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Changing the Face of Addiction Treatment

Moving a Broken System into Integrative Care

As the current wave of ethics and operating violations continues to breeze through the media, within the overtly fraudulent community of addiction treatment, brighter horizons of care are on the move.

Typically what we see in treatment centers (at least here in Southern California) is a saturation of pop-up facilities inhabiting the coastline. In my experience, many of these “treatment options” are owned and operated by someone with recent sobriety, a smoke-screen bio and absolutely no training or credentials in treatment who believe “they too can own a treatment center.” The result, as discussed in my previous articles, is a slew of insurance fraud, body brokering, people overdosing in unmanned facilities and a staff of unlicensed or uncredentialed professionals, assuming titles for which they are not trained.

However, with every downfall there is hope and opportunity for positive change. By using an integrative approach to care along with a fully licensed, certified and trained staff, ethical treatment can change the face and direction of addiction treatment in the future.

Amongst these diverse integrative care professionals are recreational therapists. Last week, I walked by recreational therapist, Ray Alameddine who was completing a psychiatric patient assessment. I frankly could not imagine what he was doing as the most adept “art therapist” I had ever been exposed to working in treatment centers was the owners relative who had mastered yoga and was assigned the task to “teach recreation and art.”

I asked newly credentialed Alameddine what he was doing. He responded “I have to understand the patient’s diagnosis so I can best design a program to help them and suit their needs.” This brought to my awareness another shortcut treatment owners are taking to save money, by hiring non credentialed staff and giving them a title. Using professionals like Alameddine, with a passion for what they are doing, raises standards of care. In best treatment practices, credentials equal credibility.

The reality is a majority of the people in treatment never learned to relax, play or have fun without their drug of choice. Plus, 70% have an underlying psychiatric diagnosis, and most used or drank to self-medicate, leaving them void of safe and healthy play habits. In ethical treatment all classes of care should be credentialed. The American Therapeutic Recreation Association (ATRC) defines a recreation therapy as a process that utilizes recreation and activity-based interventions to address the needs of individuals as a means to psychological and physical health, recovery and well-being.

“You can discover more about a person in an hour of play than in a year of conversation.” Plato

According to Sarah Magana, RTC CTRS, Director of Activity Therapy & Program at College Hospital, recreational therapy is so important Plato said “You can discover more about a person in an hour of play than in a year of conversation. ” A good recreational therapist is trained to see this and knows how to use their skills to move the person into better ways of functioning. Magana and her team spend hours designing ways folks struggling with a mental illness diagnosis and addiction can learn to integrate safe play into their lives.

Integrating recreational therapy is only one of the facets included in an team approach. Professionals on staff should include but are not limited to: addiction counselors & therapists, recreational & activity therapists, nutritionists, dieticians, medical doctors (including a psychiatrist), and certified case managers.

Therefore, as always, if you are seeking treatment for yourself or a loved one be sure to look for the following things:

  • A licensed and accredited facility in your state or region
  • A comprehensive staff who are fully licensed or certified by government agenciesin the state where the facility exists. (In reputable facilities staff credentials are listed next to the person’s name and not hidden by smoke screen bios.)
  • Ask friends and colleagues for reputable referrals where known success exists. (**Remember reputable treatment centers DO NOT PAY clients or patients to get treatment. RUN FAST if you encounter this type of facility.**)
  • Look for treatment centers that offer an integrative care approach with a multi-disciplinary system by a credentialed staff,

Be sure to do your research before choosing a facility. Check for a list of licensed providers in your area.

If you are a professional interested in raising the standards of care, take the time to talk with your peers and inquire as to their scope of practice, specialites and credentials. With the rising awareness of the opioid epidemic and quality providers speaking out against the old way of doing things, room for advanced comprehensive care is underway. Working together as a qualified treatment team increases everyone’s chance of success.

Knowledge and power speak volumes when consumers utilize proper vetting skills to ensure quality care. Together we can change the face of addiction treatment.

