Not all substance use treatment is created equal

Substance use disorder (SUD) impacts an alarmingly large portion of the population. In 2023, 70 million Americans struggled with a substance use disorder.

Substance use disorder encompasses all types of substances, but alcohol and opioids are two of the most prominent. 20.4% of people who drink alcohol have an alcohol use disorder and 8.9 million people have misused opioids in the past year.

Many people struggle with substance use and, unfortunately, many don’t get treatment. Among those who can access recovery services, there’s another major problem: low-quality treatment in the form of addiction treatment mills.

What are addiction treatment mills?

Addiction treatment mills are treatment facilities that prioritize profits over patient care. These providers are incentivized by money (in the form of insurance reimbursements) rather than positive recovery outcomes for patients.

According to American Addiction Centers, these low-quality rehabilitation facilities often have some or all of the following characteristics:

• Lack of licensing and accreditations
• Refusal to share information
• Unqualified or inadequate staffing
• Lack of tailored treatment plans
• High-pressure sales tactics
• No aftercare planning
• No privacy or confidentiality

It’s difficult enough for people with addiction to find any treatment at all. In 2023, 95% of people who needed drug rehabilitation services didn’t receive the care they needed. But it’s not just an issue of finding available treatment—it’s even more difficult to find high-quality treatment. Sub-standard facilities seem to be more of a rule than an exception.

In one 2017 study, only half (or fewer) of the facilities in online directories offered services considered indicative of higher quality addiction treatment. These services include mental health assessments, self-help groups, employment or transportation assistance, medications for opioid use disorder, and testing for hepatitis C, HIV, and STDs.

The “washing machine cycle”: The toxic pattern of low-quality treatment centers

Most viable businesses want repeat customers, but that business model doesn’t work in healthcare. The “washing machine cycle” (a phrase common in the addiction recovery community) is the term for what happens when low-quality treatment centers approach addiction recovery as a rinse-and-repeat pattern.

With these treatment mills, the goal isn’t to help patients overcome or manage their addiction and lead healthy, happy lives. Instead, the goal is for them to relapse (sometimes quickly) and return to the treatment center for more services.

These unethical—and predatory—treatment facilities often enlist the help of representatives (called patient brokers) who actively pursue people who are struggling with addiction and refer them to an inadequate treatment center in exchange for a financial cut of that patient’s treatment cost.

These patient brokers will frequently seek out people at addiction recovery meetings—particularly those who have insurance. The person might believe they’re being connected to high-quality care to help them change their lives when, in reality, they’re being lured into a system that only intends to profit off of them.

Some of these shoddy treatment centers have even gone so far as to allow residents of sober homes and treatment facilities to continue to use drugs and alcohol while in treatment—without any consequences. Ultimately, they don’t want patients to recover—they want them to return.

How can treatment mills continue to operate?

When substance use is such an ongoing and growing problem, how can these inadequate treatment centers continue to operate legally? There are several factors at play, including:

• Substance use treatment facilities remain largely unmonitored, which means it’s relatively easy to get away with providing inferior care
• Substance use treatment is mostly disconnected from the mainstream healthcare system, which means these facilities operate as standalone entities without much oversight or cross-checking
• People who pursue or need substance use treatment are frequently in a vulnerable state, which means they and their loved ones are easy to prey on

And because this unethical model is so financially profitable for the treatment centers, there’s no incentive for them to stop. The more a patient returns, the more money the treatment facility makes.

The serious consequences of treatment mills

Addiction recovery itself is incredibly difficult. An estimated 40 to 60% of individuals relapse while in recovery and it can take many recovery attempts before someone can successfully overcome their substance addiction.

So, when a person is fighting that uphill battle while simultaneously relying on immoral, dishonest, and fraudulent treatment centers, the consequences can be dire:

• Patients struggle emotionally and psychologically because they feel like they’re repeatedly failing when it’s the system that’s failing them
• Chronic relapses increase the risk of crime and legal issues as well as overdoses (which have been steadily increasing for years)
• Needing to make repeated attempts at recovery is significantly associated with a lower quality of life, happiness, and self-esteem in addition to higher psychological distress
• Addiction recovery is often expensive and repeated unsuccessful attempts at low-quality centers can lead to financial ruin for patients and their families

To be clear: Relapses can still happen even when a patient seeks help at a high-quality treatment facility, but they’re less likely to happen since higher-quality facilities are truly motivated by outcomes versus financial reward.

The good news: How Carrum Health can help

The good news is there are high-quality substance use centers around the country and Carrum Health can help you connect your employees with the care they need and deserve. Carrum partners with substance use treatment centers of excellence—such as Hazelden Betty Ford, and Recovery Centers of America—that meet the established criteria for high-quality substance use treatment. These programs:

Carrum’s substance use COEs focus on the deep internal work (e.g., diving into past traumas) that it takes to become motivated to overcome substance use. They are truly invested in seeing the patient succeed.

Want some more good news? This level of care doesn’t need to mean huge employer costs or a major financial burden for employees. Your employees can receive the right treatment quickly with little to no out-of-pocket costs.  Plus, the moment they connect with Carrum, they’ll be paired with a dedicated clinical care navigator (a licensed clinician and certified substance use counselor) who will support the member every step of their journey.

Pursuing treatment for substance use disorder is often a sensitive and overwhelming time. People deserve access to trustworthy and adequate care options without worrying about being taken advantage of. With Carrum Health, you can help your employees skip the revolving door and focus on what matters most: their recovery journey.

Learn more about Carrum’s valued-based substance use treatment program.

The information contained on this page is for informational purposes only. No material is intended to be a substitute for professional medical advice, diagnosis, or treatment.