HBO Host John Oliver Calls Out Unregulated Addiction Treatment Industry
Recently, John Oliver on his HBO show “Last Week Tonight” took on the $35 billion rehab industry, where he explains that there are no federal standards for rehab programs and the vast majority of people in need of addiction treatment do not receive anything that approximates evidence-based care. Furthermore, he quotes city commissioner, Andy Moroso, who is recorded on the news as saying “stop sending your loved ones to south Florida [for treatment] because we are sending them back in body bags.” John Oliver is a genius at cracking jokes while presenting the dire nature of the problem. He references the NYT coverage of the high profits from urine screens as liquid gold and quips, “Peeing liquid gold sounds like the symptom of an STD you can only contract from fucking C-3PO.” His coverage in this short segment is thorough and informative, presenting two very important principles: (1) addiction is a chronic medical condition needing a continuance of care, and (2) we need medical doctors involved in the standardization of practices implementing a system of evidence-based treatment.
It is pleasing for me to see the popular, sardonic coverage on this issue, as reminds me of my early public policy & advocacy days in stem cell research where, for example, Jon Stewart of the Daily Show covered the “Stem Cell Wars” on Comedy Central, suggesting a similar recognition by the media of a public imperative and the critical nature tipping to an inflection point of social change. While over the last 10 years, we have made significant progress in advancing the policy and science of stem cell research; for decades now, by any societal measure, not a lot has improved on any front regarding addiction. Deaths from overdose are the highest in human history, the successful recovery rate post-treatment continues to be abysmal, and scientific, medical advances is under-appreciated and poorly translated for patient-value.
In an interview with Marcus Chatfield published in the Faces and Voices of Recovery, renown addiction treatment historian William White presents one of the archtype treatment facilities, Straight Inc., that existed from the 70-90’s, that employed abusive techniques for the behavior modification of adolescents. In his article, William introduces the concept of iatrogenic medicine, known as treatment induced illness or otherwise stated as, harm in the name of help. Acclaimed author, Maia Szalavitz also covers adolescent treatment in her book, Help at Any Cost: How the Troubled-Teen Industry Cons Parents and Hurts Kids. All together, these resources paint a grim picture on the history and current state of the addiction treatment industry. Of the 14,500 rehab treatment facilities that exist, there are of course many good actors, but unfortunately, due to the complexity of addiction it has been tough to make real progress at the population level.
Addiction is highly complex, in which, each of the three biopsychosocial aspects needs to be addressed. Additionally, each person may vary in their relative proportion of the three aspects. For example, someone’s addiction may be predominantly genetically-informed, while someone else may have theirs largely rooted in childhood trauma. What has become common in other medical conditions, such as cancer, is the practice of personalized medicine and addiction is no different. What a person with substance use disorder will respond to is a matter of trial and error, just as with any other illness. Diabetes, cardiovascular disease, and other chronic disorders all have relapse and recovery rates, similar in principle to addiction, but we cast no moral failing on the patient. In addiction treatment, we have failed to appropriately establish the medical setting and a system for tracking evidence-based approaches. So, while John Oliver takes addiction seriously, showing how two of the people covered in his segment are now dead, his calling the unregulated treatment industry a “joke” is hard to deny and is certainly no laughing matter.