A letter to the family or person seeking treatment…….again
Let me start by saying, I am really sorry this is happening. I don’t say it out of pity as I spent some years in my own active addiction and in addiction treatment. I just know how it feels and I’m really am sorry you are in it. If you are a man or a woman who is faced with this again, the frustration, embarrassment, and exhaustion can be monumental. Lets face it, it sucks.
I work with a lot of people and have for a long time. Many of them with a story like yours. They have been to 1,2,17 treatment programs in the past. Each of them promising a plethora of miracles and rarely any of them saying, “you know, we are going to do our best with the best knowledge available, but we don’t know how this is going to turn out.” That statement is the truth really. If you are a loved one reading this, it may be even harder to hear because the anxiety, fear, even terror has mounted. Trying everything you can to influence or even control the behavior of your loved one has left you exhausted. For your situation as well, I am sorry. I face it within my own immediate family. Even with 20 years of experience helping a lot of people break their chains, I can’t help my mom. She’s been dying for a number of years now and I have done a lot to stop it, including being an example myself. It just isn’t up to me. It isn’t up to you either. I know I can make sure I don’t enable her and I can make sure I keep myself as emotionally sane about all of it as I can, but some days are better than others.
Adding to all of this frustration are the barriers. The moments of willingness can sometimes be fleeting and quickly lost if not seized upon. Sometimes even what appears to be a moment of willingness has turned out to be an attempt to get heat off that puts you back in the same situation, or worse, with a wallet that’s 50 thousand dollars lighter.
Now comes the part where I level with you. (There will be swearing)
Our field of addiction treatment hasn’t been your friend. Here are some of the facts about what a lot of us have been doing to you:
- The day you called into the 1-800 dial a rehab number that had a sympathetic commercial, we lied to you. We then turned around and sold you to the highest bidding rehab out there, no matter how bad it was. The going rate was anywhere from 500-5,000 depending on what kind of insurance you had. It is fucked up and its happening all the time, to this day. You weren’t even talking to a counselor most likely, or anyone even remotely qualified to assess you. In some of the worst call centers, the people on the phone were actively ill with a substance use disorder themselves. In nearly all cases, they are sales people who are on commission. The more a facility is paying, the more they make on you. It’s illegal to sell you in nearly every state. I’m sorry the legal system has done so little to protect you when you are this vulnerable.
Don’t use these lines. If you need a referral for a treatment center, get one from a licensed physician, therapist, or professional. Insist on knowing their credentials and look up the credentials if they are unfamiliar to you. Some of them were just flat out purchased. Even some degrees are sometimes purchased. Wikipedia usually keeps a good list of degree mills.
- We promised you “free sober living”. This seemed like a god send at the time didn’t it? What you didn’t know was that we were going to commit fraud with your insurance company (who doesn’t pay for non-medical services), take advantage of the laws that protect your rights to a clean and sober living environment, and drive the cost of already overpriced treatment up so the next time you needed help it was even harder to access.
You are better off in a very low cost sober living home that isn’t involved in any of this. Motives count do they not? If you cannot afford a high end sober living home, that is a reality of your use and one that should be faced. Frankly, we are enabling you and shielding you from the realities. We may also be incentivizing relapse by making your “treatment” have more amenities than your real life.
- We sold your pee. Believe it or not, your urine is worth a lot of money to a lot of laboratories out there and they pay a lot. I get an email on LinkedIn about once a week from some new lab that wants your urine. This is called a kickback and its again, illegal. This is the other way we give you the free sober living. My favorite lab rep was the one who said I “hurt his feelings” because I told him to get the hell out of my office.
Its hard to tell who is doing this from the patient point of view. Some signs of these types of activities are explosive, fast growth of a facility. Did the program go from 6 or 12 beds to 50-100 in three years? This is how unless they had a major capital infusion which isn’t common unless these kinds of profits are illustrated to the investment group. Investors typically don’t care about you. They care about spreadsheets. That is a fact.
- We placed you at the wrong level of care. We wrote our assessments up in a way that would make you fit the criteria for the highest reimbursing level of care whether it was what you needed or not. We then kept you in those levels of care while your life passed you by, over and over again. Using for a week does not mean you need another 6 months in treatment.
If you question this, sit down with a trusted clinician and the American Society of Addiction Medicine’s criteria for various levels of care. Go through them with the physician or therapist and see what they think. Do they think you need this level of care based on this criteria? An independent assessment can go a long way toward finding out what is what.
- We delivered shitty treatment. Group therapy is done with 4-8 people in group. Anything more than that usually isn’t therapy (with some exceptions like sociometry/psychodrama, and within reason, multifamily process groups). It’s a class. One that you already went to in the first three programs. Why are we putting you through it again? Having 20 people in a room and calling it “group therapy” is a farce, and you should know it. This isn’t to say that education isn’t part of treatment. It is, but not like this.