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Body Brokering in Addiction Treatment (Part 1)

The Addictive (and illegal) Behavior of Rehab Owners

In the continuously evolving world of addiction treatment new addictions arise daily. You may automatically think of the the rising opioid epidemic, addiction to mass media online gaming, or other compulsive behaviors now frequent on the horizon. Yet, the new “secret sin” in the world of addiction treatment is known as “body brokering” and instead of it being a problem of the addict, it is the treatment owners who are at fault.

Body brokering is an intentional behavior of many treatment center owners trying to make a fast buck while taking advantage unknowing folks struggling with substance use disorders and other addictions.

Body brokering is a compromise of ethics (and often law) where money exchanges hands of treatment centers for leads to viable clients for patients with good PPO insurance. This often results in large sums being earned by “brokers” before the addicted person ever sees the inside of a treatment center. “Brokering bodies” is a money-making machine with little to no concern as to if a client ever experiences a day of sobriety.

Clients with viable insurance plans are hot commodities. With a national average cost of $27,500 a month for 28 days of treatment, insurance leaves many treatment center owners racking up large sums of cash. These owners are often driving lavish cars while their staff works for low wages and few clients ever gain sobriety.

As a master’s level treatment counselor I like most of my colleagues, seek work with hoping it will add to my career and aid in helping kill the opioid crisis faced in our country. Like other professionals, I seek out web sites, use social networking and spend countless hours filling out online applications all in an effort to land a position at an ethical company. Yet, what I have found instead are positions that have left me feeling like I need a shower at the end of the day from jobs that will never see the light of day on my resume for fear of the negative professional association.

Body-brokering manifests in many ways. I recall one time where I sat with pen and notepad in hand during an initial counseling session. During the course of the session the unknowing client shared how “great it was” that the clinic owners found him at an out of state detox, paid for his flight and his insurance so he could get treatment. I nearly fell off my chair and struggled to keep a non-emotional face at hearing this news as it is illegal to pay for someone’s healthcare if you stand to reap monetary benefits. Unfortunately, what happens is after 30 days of treatment, these unsuspecting clients are often kicked out when the insurance stops paying and they are tossed to the curb…literally.

Clinicians like myself often hold more than one position to avoid holes in our resumes to account for any potential lapses of employment when we discover these internal indiscretions and run for the hills not wanting any connection or professional affiliation with the company. So frequent are these types of scenarios the treatment center owners are often more addicted to fraud and the cash than helping anyone.

So what are ethical clinicians, workers, and potential clients to do in a corrupt industry where they desire to work and/or seek help?

Do your research. Begin with checking the licensure of the facility. Are they appropriately credentialed for your state? Do they have the properly licensed staff to run the business? Do they maintain a Joint Commission’s, CARF (check which agencies govern in your state) or other secondary accreditation that helps ensure ethics? Are there complaints filed for fraud on the company? How long have they been in business?

In this industry length of time in business matters as does the “word on the street” so ask around. I have seen one too many places where recently sober and other people with money think “they too” can open a treatment center, cut corners and make a buck.

Seek out others who have found successful treatment or a positive work experience. And do not be afraid to report or call out illegal activities if you come across them. As they say in recovery “you are as sick as your secrets” and if you hide your experience this pandemic of toxic treatment centers will continue to spread. Where I reside in Southern California body-brokering is the norm with viable healthy treatment centers being few and far between and trying to keep their doors open.

But fret not, there are good and ethical treatment centers with strong client care, medical protocols, and caring staff that actually help a lot of folks on a daily basis.

If you are struggling with an addictive disorder DO NOT USE random referral lines or 800 numbers. Be sure to contact an ethical facility directly for help or contact SAMHSA for an licensed referral.

Have you experienced body brokering as a professional or a client? Share your comment below so we can put an end to this illegal addictive behavior of some treatment owners.

Part 2:

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Body Brokering in Addiction Part 2: Implant Therapy

  • By: D. Dawn Maxwell MA LAADC MATC

The existence of body brokering in addiction is an old story in the treatment world especially in the Los Angeles/Orange County, CA area, also known as the “Rehab Riviera.”

