Residential addiction treatment in America is fraught with exploitation, fraud, abuse, and preventable deaths, according to journalist Shoshana Walter’s investigation “Rehab: An American Scandal.” Unlike other forms of medical treatment, there are no real standards or even a proven addiction cure in the rehabilitation industry, which has become a $53 billion-per-year industry following insurance coverage expansion.
The investigation examines several facilities and cases. At Cenikor, a nonprofit rehab with locations across Texas and Louisiana, patients were forced to perform labor for no pay at industrial laundromats, Exxon, Shell, and Walmart, claiming that physical work could help cure addiction. One former patient reported that bosses would “talk about you like you were just inventory.” In 2019, regulators in Texas found Cenikor guilty of exploiting patients for financial gain, sexual harassment and assault, overdoses, and unsafe facilities, imposing a fine of over $1 million, though the case ended in a settlement with the company paying just $125,000. Cenikor continues to operate.
The Structural Failures and Regulatory Gaps
At Above It All Treatment Center in Skyforest, California, 21-year-old Donovan Doyle disappeared in 2014 after being discharged in heavy snow without notification to his family or transportation to the nearest bus station. His body was later found in the San Bernardino National Forest. The rehab’s supervisor, Kory Avarell—a Mormon businessman with no training in addiction treatment—ordered an employee not to call 911 when Doyle threatened suicide.
Few rehabs offer evidence-based treatment. A 2020 survey revealed that only 29 percent of residential treatment facilities offered medications like methadone and buprenorphine, the only treatment interventions proven to significantly reduce overdose rates. Despite limited data proving their efficacy, 12-step programs reign supreme at rehabs across the country, yet they tend to abjure medication. The opioid crisis expanded addiction treatment through Bush and Obama-era mandates and the Affordable Care Act of 2010, but too many rehabs emerged with insufficient state and federal regulators. Additionally, sober living homes—places where many people go after inpatient rehab—are even less regulated because they do not offer treatment, just housing.
This article is an AI-assisted summary. All facts and figures are drawn from the original report: https://www.thenation.com/?post_type=article&p=592092