Ask for specifics. How many people are in group sessions? Who facilitates the bulk of the groups? The website says there are several types of professionals? How much time in the clinical calendar do they spend with you? Is it a bait and switch? If the whole staff is filled with consultants who stop by, they wont know you or your case most likely. Are they part of the clinical treatment team meetings that occur daily or weekly depending on the facility? If they aren’t, they are not going to be the ones who are doing most of the influencing of your care. Some consultants are ok, but be careful of this. By the way, life skills is often a billable, bullshit group and isn’t done well. When it is there is a specific curriculum for it. Otherwise its probably beach walks with a tech or chopping vegetables with the cook for a day.
- We gave you the least qualified people in the field to do the bulk of your work with. Most of the people you are sitting with the most have been to one year of community college in most programs followed by some often loosely supervised internship hours they may still be getting. Mostly they are well meaning members of AA or NA, telling you about AA or NA. Sometimes you get a therapist for part of your treatment. Often that therapist is at the very beginning of their career. A lot of you were getting more from your therapist back home in once a week appointments because that therapist has been in their profession for 10 or more years.
This solution is largely the same as the last. Find out who is giving you the treatment. If you want a non-12-step pathway, who on their staff has any training in anything else? Is the DBT group really DBT or do they throw a worksheet at you once in awhile and mostly confront you on not having a sponsor yet?
- We sojourned you from your family. By swooping you up and sending you out of state, we cut you off from meaningful work with your primary support system. It just doesn’t make any damned sense. Then we used up all of your outpatient benefits to keep you longer and then sent you home without any change in the home environment or help to improve it. You no longer meet criteria for outpatient treatment and/or we used up all your benefits. You’re welcome, we taught you how to stay sober with almost 24 hour monitoring and sent you home to sort it out. Usually we at least give you the website for AA in your area along with a random therapist in your area that we got off of a directory website.
How is your family involved? Do they make a point of asking you about it at intake? Do they have dedicated family therapy that’s happening? Intensives? Regular family therapy appointments? The intensive is more important in residential because you don’t have time to build rapport with most families otherwise and as a therapist you can only go so far if you do only weekly sessions because there isn’t enough containment to build the emotional safety required in the midst of all of the chaos surrounding entering treatment. Once you are in PHP or IOP levels of care, it should be offered regularly.
- We let you believe that accreditation boards meant anything at all. Having accreditation as a program by CARF or JCAHO means you knew which lawyer to hire. All it is really is writing up a good policy and procedure manual. There are some good ideas in there, but none of them can overturn purely profit motives. Sorry we made you a widget and got the factory certified to fool you. Let me tell you here and now, these accreditation boards mean nothing anymore. Once upon a time they did. Now, at least in this field, they mean you get an easier ride with the insurance companies. That’s it.
To a degree on this one, I don’t know what to tell you. These organizations have failed us. Make sure the program is licensed by the state and that the staff are licensed and certified appropriately. You can usually look up professionals certifications and licenses online to verify, including physicians.
- We referred you to unlicensed, uneducated people and told you they were the best thing for you. Most of them got some training over the weekend at a seminar on methods that are not even evidence based, and the folks with them usually don’t have the qualifications or baseline education to even understand the concepts. We call them coaches, companions, partners, etc. Mostly they are people who saw a quick buck to be made, especially in major metro areas, and went for it. Some of them saw the emerging trend and set up “schools” for them. The schools are not accredited and are usually not run by active clinicians. Again, we fucked you. And it was expensive. At least here in CA, most of them are guilty of committing a crime according to our business and professionals code. They are practicing psychotherapy, in private practice, without a state vetted license. Let me tell you, as a licensed therapist, we go through a lot to get these licenses, and its for your protection.
There are a few good ones out there. But they are very few. Most of them are straight up hustlers and/or incompetent, and unless you have a really trusted referral source, I wouldn’t seek them out. (this will create some negative attention to this post online so be forwarned) Most of them will be out of the field in a few years or less. Some of them are independently wealthy themselves and survive a bit longer because they don’t need to hold a job and they can go long stretches without work.
Look, by writing all of this, I am going to catch a lot of guff online. Probably a bit of applause from some brave people who see it too. The fact is, a lot of us are tired of it. Really tired of it. But a lot of people are selling false hope and making a “killing” on it. Some movement has been made to stop some of the biggest and worst but its slow going and you don’t have time to wait to get help. I will probably be called jaded, or resentful. Maybe worse. That’s ok. I can survive that just fine. I want you to know what’s happening out here. It’s the wild wild west, or south if you are in Florida. The fact is, I was here before this “boom” of treatment programs and I will be here long after they are gone. I will never see the volume of people they will, but ill guarandamntee you my outcomes will be better.
James “Kansas” Cafferty, LMFT is the founder of True North Recovery Services and Cafferty Clinic. He has been in the field of addiction treatment since 1997 and is a person in long term recovery since 1996. He has worked in facilities ranging from non-profit outpatient to high end and exclusive. His article can be reproduced only in its entirety and only when credit is given to the author inclusive of this section.