Addiction Treatment Is a Story in Search of a Villain


There's a difference between something that's interesting and worthy of comment vs.. a journalistic attempt to concoct controversy and intrigue that people might buy. There's not much of the former, but a lot of the latter. People in recovery being victimized by horrible, greedy people is an interesting story. Unfortunately, it's off the mark and really not helpful to anyone.

There are three pretty safe assumptions we can almost all agree on: first, there are a lot of people who want to live life without active addiction. Second, many of them think they need help to create a better life. Third, some providers of help to people in recovery make a bundle of money providing that service.

There's probably nothing new about any of this. What is new? Maybe this: we live in a time when the concept of privacy is rapidly changing. Lines between what's said and what's not said, between what's OK on the TV at 6 at night have changed. And public discussion about all sorts of things that once were considered to be private, including addiction, is front and center. That sort of "boundary" change invites thing public discussion of addiction, gender identification and all sorts of stuff. Our culture has changed.

It also seems like the more "transparent" we become as a culture, the greater the tolerance and need for being entertained. Reality TV gets more and more shocking, interesting. And our need for a good story is the product of a voracious human appetite for stimulation. And that leads us to confuse what's probative with what's entertaining.

There's a lot of entertaining stuff written about the addiction treatment industry, but not all of it is honest or even useful. Look, the fact that addiction is now part of the public conversation is probably a good thing. Maybe talking about it is a good step in the direction of addressing it like any other health related issue. Non one's shocked, shamed or convicted for dealing with arthritis, allergies or cancer, but addiction invites all of that nastiness.

So what's fact versus entertainment? What's the wheat vs. the chaff? The "story," the one being pumped into the public consciousness about people in recovery, is that they're powerless as powerless victims of wealthy people who want to steal from insurance companies. And I can not ignore that the story arises in our culture at a time when a popularized belief is that only bad people have more money than they need to live, that there are "good" people and "bad" people and that the differentiating factor is money. Good people = do not have a lot of money. Bad people = have a lot of money. And bad people can become good by giving money to good people.

Let's dial back to the recent newspaper article: the guy they say was a "bad" man has never been charged with anything. It had a picture of the guy's face. Is that so people can say he looks like he's done something bad? I do not get the value there. Maybe that's entertaining, but of no value.

The lawsuit described in the article (that had not been answered by the other party) says all sorts of things that anyone can say in a lawsuit. It may shock some to know that what lawyers say in lawsuits does not have to be true. I did not see in the article the fact that the business sued is owed millions by the insurance company or that the parties have been trying to come to terms to settle an unrelated business issue for months. Seems relevant, but only if you want to discuss the facts. Otherwise, it's just … entertainment.

And the bit about insurance companies paying a lot for tox lab services … No one tells an insurance company what to pay. They decide what to pay. Where's the story? Where's the villain, the victim? The story needs one, right? In order to be entertaining, there has to be a victim and a villain. That's what makes it fun, right? It makes it entertainment. And that's different from reporting facts about an issue.

In the drug and alcohol treatment space, there are serious elements of the truth that are missing, because they do not sell, such as:

1. The treatment industry is undergoing a huge change because they've expanded from providing psychotherapeutic services to providing medical services;

2. Insurer challenges and law enforcement activity is a huge wake up call to an industry that needs to be woken up to compliance and viewing medical services in the same way traditional medical service providers view them-driven by scientifically validated and documented medical necessity. Physicians have played within these boundaries for many years, but treatment providers are new to what's required to provide medical services;

3. Providers that make a lot of money from treating people in recovery do so almost entirely because they do a good job and know how to manage their expenses. Our community does not yet believe the healthcare providers bought to work solely for non-profit organizations and be part of a "healthcare clergy" ("If you really care, you'd do it for free");

4. Insurance companies have been masterful in managing the PR related to the treatment industry. In an era of record-breaking insurance company profits, they often do not have any policies and procedures about how many or how much of anything people in recovery should receive, but then refuse to pay and point the finger at providers. And ironically, many treatment providers beg payers for such guidelines and have approached them to contract (at lower rates than the insurers are paying!);

5. Insurance companies decide how much to pay for services, not the providers; and

6. Neither treatment center owners nor those in recovery speak with one voice and have no effective political / legislative power. Insurance companies, however, have intense political and legislative power.

After that, I have not been convinced that we actually are open minded. Articles fly around that oversimplify things and sell stories designed to entertain. There is a huge gap in available insurance benefits for people in recovery from addiction. The current squeeze (payment denials, delays and reductions) placed by insurers on treatment providers, for instance, is missing from any other aspect of healthcare.

In fact, the payer challenges to providers in this space reflect a view by insurers of addiction treatment as episodic, not chronic. Payers do not challenge diabetes treatment like they challenge addiction treatment. Laws are passed (the recent sober home regulation law) that reflect the fact that the state of Florida will not protect people in recovery who will stay in sober homes (they kicked the issue to some unregulated, and unnamed "not for profit" entity) . At the end of the day, there is really no consequence for this sort of showboating, since both the treatment industry and people in recovery are easy to kick around. They're still outcasts and lack any serious political presence.

If there is ever going to be meaningful treatment for addiction, then the entire story needs to be told, and all the players need to work together to agree on meaningful solutions. The problem with the treatment industry is not that there are a bunch of fat cats taking advantage of addicts. The problem is that our culture is more interested in pointing fingers and sticking our heads in the sand on this issue (imagine how real treatment might affect the prison conglomerate!) Than we are in creating solutions. Right now, there is no urgency to the issue of treatment (because it's not being pressed). Instead, we're just entertaining ourselves.