- Rehabs and Sober Livings are a BUSINESS... And what businesses want are REPEAT CUSTOMERS!
Being an active member of a 12-step program, I see rehab survivors and sober-living residents nearly daily. Most of the people who have come into the program in the last 20-25 years have come from one of these facilities.
However, most of those have come from several of these facilities. . .
Sobriety is the product they are selling, or so they say. Actually, it is relief... from the stress of addiction. And because it is such a toxic cesspool of unnecessary and destructive drama, the public face of being in the treatment business is benevolent. "Angels" among us, really. But are they? Or is that just another myth of the business of treatment?
My anecdotal information is probably similar to the stories you would hear in any big city, from Atlanta, Miami, New York, San Francisco, etc. And the facilities exist in abundance... Especially in Los Angeles and Phoenix, two areas where they sprang up before the onset of regulations and oversight and where the models were often created. Existing locations were grandfathered in with the regulations reflecting what already existed with some modification. In towns like this, the rehab business is contributing heavily to the bottom line, meaning government takes a partnership role, rather than a supervisory role...
So an article that appeared in the Hollywood Reporter 8/8/2013 that pretends to be aghast at the deaths of two people because of alleged lack of oversight and prevention seems so "Unh?" at best.
(Look here for a photo album of celebrities in rehab)
When I got sober in 1978, there were very few facilities that would treat addiction and dependency. The term "dual-diagnosis" was not invented yet. Insurance would not cover addiction - only mental illness; and in those days, it DID cover mental illness! People with addiction problems went to mental institutions and the few places pre-Betty Ford that covered this kind of thing.
I know that - because at the age of 18 I was sent to Del Amo Hospital where I spent a year incarcerated with bonafide lunatics for my addiction to cocaine. Too bad for me, cocaine was not considered addicting in those days; they just said I was nuts and treated me that way. I was on a locked unit for 10.5 months...
That was the best they could do for me, and fortunately, I was exposed to a 12-step group whose members brought meetings and literature into the hospital. Like so many others, I was loaded within 6 months of leaving the facility. However, it was one of the two psychiatrists I was seeing who recommended that a glass of wine might be helpful for a social lubricant, exhibiting the enormous divide between psychiatric professionals and the addiction problem. For if one drink was too many, a thousand was not enough; I was off and running. It took a few years and several dangerous events but I remembered what I had seen and I returned to the (free) 12-step program when my bottom proved to have a trap door. I have spent my life in it.
As I said, addiction is big business and like any big business, it depends upon repeat business. How better to get that than to provide a cushy environment replete with treats on call, like horse back riding or tennis therapy, massage and meditation, nature hikes and beach volleyball? These rehabs often appear more like Adult Summer Camps than therapeutic environments! Who wouldn't want to check out of life when the heat is on - check into a rehab - and use the excuse, "I'm working on myself" for every perk the place has to offer? Wouldn't that predispose you to do it all over again the next time you got into trouble? Wouldn't anyone want to be a stoner just to get that all over again?
This also speaks to the issue of what to do for the alcoholic or addict who has money. Take the money? Let them keep buying time in 30-day increments? How can a person who can buy his way out ever hope to get sober? That is another dilemma for another blog.
For the record, I did not ride horses or play tennis at Del Amo. I did, however, check out of life, dump my responsibilities and get to spend a year focused on me, my favorite subject. With three squares and a cot, I was pretty comfortable, thanks to daddy's insurance. I got used to the locked doors and the crazies. I learned to deal with institutional living. But I digress.
But the sober living and rehab "fix" is an insidious compromise of good intentions, alchemy and human failings. And apropos of that I don't want to throw the baby out with the bathwater - there are some really good people and places where sobriety does comes first, with compassion and kindness and a healing environment that inspires sobriety. You just have to find them.
Promises, the world-famous hi-end treatment facility in Malibu, has garnered its reputation by being one of the first to promise (no pun intended) luxury facilities - a promise truly delivered. Some other such facilities run by the group are downscale but by no means low-end. Catering to the rich and famous is their business, and in some ways, puts them at risk because of the tendency of the rich to "relapse."(see above, "how does a rich person get sober?") Relapse prevention is a voluntary, post-stay option. For many it is simply not an option, especially if attaining long-term sobriety is not a goal.
There are so many rehabs and sober living homes in West Los Angeles that it is hard to keep up with them. Its so incredibly lucrative! Once a home is leased, certified and active, business is good. In some homes, there are regular pee tests and breathalyzers, depending on the case and payee, but most are relatively unregulated, despite what you think. There are no shortage of drunks and drug addicts. Today's young addicts have a new/old craze - they have resurrected shooting heroin! That and speed. Nice. Bring back the DARE program and Just Say No!
