But another crisis is afoot. That’s what investigative reporter Shoshana Walter from The Marshall Project presents in her first book, “Rehab: An American Scandal.” StateImpact’s Jillian Taylor spoke with Walter about her findings on the treatment industry and how it chased profits over patients.
TRANSCRIPT
Jillian Taylor: Shoshana, thank you so much for joining me.
Shoshana Walter: Thanks so much for having me, Jillian.
JT: So your book focuses on the evolution of the U.S.'s approach to drug addiction. Could you tell me a little bit about that shift?
SW: During the crack cocaine epidemic of the '80s and '90s, our country's approach to addiction was very much punishment-driven. And then fast forward to the opioid epidemic. It started out as a pain pill epidemic. It mainly affected white communities at first. And our approach to addiction at that time was very different. You had lawmakers suddenly referring to addiction as a disease. And so our country underwent this enormous expansion of our addiction treatment system. And that expansion has helped many people in many ways, but it's also led to the system that we have now, which my book shows is really not working as the solution it was intended.
JT: So then you're reporting on that system started here in Oklahoma, with a Christian rehab facility for drug offenders. What did you find, and how did it inspire what you decided to write?
SW: Seven years ago, I was a reporter at Reveal, when I just sort of stumbled across this drug rehab program that was being utilized by courts throughout Oklahoma and Arkansas and Missouri called Christian Alcoholics & Addicts in Recovery. I learned that it had been founded by a former poultry industry executive and that the program was sending people to work without pay at for-profit chicken processing plants. They were working incredibly long hours in really dangerous conditions. And this was predominantly their sole form of what they were calling treatment. It really made me wonder how common that is. And also, if unpaid labor could be considered treatment in this day and age in the United States, what does the rest of our treatment landscape look like?
JT: And to answer those questions, you focused particularly on four people. And through that, you found some themes of how inequity fuels the crisis for certain groups. Could you give an example of one of those stories and how it touched on those themes?
SW: One of the people that I focus on in the book, April Lee, is a Black single mother of three from Philadelphia. She was surrounded by addiction, and she had always just believed that she would not fall to the same fate. But she also had unaddressed childhood trauma. In her young adult years, she experienced sexual assault. She faced this predicament: take care of her children, be there for her children as the sole caregiver, as the sole breadwinner, or go take care of herself.
There are years, decades of studies that show that programs that allow women to bring their children with them have the best outcomes for the entire family. So April really could have benefited at that time from a program that would have allowed her to stay with her kids. Instead, her addiction worsened. She went through a traumatic experience. It got very bad, and she ended up getting separated from her children, who were removed into the foster care system. And that's when her addiction got far worse.
April went to a 30-day program, but it was a very common experience. She went in, she left, and without the resources to fall back on, like a place to live, housing, a job or income, she ended up relapsing. All she wanted to do was to stop, and to get better, and to reunite with her kids. And she just couldn't. She couldn't find the help that she needed. And in fact, the only way she was able to eventually stop herself was to get herself arrested.
JT: One of the things that you found early on in your reporting in Oklahoma – the way that these treatment facilities were profiting off of their patients – you ended up finding that it was a more widespread issue.
SW: In part, due to the expansion of addiction treatment under the Affordable Care Act, most residential treatment programs in the United States last no more than 30, 60 days. And we know that those lengths of program can actually fuel relapse and overdose death rates. And then for programs that last longer, or for people who don't have insurance coverage or can't afford to pay out of pocket for treatment, there are these longer-term programs, typically called recovery programs, typically unlicensed, and they're typically free or low cost to enter. And then once people enter these programs, they're expected to work to fund their stays.
And there's one young man whom I follow in the book, Chris Koon. He started his addiction when he was 15 after he broke his ankle on a three-wheeler. That really developed, he went to a 30-day treatment program in young adulthood. He finished the program, but immediately upon leaving, he relapsed – very common story. And then he was arrested and court ordered to a program called the Cenikor Foundation in Baton Rouge, Louisiana. And before he went to the program, he was told he would live there and work there for about two years. He'd be able to save up money for after he left treatment. He would receive counseling and medical care.
But when he arrived, he discovered that he would be working up to 80 hours per week without pay in really tough manual labor jobs. His only compensation was a pack of cigarettes per week, and he rarely had time for counseling. And unfortunately, this is really not an unusual story. I have interviewed hundreds of people across the United States who've been through a program just like that.
JT: Have things gotten better following your reporting?
SW: I think that my reporting has raised awareness of some of these issues, and I've seen some small developments as a result. But by and large, this kind of remains our system. I know lawmakers are reading the book, and I know that there are lots of people calling for change. But, in my experience as a reporter that's covered this issue for many years, change can be a really long-term process. And so I'm curious to see what change comes.
JT: If you could have a say in that change, what things would you recommend based on the stories you got to tell?
SW: One change that I think would really benefit a lot of people would be paying for longer-term care. I think it's actually more expensive to do what we're doing now, which is funding cycle after cycle after cycle of rehab. And then the other change that I think would help and benefit a lot of people is for treatment programs to help people access recovery capital. That is the mixture of internal and external resources that people really need in order to enter and sustain recovery. And that can include community support, social networks, housing, financial stability, transportation, food, access to health care. So, the more treatment facilities can help people break down those barriers and establish a foothold in regular life, I think the more successful those treatment programs will be.
JT: That's Shoshana Walter with The Marshall Project. Thank you so much.
SW: Thanks so much for having me, Jillian.
This transcript has been edited for clarity and length.
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