If you saw my son in Prescott, Arizona– or Orange County, California, or somewhere in south Florida– he looked like an ordinary twenty-something riding in a nondescript, however telltale, white cargo van. His mainstream appearance must have provoked speculation about the path that led another addict to take up temporary residence in the community.
I was torn between anxiety and relief when research led us to an accredited, out-of-state facility to treat his opiate addiction. The Admissions Director detailed a thorough approach and promised to implement a customized treatment plan. Although he reassured me that their idyllic setting would expedite his recovery, that would not be the case. Instead, we unknowingly became “lifers”, indoctrinated to a world of outrageously expensive short-term solutions.
Five years and twenty rehabs later, it is logical that my son’s commitment and motivation are questionable. I frequently hear, “He’s just not ready to be sober” or “Another rehab, he must enjoy it”. While I wholeheartedly agree that he is responsible for his drug use, I also recognize that the profit-based rehab industry has made sobriety far more complicated than possessing the virtue of willpower. Treatment is now a circular process, a dysfunctional lifestyle that is organically fed by antiquated methodology, societal stigma, and fear. These factors make it easy to become unconsciously entangled and perpetuate dependence on an ineffective system.
In retrospect, every single treatment program applied a universal blueprint. Any differentiation, either promised or implied was superficial or undetectable. This is equated to detox followed by inpatient treatment, partial hospitalization or intensive outpatient, usually in a step-down process. The formats differ only by the number of meetings per day, and what is billed to medical insurance.
All levels of care require patients to engage in in-depth discovery and psychotherapy. On countless occasions, staff members commented on my son’s sincere commitment. He was doing the “hard work”, together with his counterparts they repeatedly analyzed the damages of their actions. The young men cemented their friendship by sharing their horrific experiences like soldiers in a foxhole. Despite the camaraderie, these weren’t long-term buddies. A fortunate few returned to their families, and but many more became homeless or succumbed to their addictions.
Rehabs are an unconventional environment by design. Patients are isolated from members of the opposite sex. My son moved throughout the community as a member of an all-male posse. The standard mode of transportation, a white cargo van that made his origins conspicuous and elicited negative reactions from locals. On one outing, a door was pulled shut in their faces by an older gentleman who commented, “Druggies don’t deserve to watch movies.” Being mandated to function as a group has other drawbacks as well. Accessing routine dental or medical care, for example, is simply too burdensome. In my son’s case, this means that despite his blurred vision, he hasn’t had a pair of eyeglasses in years.
The housing provided while he was in treatment offered the stability of a drifter. His moves were frequent, unpredictable and outside of his control. A facility’s merger or acquisition, staff shortages, or reductions in our insurance coverage meant a new facility, house, bed and roommate, and equated to reacclimating to new rules, expectations, guidelines and personalities.
Patients are insulated while in treatment, contact with family and friends is both limited and monitored. The intent is to remove distraction and focus on recovery, however, there is risk in isolation. Although my son witnessed insurance fraud, identity theft, prescription drug sharing, sexual harassment, and rape, he remained silent. He learned that an addict lacks credibility and, furthermore, being outspoken risked his well-being. He was promptly handed a trash bag of his clothing and deposited on a street corner, 2,600 miles from home, after treatment center staff overheard him mentioning that he witnessed a doctor give his prescription medication to another patient.
Although he was definitively kicked out of the program, he was denied access to the remainder of his belongings, including his medication. I reached out to the facility and explained that he was sitting in a grocery store parking lot with nowhere to go and was told there was a 72-hour hold on his personal property, a rule. They would only offer transportation to sister facility for his readmittance, a tactic to refresh our insurance and increase the funds paid for his care.
On another occasion, I answered a call while on my commute home, “Your son is no longer with us,” was an unfortunate choice of words to let me know that he was discharged for not wearing shoes during the distribution of medications. I was told that being barefoot was dangerous, which was as illogical as their stipulation that all his personal property was to be collected within twenty-four hours or everything would be donated, “no exceptions!”
