KICKBACKS FOR ADDICTION TREATMENT PATIENTS

Art Reflects Life: New Film Body Brokers Explores the Dark Side of Finder’s Fees for Treatment Patients

Unethical treatment providers are exploiting vulnerabilities to take advantage of families and addicts desperately looking for help. The three key ingredients:

  • Infusion of cash (from parents and insurance)
  • Inadequate regulation
  • Vulnerable patients

With 22 million Americans struggling with addiction and alcoholism, and many often seeking help in a crisis with little information as to effective treatment, it is easy to see how this population can be manipulated by providers maximizing profit over service.

A recent article in Counseling Magazine, “Breaking the Body Brokers[i]” discusses California’s reform measures to restrict these predatory practices. Examples include selling addiction placement patients and paying people to relapse to reenter treatment. Other forms include providing housing and transportation to enroll in a center, and referral fees and financial relationships between drug testing labs, outpatient and housing entities.

  • A seamy, sordid business too many families and their loved ones have been caught up in, leading to failed treatments and despair at ever recovering.

These are evil people, by the way – making money while our addicted family members and friends suffer and die.

The Film

A recent film, Body Brokers, captures the reality of this patient exploitation in ways that will turn your stomach and break your heart. Fortunately, California passed legislation restricting these practices. But few other states have acted, meaning that you as the consumer are still subject to the many tactics used to separate you from your money while duping you into believing your loved one is receiving excellent inpatient or sober housing care.

Isolating You From You Addicted Loved One

One problem is separating the addict from his/her family and other support systems. Once that happens, your loved one is open to exploitation because there is no one to be accountable to and the system lacks effective regulatory oversight. People who say, “I’ll take care of everything” or “It’s not your role to tell the addict where to go to treatment,” are to be avoided.

  • Not only is family involvement the key to long-term recovery, but also the key to minimizing exploitation by treatment providers.

Keep this in mind as a first warning sign: Is your helper fully informing and including you in the entire evaluating and treatment selection process?

Common, Less Visible Referral Transactions

Pay Interventionist/Patient Finder (IPF) a Lump Sum for Treatment

In this scenario, the family pays the IPF a lump sum to cover both the intervention and treatment, say $50,000. The IPF then brokers the patient to the treatment center giving the lowest price for treatment and pockets the difference.

Quid Pro Quo

The IPF refers the patient to a treatment center with the treatment center referring the patient back for post-treatment services such as phone counseling and drug testing. Common practice now among high-end centers. 

Client experience: Family member goes to treatment from affluent family with several tricky financial issues. Treatment center sends the family member to their preferred aftercare provider who does not understand or address financial concerns. Plus, the level of service is less than needed to support recovery. End result, relapse with the family member refusing to agree to further help.

IPF Receives Referral Fee

Client experience: I was once called by a family whose adult son was in treatment at a beach resort treatment center that did not consider addiction to be a primary disease and instead were focusing on mental health concerns. He had a previous alcohol dependency diagnosis. How did the son select this center?  On the advice of the IPF.  I strongly suspected a referral fee was paid because there was no clinical reason for selecting this center.

IPF Gets Referrals Based on Patients Delivered

The treatment center gives more referrals to IPFs who provide more patients. Callers to treatment centers are given the names of IPFs who send the most patients to the center.

Web Internet Treatment Center Resources

Searching for addiction treatment on the web often leads the searcher to sites that pay to be promoted on search engines. These sites often are owned or run by the same group who then refer the caller to treatment centers that pay fees for these potential clients.

Remember The Basics

Standard Required Practices for Admission for Treatment

Many IPFs do not follow standard protocols required by regulations and professional standards for admission to inpatient treatment because doing so might likely dictate a less drastic alternative to such care. Plus, many IPFs are not qualified or licensed to apply these protocols. To be blunt, their goal is to send the patient (your loved one) off to treatment without determining if inpatient treatment is needed or the best option.

Diagnosis of Substance Dependence

Use the DSM-V criteria for the substances in question and assess the degree of the disorder, with three levels: mild, moderate and severe. A mild diagnosis usually does not warrant inpatient treatment.

Applying ASAM Placement Criteria

The American Society of Addiction Medicine has developed six criteria for evaluating the level of care, including inpatient:

  • Acute Intoxication and/or Withdrawal Potential
  • Biomedical Conditions and Complications
  • Emotional, Behavioral or Cognitive Conditions and Complications
  • Readiness for Change (Is the patient willing to go in-patient?)
  • Relapse, Continued Use or Continued Problem Potential
  • Recovery/Living Environment

These standards are used in deciding whether or not an addict needs to be treated as an inpatient or in the community.

