March 14, 2018 – The moment someone hooked on alcohol, opioids or other drugs decides to hunt treatment is crucial.But the following step – searching for help – may very well be fraught with danger.”The addiction treatment industry as a whole has become very predatory,” says Dr. Michael E. Schatman, director of research and network development at Boston Pain Care. “The consumer seeking help is in a bad position and doesn't know where to turn.”According to a directory maintained by the Substance Abuse and Mental Health Services Administration, there are greater than 12,000 facilities within the United States that provide substance abuse treatment. However, state licensing requirements vary and the standard of programs varies considerably.According to experts, certainly one of the largest problems is that individuals rely heavily on Google when looking for addiction treatment.A grand jury in Palm Beach County, Florida, released a report in 2016 listing many offenses that reflect problems nationwide. Among other things, it found that online marketers use Google to hijack the name of legitimate centers by purchasing a Google ad and manipulating the search engine to make them appear high in search results. The marketers then directed callers to incompetent and even dangerous centers, or to centers removed from where they lived, even when treatment was available nearby. The results were often not only ineffective treatment, but in rare cases, human trafficking and other atrocities. “We call it addiction tourism,” says Greg Williams, vice chair of Facing Addiction at NCADD (National Council on Alcoholism and Drug Dependence), a company dedicated to helping 45 million people and their family members affected by alcohol and drug addiction.Google's AdWords system disadvantages those with smaller budgets, similar to nonprofits and government agencies, Williams says. His groups and others are working to curb abuse, including in discussions with Google officials.Google had already suspended all ads for addiction treatment centers within the US. That suspension has now been prolonged globally, despite acknowledging that there are more “bad actors taking advantage of those in need,” Google said in an announcement. The statement said the corporate is continuous to work on the problem and plans to “consult with experts to find a better way to connect people with the treatment they need.”How bad is the issue?
Aside from the AdWords problem, online searches also make it difficult to find out the standard of a program from its website, says Peter Thomas, membership and quality assurance officer for the National Association of Addiction Treatment Providers.
Another problem, he says, is that web sites that collect details about treatment centers can have direct financial ties to specific treatment providers that usually are not disclosed. “In these cases, they have a clear incentive to refer within their corporate structure or to entities that pay them for referrals,” he says.
Thomas says his organization views selling or buying referrals as unethical. Kurt Isaacson, president and CEO of Spectrum Health Systems, a big addiction treatment organization in Massachusetts, is aware of such unethical practices. He says he recently received a call from a referral hotline. “It wasn't affiliated with any facility and didn't offer treatment,” he says. Still, they offered him referrals, guaranteeing 20 to 30 a month for a fee of $50,000.
“We also had an incident where our 800 number was hijacked,” Isaacson says. “If you Googled Spectrum Health Systems, a link would come up, and in the link was our 800 number. But if you called it, you would be redirected to a landline number. It wasn't easy to get that back in order.”
“Google is a natural path”
The shame and stigma that include addiction can lead people to make use of Google or call toll-free numbers, Williams says. There's also an issue of urgency — when an addict agrees to simply accept help, members of the family normally need to get the person into treatment as soon as possible. “So Google is a natural path,” he says.
“For everyone else [health-related] problem, contact your primary care doctor,” says Williams. But not for addiction. He says people often spend more time researching how to buy a computer than the best addiction treatment program. Another plus for those who don't want to make their need for help public: Google searches are private.
Google's steps to improve
Williams applauds Google's decision to crack down on AdWords abuse, but there are other ways in which unscrupulous programs can surface, including simple search.
“You need to punish aggregators and other forms of manipulation of the system,” says Williams. Google has to somehow weed out the unscrupulous operators, which, he admits, is complicated.
A Google representative said the company is working on a long-term solution.
How could the search be improved?
The government could conduct independent research on addiction treatment centers, Schatman suggests, similar to what it does in other areas of health care. For example, the CDC publishes data from American fertility clinics, including the number of pregnancies and births a clinic cares for.
In addiction treatment, benchmarks such as the percentage of people who are still clean after 6, 12 months, etc., could help demonstrate the effectiveness of a program, Schatman says.
Advice for those seeking help
What can people do to ensure they find a good program? Experts recommend these steps:
- Get a referral from someone who knows your medical history. If your primary care doctor can't help, see an addiction specialist, Schatman advises. Find someone who is board-certified in addiction medicine, such as the American Board of Addiction Medicine. The group has a searchable directory on its website. Make sure this person isn't affiliated with a specific treatment center.
- Check out the Substance Abuse and Mental Health Services Administration's treatment search tool on their website. Or visit Facing Addiction's Resource Hub for more information.
- Find out if a center or program is for-profit or nonprofit, Schatman says. “I believe individuals are higher off searching for a nonprofit,” he says, adding that the chances of finding an effective program are also greater if it's affiliated with a university or teaching hospital.
- Watch for warning signs. “If you call an 800 hotline and it's not connected to a facility,” that's a bad sign, Isaacson says. “If they struggle to place you on a plane and direct you to a facility that's distant, that's the following warning sign.”
- If possible, seek help in your home community, Isaacson advises. This will ensure that the aftercare that is so important is available and nearby. “You'll improve results closer to your natural habitat,” Williams agrees.
- Ask questions. Is the program accredited by a reputable organization such as the Joint Commission or the Commission on Accreditation of Rehabilitation Facilities? “Accreditation is nice, nevertheless it's not a panacea,” says Williams. His organization is trying to create a certification system.
Addiction programs also need to adopt the model of other health interventions for aftercare, says Williams. “In oncology clinics, we ask, 'What can we do to aid you recuperate?' We don't design addiction care that way. We graduate people [from addiction programs] and say, 'Don't drive past a liquor store on the best way home.'”