Although it’s difficult to figure out exact numbers, the thought process is that in the United States over 24 million people deal with addiction and meet criteria for needing treatment for a substance use disorder. Of that number of people in need of help, only about 10% receive services or access treatment. There is certainly a great need for addiction treatment services taking place in the United States due to the opioid crisis and overall addiction epidemic impacting American society. And of those individuals and families that do seek help for addiction through treatment, many if not most seek out help during a crisis, due to the secrecy, shame and stigma of addiction. This creates an incredible opportunity for shady operators and unethical practices to occur, as those out for a quick buck prey on the individuals and families in crisis that are unsuspecting and trusting, uneducated to what help they are seeking out and unfortunately ripe to be taken advantage of and exploited.
Patient brokering, enticements, bait and switch tactics, overbilling of insurance, double billing for services, outrageous bills to insurance and families for toxicology services. All these are examples of unethical, immoral or illegal practices that take place in addiction treatment. However, this is another example that many people don’t often think about or doesn’t garner as many media headlines as the other: Low quality treatment services. There are many operators in the addiction treatment space who, while may not be engaging in the most egregious business practices, simply are not putting out a quality product in terms of the treatment services they are offering.
So how does a mother, a father, a spouse, a loved one or an individual seeking treatment themselves vet a treatment program? How to do they know they are finding a high quality, clinically-appropriate rehab that will meet the clinical needs of the individual suffering from addiction or co-occurring disorders? Unfortunately, there is no fool proof way. However, here is some information to consider when searching for a facility and also some important questions to ask in order to gather information from a potential treatment center you are considering sending your loved one to:
- When searching for a facility, make sure you call that specific facility. Avoid ads on Google or Bing or other search engines. Do not call listings but rather make sure you find the actual web site of the facility and dial the number listed on the treatment center web site
- Find out who you’re talking with on the initial phone call. Make sure the person is an employee of the treatment center you’re calling and that they are at the facility. Make sure you are not speaking to a call center or a call aggregate company that is filtering your calls to a treatment center that is paying for calls to be directed to them. If need be, ask to speak to a clinician or someone in leadership at the facility to make sure you are speaking directly to the facility you are trying to connect with.
- Make sure the rehab you’re calling is state licensed and accredited by an accrediting body (often The Joint Commission or CARF.) It is important to understand that national accreditation does not ensure ethical business practices or even clinical practices, but it does make sure that the facility is being regularly audited for patient safety standards and practices.
- Ask for a listing of full-time staff members and their credentials. You want to make sure that the clinical staff is highly educated and licensed and that they are full time staff members. Many programs incorporate only a small number of full-time clinicians with the rest of the actual direct clinical services being handled by part time per diem or contracted clinical staff. This does not facilitate best practices and does not create a comprehensive treatment program. Additionally, ask about the medical and psychiatric coverage. How many psychiatrists are on staff? How often are they at the facility? Ask about the psychiatric care and how long and how much a patient will be seen by a psychiatrist or psych nurse practitioner. Many facilities employee a psychiatrist once a week who only handles short (sometimes 5-10 minute) med management sessions. Make sure the medical and psychiatric coverage is adequate enough to handle co-occurring issues your loved one may have and need help in dealing with while at the rehab.
- Ask about drug testing policies and pricing. Ask how often a loved one is regularly drug tested and the protocol if they need to be tested outside of those protocols (as an example: what happens if there is suspected use and they need to be tested?) Find out about billing practices. Inquire what toxicology company the addiction treatment center uses for its tests and ask if the ownership of the rehab has an ownership stake in the lab. This type of relationship is often grounds for illegal or unethical practices and often families are sent bills for tens of thousands of dollars they were not expecting once a loved one discharges from care.
- Inquire what the family involvement in treatment will look like and how the rehab engages the family in care. Any reputable facility will have guidelines in place about communication with the family, how often the family is involved in phone calls, in person or online sessions. Is there a family program in place? Is there a family education piece included in treatment of the loved one? Ask about a situation where a loved one might be resistant to having a family involved in treatment or what happens if a patient refuses to sign a Release of Information (ROI) that prohibits the facility from communication with the family? This is a fairly regular occurrence due to the resistance of the addicted patient population, so a reputable treatment center should be adequately able to answer these questions. Any rehab that says they can’t speak with a family due to HIPAA is already setting barriers up in case such a scenario occurs. A clinically sophisticated facility can explain how they would handle these situations appropriately. A rehab should make clear on the front end before a loved one admits the expectations of the family in the treatment experience and what that looks like.