As noted in a past blog, many treatment centers admit patients without going through any evaluation as to level of care or diagnosis. Avoid these centers. I also wish to remind readers that the authoritarian model prevalent in the addiction field is based on the idea that addicts and alcoholics need to be told what to do and their preferences ignored. Thus, families who only know this model, are vulnerable to sales pitches promoting in-\patient treatment over the objection of their loved ones needing help but wanting to try alternatives.

No Oversight – No Complaint Process – No Accountability

An additional super significant concern about working with patient finder/interventionists is that many are not subject to oversight by any regulatory bodies. This means that when the IPF engages in unethical behavior or provides incompetent services, there is no one to complain to.

What happens is that IPF and AA sponsors/members use their access and interactions to develop a relationship with your family member in early recovery.

  • Then they use that relationship to exploit and take advantage of your loved one: sexual, economic or psychological abuse are not uncommon for our affluent loved ones.

The only recourse is to sue the IPF or sponsor. Few loved ones are in a position to do so and most families are too embarrassed to consider litigation, or they buy into the message that their loved one is at fault. Exploitation is a real danger and another reason to find professional help.

Resources for Professional Help

As emphasized, do not call a treatment center or interventionist or look on the internet for help. You will likely be caught up in this patient brokering, referral fee network that places making money at a much higher priority than patient well-being. And do not call your friend or friend of a friend in AA. Not only are AA recovery rates low, but you need professional help. AA members tend to think their way is the only way to stay clean and reject concepts related to successful recovery management programs.

Professional resources include the following suggestions to find help for your family.

  • Use your Health Care Insurance and Call for a Referral to a Qualified Counselor
  • Network of Independent Interventionists (NII)
  • NAADAC Credentialed Counselors
  • ICRC – International Certification and Reciprocity Consortium
  • American Society of Addiction Medicine (ASAM) providers
  • Physicians Health Programs (PHP)
  • O’Connor Professional Group (OPG)

While I provide a short description and website reference below to most resources, my strong preference for the well off and well known is OPG. Next choice is to find an ASAM physician as they are used to working with a more affluent clientele. Remember the goal is obtaining help for you and your family and to come up with a plan to address your LO’s substance abuse.

1. Use your Health Care Insurance and Call for a Referral to a Qualified Counselor

This is the best option for families that cannot afford specialized help for their families. Use your insurance and find a counselor to help you and your family. For wealthier families there are better alternatives because many counselors do not understand the unique dynamics of affluent families.

2.  Network of Independent Interventionists (NII)

These interventionists are credentialed and independent of treatment centers. For example, the fourth of their policy guidelines for members is:

4th: Being independent of treatment centers means that the interventionist has no financial ties to any residential treatment center through employment, retainers, or through any other arrangement that could render the interventionist partial or biased towards them.

While there are not members in every state, most members will travel to meet you. And their approach to interventions is more oriented towards engaging the person with a problem in the process, rather than the “quickie” type of intervention. Also, note that most members also provide family counseling and can help you manage your loved one’s recovery journey.

3. NAADAC Credentialed Counselors

National Association for Alcoholism and Drug Abuse Counselors has different classes of counselors based on their educational degrees, experience and training.  The various categories are listed on the NAADAC website.  

For example, see the following credentialing criteria for a “Level One Counselor”

National Certified Addiction Counselor, Level I (NCAC I)

  • Copy of GED, High School or higher diploma or transcript.
  • Evidence of current credential or license as a Substance Use Disorders/Addiction Counselor or Professional Counselor (social worker, mental health, marriage & family therapist or LAP-C) issued by a state or credentialing authority.
  • Written verification of competency in all skills groups by a supervisor or other health care professionals who have personally observed the candidate’s Substance Use Disorders/Addiction work for a total of three years full-time or 6,000 hours.
  • Evidence of 270 contact hours of education and training in Substance Use Disorders/Addiction or related counseling subjects.
    • Must include at least six hours of ethics education and training within the last six years.
    • Must include at least six hours of HIV/other pathogens education and training within the last six years.
  • Submission of a signed and dated statement that the candidate has read and adheres to the NAADAC/NCC AP Code of Ethics.

Did the interventionist you were referred to meet these standards? How about that AA friend of a friend? Likely not.

4. International Certification & Reciprocity Consortium

IC&RC is an organization that is made up of state and international boards that approve credentials and oversee examinations to make sure counselors meet minimum standards in their profession. Working with a counselor or other recovery specialist with an IC&RC certificate assures the client that the prospective counselor has been IC&RC standards.  See their website for a list of State Certification Boards.

5. American Society of Addiction Medicine

Find a certified addiction medicine provider. Go to the ASAM website. I like ASAM because the professionals can work with your family on an individual basis.  For example, a family business looking for help for a family member. Our local ASAM certified doctor offers an evaluation for under $500 dollars private pay. No insurance records. No hoops.

