The Wild, Wild West of Addiction Treatment

Screenshot of an episode of HBO’s “Last Week Tonight with John Oliver” on rehabilitation centers

Addiction is complex. Addiction treatment is even more so. John Oliver, the host of Last Week Tonight, provides an intriguing glimpse into some of the complexities of this industry during his May 20, 2018, episode.[1] I recently watched the episode, and even as someone whose work over the past five years has centered on drug treatment courts (including drug treatment), I was shocked. I found it hard to believe that the $34 billion treatment industry, an industry that includes over 14,500 drug treatment facilities in the United States, is effectively unregulated at the federal level with “no federal standards for counseling practices or rehab programs.”

Without robust federal standards, it can be exceedingly difficult for those suffering from substance use disorders, their loved ones, and even well-intentioned programs such as drug treatment courts to know the quality of treatment available to an individual at a given drug treatment facility. Case in point is the experience of Thomas McLellan, former Deputy Director of the Office of National Drug Control Policy under President Obama, who lost a son to overdose. During a clip of an interview aired on Last Week Tonight¸ Dr. McLellan makes this sobering statement: “I had become an expert in the addiction field … all that training, all that knowledge about addiction did not prepare me for the most fundamental question of all. Where do you send your kid for treatment?”

Dr. McLellan words reminded me of what one treatment provider had said while being interviewed by our office during a technical assistance site visit to a drug treatment court years ago. When asked if their facility used manualized, evidence-based curricula, the gentleman cheerfully said yes and went over to his bookshelf to show us the curricula they used. It was a nice surprise. Many of the treatment providers that we had visited did not in fact use manualized, evidence-based curricula. These treatment providers and substance abuse counselors had the best intentions – they desperately wanted to help individuals suffering from substance use disorders – but they just did not have the ability to keep up with the quickly evolving field of evidence-based treatments (EBT).[2] When the gentleman returned to show us the binder used with their drug treatment court clients, it did in fact contain manualized EBT. Unfortunately, they had taken chapters/modules from several different evidence-based curricula and combined them into their own Frankensteinian treatment regime. A treatment regimen which potentially negated any efficacy originally present in the various EBT used to create their treatment regime. I cannot even imagine how difficult it must be for the layman, desperate to help a loved one with a substance use disorder, to navigate such a complex environment.

Unfortunately, confusion and misinformation relating to substance use treatment and rehab centers extends into the digital realm. John Oliver spends some time at the end of the show discussing how some seemingly innocuous websites focused on addiction and treatment are in fact owned and operated by the very for-profit treatment centers peddling unproven treatment practices at exorbitant rates. It’s an issue that the National Drug Court Resource Center (NDCRC) has increasingly had to deal with over the past few months. More and more websites have been in contact with our project looking to have their site linked to on www.NDCRC.org. At first glance, many of the sites that have contacted us contain helpful articles about addiction and treatment. A deeper look into these websites, however, raises troubling concerns about who is funding them. In many cases, these websites include a toll-free number to call for information about treatment centers near you.

As the opioid crisis within the United States rages on, providing unbiased information on substance use disorders and how to effectively treat them is becoming increasingly more important. It’s a role that the Justice Programs Office, through its work on NDCRC, has been providing and will continue to provide.

Steve Collins is a Senior Program Associate at the Justice Programs Office. He works primarily on the National Drug Court Resource Center.

[1] “Last Week Tonight with John Oliver” contains strong language that might not be suitable for all ages. 


[2] It should be noted that the Substance Abuse and Mental Health Services Administration (SAMHSA) has an excellent resource which provides information and outcomes on mental health and substance use interventions. The National Registry of Evidence-based Programs and Practices can be accessed at https://nrepp.samhsa.gov/landing.aspx.

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