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Getting the Worms Out of the Apples in Florida

Recent media reports including one earlier this week on Sunday Night with Megyn Kelly and a report in last week's New York Times drew national attention to what those of us who provide legitimate and effective treatment in Florida have been fighting for the past few years – unscrupulous practices branded as addiction treatment that not only fail to deliver the treatment promised…they can be deadly.

Sadly, this profiteering is not new to the addiction treatment industry, nor is it unique to Florida. As a not-for-profit behavioral healthcare provider with more than 60 years of experience treating addiction, Caron Treatment Centers has seen this exploitation before and it is damaging to an industry trying to help people struggling with the disease of addiction.

As state budgets expanded to support the war on drugs, the number of addiction treatment centers grew from 500 in 1970 to more than 9000 in 1991. The industry saw the rise of many unqualified centers promising hope, but delivering little more than empty promises. Similar to now, as speculators came into the industry, patient care fell by the wayside in some cases as the focus on profit grew. When states cut back support for addiction treatment and instead began to send those suffering with the disease of addiction to jail, the speculators left the industry, leaving behind qualified treatment centers that have spent the last thirty years developing the evidence-based addiction treatment practices that we know work – including the Florida model.

When delivered as it was designed, the Florida model, where a person lives in one location while receiving treatment in another, is an effective treatment model. The Florida model fosters independence, confidence and maturity to help patients learn to respond to life's events without picking up a drink or drug, or engaging in other addictive and destructive behaviors. Despite the State Attorney for Palm Beach County’s assertion that “most of the apples are spoiled,” there are legitimate treatment providers in Florida, including Caron, helping patients and their families find wellness.

Regulations for addiction treatment centers vary state by state – and in some states regulations are virtually non-existent. This lack of regulation and standards within the industry makes it hard for families and individuals with substance use disorders to identify quality treatment programs. It also creates a fertile environment for deceptive business practices, fraud, patient neglect and, ultimately, treatment malpractice. Florida’s new “Marketing Practices for Substance Abuse Services” law, which takes effect July 1, is a move in the right direction but the state must also provide adequate funding and resources to enforce the new law.

At Caron, we have been working with officials in Palm Beach County and with Florida’s State Attorney General to identify and find solutions to the fraudulent business practices and unsafe living conditions. We are working with other leading treatment providers to define a standard of ethics and outcomes that will help families in distress determine which providers are acting in good faith. In addition, together with the Hazelden Betty Ford Foundation, Caron Treatment Centers authored a white paper entitled Defining a Center of Excellence: An Addiction Treatment Model that identifies standards necessary to deliver outstanding quality of care.

The Key Attributes for an Addiction Treatment Center of Excellence are:

  • Accreditation – In addition to having a state license,centers should be accredited from external regulatory organizations such as the Joint Commission (JCAHO) or the Commission on Accreditation of Rehabilitation Facilities (CARF).
  • Qualified Clinicians –Well-trained and credentialed clinicians are critical to providing quality care. Centers should have addiction medicine physicians, doctoral-level psychologists and licensed or certified addiction counselors.
  • Use of Technology and Data Systems –The use of electronic health records and state-of-the-art case management and data systems allows information to be shared across all involved in the treatment process and helps provide accurate and reliable data that can be used for benchmarking and quality performance assessment.
  • Evidence-Based Treatment – Clinical services offered to patients should be “evidence-based,” serve as “practice-based evidence” and/or be rooted in research and aimed at establishing new innovations in practice. In addition, the treatment provider should have an established process for routinely reviewing the ongoing research literature and exploring ways to incorporate new practices and methods as the evidence base for these develops.
  • Care for Co-Occurring Disorders – The majority of individuals with a substance use disorder also have a co-occurring mental health condition or other co-existing addiction. An addiction treatment provider should offer formal treatment for these co-occurring disorders (in addition to treatment for the substance use disorder) and do so using evidence-based practices. An integrated approach to treatment is the best practice.
  • Performance Measurement Systems – A treatment center should have formalized, proven methods for measuring several aspects of organizational performance, including patient outcomes. Most treatment centers rely solely on patient self-reporting without methods and structures in place to reduce bias and demand characteristics. Other measures can include reports from families, information from other professionals and science-based, physical measures, such as urine drug screens in addition to self-reports.
  • Commitment to Quality and Process Improvement – A treatment provider must engage in quality and process improvement, and have reliable, valid measurement systems to track improvement efforts and demonstrate quality of care. The organization should participate in national associations dedicated to standards and outcomes such as the National Association of Addiction Treatment Programs (NAATP) and be transparent in sharing information regarding the quality of care and outcomes, and educating the consumer about services and expected results.
  • Full Continuum of Care – Treatment is only one component of a continuum of care. A center should provide access and support for a full continuum of care that includes prevention and education, formal treatment and management of addiction issues, and post-treatment services, tools and resources that support ongoing recovery, as well as services offered to the patient and family prior to admission for treatment.
  • Education and Scholarship – An addiction treatment provider should also engage in ongoing education and scholarship through collaboration with local academic centers and universities and the delivery of educational programs, fellowships, internships and opportunities for further professional development (such as continuing medical education offerings).
  • Advocacy – A center should act as a local leader and voice in the field of addiction treatment.
  • Sound and Ethical Business Practices - The core business practices of a provider should be sound and ethical. Marketing, advertising and promotional activities should be ethical, truthful and legal.

This is not just a Florida problem, although the state seems to be the epicenter of the worst abuses. Overdose is now the leading cause of death for those under the age of 50. Communities across the country are overwhelmed by the effects of opioid abuse, struggling to find hope in an ever-growing crisis and looking to treatment as a way to save millions of people. What some facilities are doing in Florida threatens all of us, as it reinforces the myth that treatment doesn’t work, calls into question treatment practices that have been effective and makes finding effective treatment even harder for families in distress.

Addiction is one of the most manageable chronic diseases, but requires access to the appropriate level of care. Patients and families in crisis should have easy access to information that helps them find the right treatment program: one that is ethical, effective and unique to their needs. It is the patient’s right to trust that a provider is working in their best interests. As an industry, community and government, we must expect more. Click here for more information on finding a good treatment center.