6. Physicians’ Health Programs (PHP)

Almost every state has a PHP program for addicted health care professionals. Some state programs sometimes will take on non-physician clients.  If not, they often are good sources for referrals to qualified professionals who are able to assist families. 

  • These programs use the concept of “leverage” – using the license to practice medicine as the incentive for doctors to comply with treatment recommendations.

Therefore, practitioners should be helpful in using access to family resources as leverage to achieve the same end with your loved one.

See https://www.fsphp.org/state-programs for a list of state program offices.

7. O’Connor Professional Group, Inc (OPG)

Founded by Arden O’Connor after her brother had been through 20+ treatments, OPG works with families to develop effective strategies to encourage loved ones to seek help. OPG has a wide variety of recovery resources, including case management and companions for people in early recovery or struggling to quit using. And OPG keeps up to date on treatment centers in order to try and make a good match for clients. Well worth the price for an initial consult. OPG offers services throughout the U.S. and overseas.

Concluding Thoughts

These seven resources for professional, credentialed help for you and your family are credible, viable alternatives to the predominant patient finder/interventionist system with its focus on making money and resultant high relapse rates. You can and must do better. It may take a little more digging on the web for some of the resources, but it is well worth the effort, given the stakes.


[i] Counselor Magazine, June 2021

MOTIVATING ADDICTS TO SEEK HELP

Data On “Intervention” Methods

Success Rates for Three Intervention Models to Motivate People to Enter Treatment

OK, readers, time for an update on the daunting topic of how to motivate our substance-abusing loved ones (LOs) to agree to seek help, BASED ON RESEARCH.

So what does the research show regarding various approaches to encouraging alcohols and addicts to agree to enter treatment?[1]

Three Different Common Models

  • CRAFT MODEL                                    64% Success Rate
  • JOHNSON MODEL                             22% Success Rate
  • Al-ANON MODEL                               14% Success Rate

This study randomly assigned 130 families to the three different models, with the success being defined as the addict entering treatment. What are the models?

Craft Model

The CRAFT (Community Reinforcement Approach to Family Training) model is described as collaborative, practical and respectful approach based on teaching families a set of positive strategies to interact with their LO with the problem.

Johnson Model

The Johnson Model is described in the book, I’ll Quit Tomorrow and popularized by the show Intervention. This model usually involves an early-morning visit to the LO’s residence by family members, under the guidance of an interventionist, who then read letters telling the target how much his/her addiction has hurt them, hope for the future and consequences if s/he does not immediately agree to go to treatment. This is the model that many interventionists (a.k.a. patient brokers) try to sell to families, with the goal of sending paying clients into treatment centers.

Al-Anon

Al-Anon recommends doing nothing and waiting for your LO to seek help when s/he decides to quit. I call this the “waiting for the light bulb to screw itself” model. This approach is one reason for the high death rates among addicts. Family members are often referred to Al-Anon by therapists, treatment centers or other professionals. I consider this malpractice.

Vital Information

The success rates for these models is vital information for family’s seeking help because they can overestimate (hope) for positive outcomes using these methods. Also, treatment centers and interventionists will oversell success rates to families to gain their business. The intervention game is an unregulated, anything-goes, buyer-beware sales market. (Note that there are better interventional models described further on [i.e., contingency management], but the emphasis in this first part is on research on the probabilities of success for these three common approaches.)

RECOVERY RATES
20% or Less at One Year

As I discuss many times elsewhere, recovery rates from treatment are low, less than 20 percent at one year, according to reliable studies. As with interventionists, any representations or reports about success rates for treatment are unreliable because the industry is unregulated.

So even when your LO does agree to go to treatment, the expected outcome is relapse. 

Which is why, my goal is to educate concerned family members and friends about data-driven models that improve the odds of sustained recovery, compared to the above models. The reader will see that by combining success rates for getting people into treatment and success rates for sustaining recovery after treatment, the likelihood of success is low.

Example: 22 percent under the Johnson model go to treatment. Of that 22 percent, 20 percent will be abstinent at one year. QED: The likelihood of recovery is 4.4 percent (22 percent x 20 percent) for those intervened on using the Johnson model.  Even if off by 500 percent, these are poor odds.  Keep in mind that the treatment center/interventionist cohort is a business, with substantial income generated by former patients who relapse. There is scant economic incentive to adopt highly effective recovery models.

War Between Old Ways and Evidence Based Practices

Right now, there is an active war going on in the addiction treatment field between the old ways practiced by treatment centers and AA sponsors and evidence-based practices based on research.

Example: A family business member returns from treatment. A member of a family business, Bob, is in treatment for the second time and the family is concerned about his return to his job in marketing involving entertaining, where alcohol is present.

Treatment Center/AA Sponsor: Bob is responsible for his own recovery and the business should make no changes or require any oversight measures. If Bob fails, he suffers the consequences until he gets the miracle of recovery.

