We at A3 have long been saying that there is something seriously wrong with the way addiction treatment is being regulated and with the addiction treatment system that has sprouted up as a result. Now, a government report created for the California Senate Rules Committee called "Rogue Rehabs: State failed to police drug and alcohol homes, with deadly results" (see here) supports our notion and extends them in alarming ways. Among the major findings:
- Over the past decade, the California department in charge of regulating residential drug and alcohol programs consistently failed to catch life threatening problems [with addiction treatment facilities].
- Many addiction treatment facilities in California are providing medical care in clear violation of their licenses and often by under-trained staff.
- Addiction treatment providers are accepting patients that are far too impaired (as in sick) for them to handle because they would rather take the money than turn away a patient.
- These problems have led to several deaths within the California addiction treatment system in the last decade.
Obviously these findings are extremely disturbing and cases like the one studies in the report of Brandon Jacques, a patient who died while under the care of one California center, could have been prevented with more attention and transparency in our system. The idea that addiction treatment facilities that are not equipped to handle severe cases are taking them just for the money is sickening and antithetical to the reason for their existence. As far as I'm concerned, such unethical flouting of patient care should lead to an immediate revocation of their license and a ban for the management from the field.
The most distrubing factor to my mind is the fact that many of these providers know that what they are doing is wrong. But they also know that more than 50% of people who are looking for addiction treatment are doing so for the first time and have no idea what to ask, what addiction services they need, or how to assess whether a facility is appropriate. That means they can take advantage of them with fancy websites and the use of terms like "holistic treatment" that mean little and promise much. It's disgusting and flies in the face of everything our field is supposed to stand for. It's also the main reason I worked so hard to develop our Rehab-Finder, which while far from perfect and in need of serious work that I can't afford to put into it, tries to fix these problems by recommending treatment that is appropriate given the specific issues a client is dealing with. We are currently conducting a study with UCLA on the effectiveness of tools like this and I am committed to figuring out a safer way to help those in need find the right addiction treatment for them.
Importantly, the report also makes a number of recommendations:
- Allow for medical service provision at addiction treatment facilities but legislate strict oversight and accountability paid for by agency fees.
- Medical detox facilities should be required to have medical directors.
- Establishing requirements and procedures for death investigations at addiction facilities.
- Strict oversight of programs found to admit clients it is not fit to treat including immediate license suspension.
- Information sharing between addiction treatment licensing boards and medical boards.
We think it's time that addiction treatment providers be held to the same standard that other medical facilities are held to. It might help finally close the gap in terms of recovery outcomes. Running as a relatively unregulated industry does not help patients, it does not help move the field forward, and although they can't see it it does not even help the treatment providers who are behaving unethically since many of them are eventually forced to close and face lawsuits. It's time to move forward on this.
© 2012 Adi Jaffe, All Rights Reserved
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