John Oliver unveils the truth of rehab centers on Last Week Tonight

John Oliver tackles the big subjects of addiction, rehab, and how it’s all gone wrong on the latest episode of Last Week Tonight.

Rehab is a big business. Addictions, which include substance abuse of alcohol, opioids, and illegal drugs, run up overall costs (including healthcare) of more than $800 billion a year. Recently, much has been made of the “opioid crisis,” an expanding epidemic of addition that killed over 100 people a day in 2016.

Until recently, addiction was seen as almost entirely a moral failing. “Experts now view addiction as a medical problem,” said John Oliver on the latest episode of Last Week Tonight. That’s progress, to be certain, but that leads to some major issues with rehabilitation centers. According to Oliver, there are now over 14,500 rehab centers throughout the United States, many with soft, inspiring names like “Milestones” or “Promises.”

It’s all connected to a rehab industry that makes over $35 billion annually. Furthermore, it’s gotten easier to use insurance money to pay for addiction treatments. That’s thanks to former Presidents George W. Bush and Barack Obama.

But what, exactly, does “good” rehab look like? How much of a center’s treatment methods are grounded in empirical evidence? The truth is that there is little oversight and regulation for rehab centers. Many of those same centers make stupendous claims about their success rates with little data to back up the talk.

Honestly, rehab isn’t easy. It takes tremendous time and effort. Often, it remains a lifetime effort. So, why does Passages in Malibu, along with many other centers, claim to completely cure people?

How to measure success?

According to Oliver, “Rehab success rates are often based on self-reported statistics based on them calling former clients.” This is not exactly a reliable way of evaluating success, especially once you learn that many centers simply call up former patients and ask them how they’re doing. People may lie because they are embarrassed or are having a difficult time, in general, admitting that they have relapsed.

It’s also hard to predict the type and quality of care that you might receive in rehab. Almost anything could be “treatment,” with or without empirical evidence. That runs the gamut from therapies based on clinical drugs, to those based on petting horses. “Anything can have a therapeutic meaning,” said Oliver.

Even brand-new centers aren’t necessarily a good bed. For example, it’s surprisingly easy to open rehab centers in many states. Idaho doesn’t even require licensing, as long as you don’t have patients living at the facility. Florida is like a free for all landscape with little substantial regulation. That’s pretty concerning, especially given that there are many rehab centers there

Florida facilities are especially corrupt. Some take significant kickbacks for urine tests, making thousands of dollars off just one patient. It’s such a racket that urine is seriously known as “liquid gold” in the so-called “recovery industry.”

The Florida shuffle

In Florida, center operators have engaged in “patient brokering,” also known as “junkie hunting,” looking for addicts with good insurance. They offer free rent, free food, and even free cigarettes. Some centers even send out people to actively solicit addicts on the street, as long as they have insurance.

This system is effectively built to encourage relapse, creating a cycle known as the “Florida shuffle.” Patients move in and out of recovery, being used and re-used for their insurance payouts until their deaths. It’s a system that clearly, ultimately does not care for the individuals who are trying to get better and beat their addictions.

So, how do you know what’s “good” treatment? Turns out it’s nearly impossible to tell who is actually invested in your health and not just your insurance money. Some of the more visible phone number systems, like the “Addiction Network,” are referral businesses. The Addiction Network makes about $40-50 off each referral. Meanwhile, some major review sites are owned by Richard Taite, the founder of Cliffside Malibu.

“I had no idea what to do”

Alright, maybe you want information from an objective outside source, like an investigative agency. First, you’ll need to file a public records request. Then, you will have to wait months for the information to get to you, all while your friend or family member is potentially in acute crisis.

Even Tom McLellan, chair of the Treatment Research Institute and former Deputy Director of the Office of National Drug Control Policy, didn’t know what to do when his son became addicted. “I had no idea what to do,” he said in an interview included on Last Week Tonight. “All that training… did not prepare me for the most fundamental question of all: where do you send your kid for treatment?”

Tragically, McLellan’s son died as a result of his addiction. Many others also die, in part because they do not have access to evidence-based, supportive treatment that is based on evidence, rather than greed.

What you can do

What if you or someone you know has an addiction? How do you get the least exploitative help available?

According to Oliver, you shouldn’t start with a treatment center, which is often exploitative and working under poor or nonexistent oversight. Instead, you should seek out a doctor who is actually board-certified in addiction medicine.

That’s a relatively new specialty, so these doctors are sometimes hard to find. However, you have a chance if you can get to certification.theabpm.org/physician-lookup.

“The word ‘rehab’ is so broadly defined as to be close to meaningless,” Oliver said. “It is honestly barely better defined than the word ‘building’ .” Imagine if you had a friend or family member who was going to get their addiction treated in a poorly-described “building” of some sort.

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Ultimately, the system needs far more empathy and sound scientific evidence. Even if you like petting horses, for instance, that’s the kind of therapy that really needs a sound study or two to back it up first.

“So much about battling addiction is really hard,” Oliver reminded viewers. “Getting good, evidence-based help… should be the easy part.”