Harry Nelson, J.D.

Choosing the right addiction treatment program

Choosing the right addiction treatment program for yourself or a loved one can be tricky business. Visiting the Internet brings a flood of information, much of it well-crafted marketing with pitches for programs across the country. At the same time, media reports bring news of troubling issues at addiction treatment programs. Some of the stories raise question about the effectiveness of particular approaches; others raise more serious safety concerns? What should participants and their friends and families be looking out for? Here are five things to watch out for:

1. Over-aggressive Marketing
The availability of insurance reimbursement has expanded the options in addiction treatment in recent years. It has also led both new entrants and longtime programs to expand their marketing  in order to be seen and heard. When reviewing marketing, be on the lookout for shady marketing practices that are illegal or, at a minimum, suggestive that the program is being over-aggressive in order to fill itself. Practices to watch out for include brokers who get paid to steer patients, programs that offer to secure insurance coverage (as opposed to providing information about how to do it yourself) and incentives, like free vacation stays to attract patients and their families. Treat these things as a warning sign. The best programs are not engaging in abusive marketing practices.

2. Waiving deductibles and patient responsibility
Given the expense of addiction treatment, programs that offer significant discounts and waivers of patient financial responsibility — deductibles and coinsurance – are appealing. The problem is that these practices can often be a form of fraud and abuse. Good programs should have a thorough process for considering financial hardship as a legitimate basis for discounting. They should not be marketing or assuring patients or families up front that they will not have to pay. Even though guaranteed discounts and waivers may be appealing, watch out. Good treatment programs should not be promoting these to recruit patients.

3. Overprescribing and Physician Involvement
Addiction recovery often involves difficult decisions about medication management, including the legitimate need for pain management of people in recovery and the increasing focus on medication assisted treatment. Good programs may have a philosophy about medication (or abstinence), but the thing to watch out for is that physicians, and not non-physician treatment program management, are the ones driving these decisions. It is striking – and troubling – how many non-physicians are playing active roles in driving medication assisted treatment, including the use of naltrexone and suboxone. Ask questions about physician leadership and be on the lookout for programs that make it too easy to obtain medication without a physician.

4. Resident Rights
Several recent cases have called attention to the lack of protection of residents’ rights as a “dark side” of the addiction treatment experience. In particular, incidents at several centers involving allegations of nonconsensual sexual behavior have triggered
law enforcement scrutiny, based on concerns that clients were being preyed upon in a period of vulnerability that is inherent in overcoming addiction. Other investigations have related to restrictions on residents that are inconsistent with the legal limits on treatment facilities. Patients and families should choose addiction treatment programs that operate with respect for resident rights.

5. Residential versus Outpatient
There are many outstanding residential and outpatient addiction treatment programs out there. Often, people need a higher intensity, residential setting at the beginning of addiction treatment, and benefit from stepping down to an outpatient setting over time.

In other cases, patients may be good candidates to live in a sober living or extended care setting while spending their days in an outpatient setting. The choice of the optimal therapeutic setting should be driven by clinical recommendations of therapeutic benefit, rather than by good marketing.

Harry Nelson is the managing partner of Nelson Hardiman, a firm that works with behavioral care providers and founding board member of the American Addiction Treatment Association (AATA). AATA is a national trade association that provides online resources and training events, for licensing and certification, operations, re-imbursement, clinical standards, patient privacy, quality assurance, and risk management.