Family Business Position: Business leadership wants Bob to sign a Return to Work Agreement, similar to agreements for pilots and doctors resuming work activities. These agreements provide for regular drug testing, changes in the work environment to reduce the risk of relapse, counseling requirements and similar accountability measures. From the family business perspective, they can’t afford Bob to relapse and harm the business and they are concerned about maximizing Bob’s opportunity to become sober.

Ongoing Warfare: This dispute is common and reflects what I call the treatment center/AA “mafia” hold on advice to addicts and family members that so often leads to relapse, versus the much higher, evidenced-based recovery outcomes of the pilot/doctor programs. This war between the two dramatically different approaches is ongoing for over 20 years, with no end in sight.

Going to Treatment is NOT the Same as Deciding to Recover

The kicker here, of course, is just because your LO agrees to GO to treatment does not mean s/he will WANT to recover or be able to SUSTAIN recovery. 

  • Got it? The decision to seek help is only the beginning.

Many people decide in treatment they do not want to quit, do not want to do what is necessary to maintain abstinence, or – even if they want to be abstinent – are provided an inadequate post-treatment program and relapse. Therefore, in the next section, I will review more successful intervention models using some form of contingency management or leverage.

Leverage Pressure – Incentives – To Seek and Sustain Recovery

Other, more successful motivational models: Treatment Courts, Incentives, Doctor/Pilot Leverage Concepts

CRIMINAL JUSTICE SYSTEM – TREATMENT COURTS

From the National Drug Court Website (NADCP.org):

Treatment courts are the single most successful intervention in our nation’s history for leading people living with substance use and mental health disorders out of the justice system and into lives of recovery and stability. Instead of viewing addiction as a moral failing, they view it as a disease. Instead of punishment, they offer treatment. Instead of indifference, they show compassion.

Treatment court judges are said to have higher success rates than treatment centers!

Treatment courts are both a model to encourage people to seek help and to keep the pressure on until the addict can sustain recovery on their own. In the context of our work with families, a criminal incident can be used as leverage to encourage a loved one to seek help. However, most often families marshal their resources to make incidents go away. Not only is a treatment opportunity lost, but the addict learns the family will come to his rescue, no matter his/her behavior.

Example: A young adult steals money/objects from parents’ home. In this situation, we commonly suggest that the parents ask their lawyer to find a criminal defense lawyer to represent their child with the goal of a plea agreement requiring successful completion of treatment in exchange for dropping the charges. It is most successful when the prosecution is informed of the desired result before the parents bring the charges. One common problem occurs when a parent or other family member subverts the system when the young adult is noncompliant with the plea agreement.

INCENTIVE-BASED SYSTEMS – ASAM CONTINGENCY MANAGEMENT

As reported previously, the American Society of Addiction Medicine (ASAM) states[2]:

Contingency management has been studied and shown to be effective in the treatment of many substance use disorders, including opioid use disorders, cannabis use disorders, and stimulant use disorders. Importantly, it is the only evidenced-based treatment for stimulant use disorders. …… The National Institute on Drug Abuse (NIDA) also promotes contingency management as a highly effective approach to increase treatment retention and promote abstinence from drugs.

I recall reading several studies that indicate using contingency management in combination with community-based support services can double recovery rates for the chronic low-income using population – perhaps up to 40 percent. 

DOCTOR/PILOT PROGRAM – CONTINGENCY MANAGEMENT

Programs run by airlines and medical boards for substance dependent pilot and doctors, respectively, have the following recovery rates:

  • Pilots:          92% continuous abstinence at two years
  • Doctors:     84% continuous abstinence at five years[3]

The pilot success rate was first reported in the Hazelden Treatment Center Newsletter, Voice, in 1998. Pilots, like doctors, are offered a special treatment program unavailable to the general public. The contingency management component of the program is simple: You comply with all treatment recommendations and you can fly or practice medicine again. Very effective.  We find using access to money and other family resources is often a very compelling tool in encouraging family to seek help and stay focused on recovery.

Closing Comment

Let’s use research and data to make treatment decisions concerning our loved ones. Most readers are likely in high states of anxiety – looking for help and worried sick about their son, daughter, sibling or parent with a serious using disorder. But keep in mind the data. Don’t settle quickly for a solution with a low chance of success. This is not like horseshoes. Close is not good enough, and you may not get another turn to pitch that shoe.

In the next several blogs, more information on leverage.


[1] Miller, Meyers and Tonigan, 1999 Study,

[2] Letter to HHS Secretary Azar, July 6, 2020 from ASAM, by WF Haning, MD

[3] The New Paradigm for Recovery: Making Recovery – and Not Relapse – the Expected Outcome of Addiction Treatment A Report of the John P. McGovern Symposium Hosted by the Institute for Behavior and Health, Inc. November 18, 2013, Washington, DC