Sober living is post-rehab, and rehab is post-detox. So there are levels of treatment. In the article in the Hollywood Reporter, this hierarchy is referenced. Detox is the first stage when a client begins to dry out from whatever it is that he or she is on. In some cases it is relatively low-key. But when the drugs include alcohol meth, heroin, prescription pain meds and tranqs, cocaine or crack and some other key drugs, detox can be gnarly and absolutely life threatening and would best be handled with medical supervision.
That being said, it is also true that in many cases in my early days in sobriety there were no doctors present when people went through withdrawal. All we had was the ER or an ambulance if things turned bad, but we muddled through it. A drunk would call Central Office downtown and a member would answer. We would get calls anytime of the day or night. It was customary to grab another member and drive out wherever it was and talk to the person about sobriety. We would sit until we could get someone else to come. We called it a 12-step call. They don't do that anymore. We don't need to take that risk today. It is stupid, especially if the client has health insurance that covers it!
Here is the scenario:
Parents come to the rehab with a nineteen year old kid; or a husband comes with his wife of two decades and the mother of his children, or the employer comes with a valuable employee upon whom he depends (think: major star in an upcoming production) and upon whose shoulders rest the livelihood of many people.
Rehab says, "No worries. We will take care of this. We have a great success rate. We know your pain. We deal with this all the time. We will treat your person with total discretion and hands-on individualized care."
In some cases, say the teenager - they even throw in, "No amount of money will ever replace your son's life."So they mortgage the house. Really.
More and more, large corporations are taking over these facilities with the full understanding that they are business. They are run with a strict profit motive and a business model to pay dividends to their investors, often doctors and people who lend their names and reputations to provide leverage in the game of recommendations.
Recommendations are everything in this business when a vulnerable family with a crisis individual presents itself. Time is crucial - the person is in a one-week detox and afterward, released to the same situation that got them there in the first place. Best to place them in treatment directly from detox. They rush to a solution in the throws of the drama, hoping that their medical professionals will be able to steer them to the right facility for their loved one. It is a devastatingly vulnerable moment. It is about available beds, cost, insurance coverage or price, performance history, desperation, love and hope.
Rehabs themselves are so fallible! They are run by humans. But Sober Living is most vulnerable to human errors.
Rehabs are subject to much oversight. The best of them, such as Betty Ford and Hazeldon, are run by highly competent individuals who are versed in decades of experience in treatment. But cost does not make it better or worse, as many of the lower end treatment facilities are extremely experienced in the business of rehab - but on a scrappier level. Their clients get deloused when they arrive. It is not a resting place for the super-entitled unless - they are court-ordered.
Robert Downey, Jr. is my hero. A died-in-the-wool addict/alcoholic, his addiction took him to prison, nearly got him banned from Hollywood, drove him to the depths of insanity and desperation and eventually ended up in the the most arduous of low-end facilities, the California Substance Abuse Treatment Facility State Prison. He got it. He got sober. But he still had a long, hard climb back up. His success is based on being the person who was always in there under a haze of substances - and the good fortune of having people who believed in him put it on the line for him so he could start over.
More about this human factor in rehabs:
I cannot name names or quote specific people without giving up their anonymity, a critical piece in the puzzle of sobriety, but there are many instances of inappropriate behavior in rehab staff and management.
Part of the problem (or not) is that often, stripped of their former profession, many emerge from treatment gung-ho for bear. On fire about the joys of sobriety and bridges to their old lives burned, they are infected with the need to spread the word. It is the most natural thing in the world to want to invest in what has saved your life. They get credentials or just get jobs in the industry (and sobriety IS an industry!) And if they have the means, they begin their own sober living facility.
However, being members of the sober community we all suffer some basic, common personality quirks. For example, we are selfish and self-seeking; we minimize and deny our faults; we self-aggrandize; we are self-righteous. Given the power of being the head of a sober living where one is treated to courts' deference and recommended by health professionals to manage people's lives- can be a heady atmosphere.
Once in the throws of believing one's own PR, it is only a matter of time before the bottom will drop out. If we forget that we are all alcoholics among alcoholics, addicts among addicts and that the same rules still apply - we lose perspective. Unfortunately it can also mean loss of sobriety or even another bad behavior cropping up in place of drugs and alcohol - ie., sex addiction, spending, gambling - the list goes on.
(Here I would like to define addiction as this: "A behavior or substance that temporarily relieves anxiety so that when it wears off, the addict will do anything to get again.")
Too often, falling off the wagon for these people threatens to be a public experience and a black eye on sober programs, the profession and the person. Finger-pointing and blame do nothing to relieve the public perception of failure. It is bad for the whole community of rehabs and 12-step programs.