Daily, new treatment centers pop up as quickly as they disappear. In fact, as discussed in my last article many rehabs work with body brokers and pay consumers to go into treatment so they can collect on their insurance benefits. These brokers and treatment owners often buy the client’s health insurance, bill it, collect the money then kick the client to the curb. With reputable news agencies such as the Orange County Register, accurately reporting on this elaborate matrix of insurance fraud, many overlook other less conspicuous acts of body-brokering.

From Sunset Blvd to Sunset Beach treatment owners are also paying clients to relapse. Vulnerable addicts are providing drugs, hotel rooms, and clean needles. This allows the client to “pee dirty” and be admitted into treatment where providers can collect upward of $1000 a day during detox. Many clients in need of cash have succumb to this temptation and assurance they will “make money and get back on track in their sobriety.”

What is less frequently discussed, is the same brokering theory, using alleged illegally imported naltrexone implants. Naltrexone (an alcohol and opioid antagonist) was first FDA approved in 1984 for treatment against opiates. It was later approved by the FDA in the 1990s for combating alcohol abuse. It works by blocking the receptors in the brain that cause the cravings and effects of both. Unfortunately, the oral form of naltrexone has a 70% fail rate due to a lack of compliance. (This means the consumer has to choose to get up and take the pill every day. Which often does not happen.)

Vivitrol, is the injectable form of naltrexone and also a very effective, safe and FDA approved form of naltrexone available to the consumer. Vivitrol last approximately 28 days and can be effective for many, reducing the compliance issue that exists with the oral form of naltrexone.

Which brings us to the newest form of available naltrexone in the marketplace. The naltrexone implant. Although the active ingredient of naltrexone is FDA approved, the implant to date itself is not a FDA approved entity, but can be safely compounded in an approved and regulated compounding pharmacy in the USA. In fact, many medications are now custom compounded by prescription in this country. Combining naltrexone into an a legally compounded implant is a great idea due to its long lasting effects (often upward of 3 months.) I have seen this used in treatment and it is a great alternative the oral and injectable versions. Plus unlike other addiction medications, naltrexone is not a controlled substance and therefore not addictive.

“…many of these implants are brought into the United States illegally and pose a public health risk.”

Unfortunately, like many other areas of addiction treatment, if there is a way to pay-off the consumer so the provider can reap gross amounts of monetary benefits, it occurs. Across the country, unsuspecting clients are accepting payments upward of $500 to receive a naltrexone implant, while body brokers educate medical providers how to bill insurance companies for major abdominal surgery and pocket thousands of dollars for a procedure that can generally be done in less than one hour in an office. Worst yet, many of these implants are brought into the United States illegally and pose a public health risk. Leaving a two fold problem of patient safety due to illegal importing and/or insurance fraud and patient pay-off.

So how can you, the unsuspecting consumer safely consider implant therapy in regards to naltrexone without buying an illegally imported pellet?

Responsible consumers and loved ones are suggested to do the following:

  • Ask the implant provider where their implant is compounded.
  • Don’t be afraid to speak directly with the implant distributer or maker if you feel your medical provider does not thoroughly answer your questions. This is your body (or your loved ones) and you have a right to know what is going in and where it came from.
  • Don’t be fooled by shiny words and well phrased promises. Many illegal implant importers create web sites with promises that are not true. There are several legal, well made and effective naltrexone implants available in the United States.
  • Finally, if anyone offers to pay you or a loved one to get an implant of any kind, run, don’t walk to your nearest exist. Reputable providers do not pay patients to get treatment unless they are reaping kickbacks from other sources and are in desperate need of having you on the table to bill your insurance.

There are many legal and safe ways for those struggling with alcohol and opioid addiction to reap positive benefits and maintain long term sobriety by being a naltrexone implant recipient. Do your research as a consumer. There are no shortcuts to safety.

Other implants containing buprenorphine or a similar substance also exist and are FDA approved. Although the buprenorphine-based implants are compounded with opioid replacements, they are often a better alternative to death and overdose. Do your homework and decide what is best for you.

