “they could take care of any and all problems,” so Tanner quickly liquidated his children’s college fund and maxed out his credit cards to come up with the $25,000 needed to get Jenna placed. He was assured that treatment would begin immediately and that Jenna would be examined by a psychiatrist within 24 hours.

Slightly more than 48 hours later, however, Tanner was stunned to return home and see Jenna sitting on his living room couch. “They had not noticed that she’d left the facility,” he reports. Worse, in the two-plus days she’d been at New Directions, Jenna had seen one movie and been transported to one AA meeting, but had not had a psychosocial evaluation.

Unfortunately, Tanner never got his money back and his incredulity is palpable. Thankfully, the story has a happy ending…

Not every story ends so positively. One reason, the filmmakers suggest, is that licensed and trained medical professionals are rarely employed by rehab centers. People in recovery are commonly hired to fulfill all functions; their sole credential is that they have been through treatment themselves. On the other hand, peer support is often effective, and the film ignores the many ways that people in recovery routinely help one another, offering an ear, a shoulder or the sage advice of someone who has been in a similar predicament. Needless to say, licenses or diplomas are no indicator of efficacy, compassion or connection.

They do, however, indicate the earning of humongous professional salaries: The film reports that the CEO of Betty Ford earns $558,950 a year; the CEO of Hazelden, $746,277; and the CEO of High Watch in Connecticut, $336,812.

They’re not the only ones cashing in.

The Business of Recovery also highlights the existence of more than 60,000 sober living houses located throughout the country. Michael Colasurdo, a 23-year-old man who was addicted to heroin and died of an overdose three months after being interviewed, was placed in a sober house early in his presumed recovery. He described the facility as a joke, blaming a lack of supervision. His death is tragic. But while offering better supervision and on-site counseling sounds rational, it is not clear what measures could actually be taken to prevent residents of sober living houses from using.

That said, the film notes that sober living houses are unlicensed and makes a case against them by zeroing in on Rick Schoonover, a Californian who owns and operates three facilities. According to filmmaker Finberg, one of the homes is severely overcrowded, with 24 men sharing a three-bedroom, two-bath unit. Most appalling? Schoonover’s take for the three residences is a whopping $42,000 a month.

Parent Wendy McEtyre, whose son died of an overdose, calls sober living houses a “cash cow business” run by “modern day slumlords … To me, it’s a conspiracy of greed, preying on the backs of vulnerable people.”

Exactly.

What’s more, we should all be alarmed by the fact that the entire recovery industry is largely unregulated. Dr. William R. Miller notes that the programs can “do anything, say anything and charge anything.” Sadly, people pay – sometimes mortgaging the proverbial farm to get needed “help” for the people they love.

It’s a story rife with avarice – a terrible tale about those who feed at the trough of others’ misery.

Needless to say, the process of recovery should not be about money, a point emphasized again and again throughout the film. Instead, advocates highlight that it should be about science and the study of evidence-based treatment modalities to learn what works in getting people to stay drug- and alcohol-free.

This is certainly true, but it should also be about more than this; a truly caring society would recognize that you can’t force people onto the straight-and-narrow. Instead, policies that help folks minimize their risk – allowing them to use safely until they are ready to stop – are imperative. At the same time, we need to challenge the stigma that surrounds drug and alcohol dependence – the perception of moral weakness that persists – and develop health systems that are humane rather than punitive, and pro-people rather than pro-business.

Editors’ note: this story was updated at 4:00 pm, Central Time.