He walked a few miles to a coffee shop with what he could carry, charged his phone and called me. It had been weeks since we were permitted contact and it was difficult from 400 miles away to determine what was happening or how he should move forward. Under pressure, I concluded that if his program was incomplete, he should commit to another one. Within an hour, another treatment center picked him up and confirmed that he was in their care.
Patterns began to emerge. I noticed the recommendations by earnest therapists and established treatment plans were disrupted by systemic greed. Overcharging was rampant, simple urine tests were billed at $1,500 and mandated every few days. The exorbitant rates strained our insurance coverage and overrode the defined recovery strategies.
Typically, at around day 30 of the program, my son had been defined as thriving and engaged would suddenly be deemed problematic or spontaneously “ready” for discharge. Apart from being offered a bed in a sober-living home or a move to another facility (with the same ownership) he was unceremoniously exited. It made no sense until I learned that my son was a commodity whose value decreases in correlation with his dwindling insurance coverage.
Completion of a treatment program leads to a sober living home. Out-pocket costs start at $600 a month, plus a security deposit, which covered living in an average-sized bedroom with a roommate or two and oversight by a house manager. Without regulatory guidelines, the culture and health of these homes varied drastically and there was no recourse if the environment was toxic.
In the best of circumstances, sober living shifts the addict from a regulated and sequestered environment, to the expectation of instant self-sufficiency. Although my son was hungry for independence and anxious to make up for lost time, there was no preparation for him to function in the mainstream. He wasn’t using, which was the goal, but he lacked the skills to function independently and immediately obtain employment. It seemed without those skills, depression was quick to cast a black cloud over his fresh sobriety.
Treatment programs on average produce an unadvertised, 10 percent success rate. After a few months of abstinence, the risk of a fatal overdose is increased due to diminished tolerance. The times that my son wasn’t in treatment, I’d think about the 200 unnamed people who die every day from drugs and pray that he would reengage in a program. Although it was a “rinse and repeat” experience, it offered some protection from the death that is commonplace in his world. Despite being in his early twenties, he is unable to keep count of all the friends and acquaintances he has lost.
We were forever grateful for the determined emergency professionals, and three doses of Narcan that revived him when he relapsed after being kicked out of a treatment program. My son survived an overdose to learn that society defines addicts as criminals who are a waste of public resources. He was incarcerated on a felony charge of internal possession. His release date was provided only after he consented to a court-assigned treatment program, where he had previously been unsuccessful. The judge denied his access to medicine-assisted treatment. and two weeks later he was returned to jail due to a relapse.
Even homelessness can offer a path to treatment. Unscrupulous, “patient brokers” creep the shadows seeking addicts with medical insurance. They use lures like motel rooms, food, cigarettes and drugs to maintain engagement. While the addict is pacified, they direct multiple treatment centers to run their insurance benefits. Once treatment is approved, the brokers facilitate transportation, same-day, cross-country plane tickets were purchased for my son. The broker collects a hefty bounty once an intake session is complete.
I confronted a broker who kept my son drugged and incoherent in a sketchy motel. The man painted himself a hero and told an elaborate tale of his altruism. He defined himself as an interventionist, yet he was unable to say how he became involved with our family. Once I attempted to pinpoint his location, his phone was disconnected, and his website was shut down.
If you see my son in Prescott, Orange County, or south Florida, know that there is more than meets the eye. Understand that he and those who are striving for long term recovery are worthy of compassion as they battle demons that want to steal their future, dominate their brains, and rob them of their worth to this world.
Recognize that those who unwell are usually far from home and living their own version Groundhog Day. That their treatment addresses acute needs and those in early recovery need more time to focus on life skills and developing self-esteem, otherwise their functionality outside of a programmatically designed world is limited.
If you see a white cargo van, say a prayer for the passengers whose sobriety is complicated by navigating profit-based systems and the opportunists who prey on the vulnerable, the 20.8 million people who live with substance use disorder. Remember those passengers and the families who love them hold out hope for change.