Implants done correctly are safe and effective. Implantation is a modern form of medication-administration and can empower people to lead more productive lives. By consumers being made aware of the problem and taking ownership of their care, we can drive out those trying to take advantage of an exhausted addicted population and those who love them. If you have experience with implant therapy for addiction, please leave your comment. Awareness is power and together we can drive out the body brokers who seek to take advantage of the opioid crisis in this country.

Part 1:


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confessions of an anti-mall mom

confessions of a shopaholic pic

A bubbled metropolis of apparent abundance, mall shopping is a past-time in the OC that delights the souls of many well-coiffed people with plastic lined wallets. Which is exactly why this Detroit-bread, OC mom transplant avoids malls at all costs…all costs. On a rare occurrence I would be forced to patronize such a place, it would be on a non-work day and I’d most likely be in my gym clothes intending to get in a workout.

Perhaps my aversion to malls started in the form of flashbacks having been raised in the midwest where we used mall-therapy to avoid the cold until the 2 1/2 month boating season came around each year. Yet, the act of shopping is not the topic of this anti-mall writing mom…or the point. It is what the culture has assimilated the experience into that got me hot and bothered this week and it is not because I missed a dose of estrogen.

After attending a day retreat at church, I was invited to lunch with some new friends at a nearby food court…inside a mall.

Embracing my newer singlehood, I forged out of my comfort zone and took the invite in an effort to meet new people. After asking the coordinator of this event specificallywhere I should park at said mall (and I mean give it to me by the name of store I should park by and how many feet I have to walk inside the mall to get there) I embarked to complete this social task.

After circling the conglomerate, it was clear this guy had never been to the mall himself. I found the Forever 21 store he insist I park near only to discover the food court was no where within a 10 block radius. My mall phobia growing with with each turn, I set off by foot to find the elusive food court location. While maintaining a rapid pace and walking with intent past several boutique specialty shops, a young woman from a center of the mall vender asked if I would like a sample of some type of face cream. Not wanting to be rude, I said thanks, took it and began to walk away. As I turned she called out to me and said she had one more thing for me.

Turning to decline her for her kind, yet unsolicited offer she looked me deeply in the eyes and asked “would you like some help with deep lines and eye puffiness?” I stood looking at her stunned that this was a supposed sales technique. “Have you heard of Botox?” she asked. I looked down and saw her holding a syringe of cream that I can only guess was meant to imitate the popular toxic beauty injectible. Clearly, this gal had no idea who she was talking to and had summed me up to be something else, insecure at best. “No, I haven’t heard of it”, I stated strongly (okay relevant truth) “I like my face the way it is.” I declared boldly, as I tossed her original sample in the trash and walked away.

As I looked around the corridors of the mall all I could see were young teens dressed to the top of fashion with overly made up faces, stylish clothing and overwhelmed sad sullen faces. Girl after girl, each looking miserable and wanting to belong. My body grew with anger at the skewed messaging designed to diminish self-worth and self-esteem in order to sell products.

The mall was even more toxic than I remembered. It had grown from a grouping of stores to a killer of souls.

I only spent 5-6 minutes walking through the mall that day and was confronted in a fashion which could have depleted me. Imagine the conscious and subconscious messaging a frequent shopper receives on a daily basis shopping in this environment. Eventually, even the strongest individual can grow desensitized to the soul battering input designed to deflate their perception of themself.

As an professional addiction counselor a great deal of females I have worked with in treatment have secondary eating disorders. Although the drug use is the presenting issue when they enter treatment, the secondary issue of binging and purging, or purging, or starving themselves is fast attached to the primary issue. In fact, one often leads to the other.

This type of toxic communications is exactly what prompted me to earn a master’s degree in Media & Communication Psychology. The misuse and skewed messaging in media and in direct sales communication for that matter, have become negative vehicles of influence in our daily lives leading to other secondary long-term illness due to stress, such as eating and addictive disorders.

Choosing to use media for positive social change is the under-riding influence in my life. Creating awareness of mishaps like this girls sales training is the beginning of shining light on a larger issue.

I’d love to hear your comments and experience on this topic as we move toward a climate of re-defining and normalize media and communication use.

What’s your story?

D. Dawn Maxwell M.A. CATC IV