- Beware of enticements and free gifts. Shady or unethical facilities will often entice patients or family members with free stuff. Free plane tickets to a facility. Waiving of insurance deductibles or copays. Free rent as sober livings. Smaller things like gift cards for groceries or free cigarettes. This is at best unethical and often illegal. These types of “gifts” often can look like a godsend to families in financial hardship. Unfortunately, they are not. While the family sees these things as helping them, the treatment center offering them sees them as a way to admit someone into their facility so they can start making money on insurance policies or urine testing. It is illegal to waive health insurance deductibles and copays. It is now a federal offense to offer enticements. And these are not harmless crimes. Many families think “Even if it’s illegal, at least my son or daughter is getting help.” However, insurance companies translate these illegal practices and their cost onto greater society through rising insurance premiums and plans or through lower reimbursements in behavioral healthcare services, which doesn’t allow for those suffering to get the length of care they need. Beware of rehabs that offer free gifts in order to admit to their facility.
- Ask about what evidence-based treatment approaches are used at the facility. This includes medical practices like utilizing Medication Assisted Treatment (MAT) as well as clinical and therapeutic approaches. Ask about the rehabs clinical philosophy and beware of buzzwords. Any reputable facility will be able to tell you what their clinical philosophy is and how that is put into practice and translated into the day-to-day treatment your loved one will be receiving.
- Ask about supportive services. Does the facility deal with issues such as life skills development? Is there a vocational or workforce program? Is there academic or educational support for young adults and college-aged patients? And what does that look like exactly? Does the facility incorporate local community support? What does the outside recovery support look like, in terms of 12 Step meetings, SMART Recovery meeting, Refuge Recovery meetings or similar community mutual support organizations? Get an understanding of how the patient is transitioned back into everyday life and will be prepared to live a life in recovery.
- Ask about cost. Is the treatment center private pay or does is accept insurance on an in network or out of network basis? If there is a living component, ask what that looks like and what is the cost. If there is a cost, it is illegal for the rehab simply to just waive the cost. Ask about a full understanding and transparency of cost. Are there any additional or ancillary services that may be billed? Families often are caught off guard after a loved one’s addiction treatment experience because they begin receiving enormous bills they weren’t expecting at the time of admission, many of which they don’t understand. A quality, reputable rehab will be transparent with their pricing and give a family a full cost upfront of the financial obligation of the entire treatment stay (whether that is a short-term detox, a residential or inpatient rehab, an outpatient program or a full continuum of care.)
- Ask for recommendations. Do not base your opinion on Google or Facebook reviews, although they are good to read and research. Also don’t base your research on testimonials on the web site of a rehab. Many treatment centers post fake testimonials. Ask for a list of both alumni families that you can call on to learn about their firsthand experience as well as a list of mental health or addiction professionals that you can call that have worked with that treatment center in the past. And be wary but trust your gut. If the reviews are all glowing reviews, proceed with caution. Addiction is a complex illness and the patient population is often resistant to treatment, so anyone that says how amazing their experience was is probably being prepped. An honest assessment is best, and a professional opinion will often be helpful in explaining the clinical treatment experience.
- Ask if the facility is a member of the National Association of Addiction Treatment Providers (NAATP.) NAATP is a nonprofit professional society of top treatment providers throughout the continuum of care and serves as a convening body that brings the addiction treatment industry together to promote collegiality and the dissemination of best practices. Although like national accreditation, being a member of NAATP does not 100% ensure that a program is operating above board, NAATP has taken major steps in the recent past and moving forward to remove members who have acted below the standards the organization has set for best practices in its Code of Ethics. Therefore, if a treatment center is not a member of NATTP, it would be a red flag. To learn more about NAATP’s Code of Ethics, click here.
Again, this is not a full proof way of making sure that a treatment center you are considering caring for your loved one is operating above board at the highest quality of standards and practices. Many unethical addiction treatment operators take great lengths to hide from public view how they are operating. However, these questions will go a long way in helping you to determine the level of quality a rehab is providing.
Although clearly not an apples-to-apples comparison, think of this analogy: Instead of addiction, let’s say your loved one was diagnosed with Stage 4 cancer. How would you handle that situation? You are not a doctor or an expert on cancer treatment, but you would take great steps to understand everything that went into your loved one’s treatment and care. If you living in Atlanta, Georgia and you were considering Johns Hopkins as the treatment provider your loved one would be going to for their cancer treatment, what would you do? You would go with your loved one, tour the hospital, meet the specialists, ask a million questions about the diagnosis, the treatment and the follow-up care. You would ask why the doctors were recommending the course of treatment they were recommending and they would take the time to explain to you why this course of treatment was going to set up your loved one with the best chance to not only overcome cancer and be cancer free but also set them up for long-term success and quality of life. You would go see, touch, smell the facility and make sure you had a comfort level with the doctors who were treating your loved one as well as the recommended treatment.
Addiction care is no different, which is why we need to stop and breath, research, not make life-saving treatment decisions in a crisis based on a Google search, a quick visit to a web site and a single phone call. Addiction is a life-threatening disease and the more families and loved ones research and ask the right questions, the more their loved ones will get to the most clinically-appropriate rehab that will meet their needs, treat their illness and set them up for long-term, sustainable recovery, and quality of life.
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