In this episode:
I sit down with award-winning investigative journalist Shoshana Walter, author of Rehab: An American Scandal, to discuss the hidden truths of America’s rehab industry and what her reporting reveals about treatment, recovery, and justice.
Resources:
Purchase Rehab: An American Scandal via Shoshana Walter’s Site
NY Times Magazine Article Referenced
Also mentioned:
Book Study On The Mountain Is You
Transcript:
Jessica Dueñas: Hi everyone, welcome back. It has been quite a break here at Bottomless to Sober, but I am super happy to pick things back up today with a very special guest.
Jessica Dueñas: I have award-winning investigative journalist Shoshana Walter, who has a new book out called Rehab, an American Scandal. She is here to talk about some of the work, some of the research that she is uncovering, especially with some of the problems that do happen in these facilities. Those of you who know my story know I was in and out of treatment about 7 or 8 times, and so I’m really, really curious to hear what Shoshana has
Jessica Dueñas: say, if you’ve been following the podcast, you know that a few weeks ago, I actually interviewed Robert Marino, who runs a treatment facility, and so he gave us one perspective, but I do think that it is so important to be well-informed while you go into your journey, or while you explore your options for others. So, here we have a fresh perspective with some research, and again, it’s a complete honor to have you, Shoshana, so thank you so much for being here.
Jessica Dueñas: And yes…
Shoshana Walter: Thank you.
Jessica Dueñas: Anyone who doesn’t know your work, can you tell me a little bit about what drew you into, investigating the rehab industry?
Shoshana Walter: Sure, yeah. I have been a long-time investigative reporter, mostly focused on the criminal justice system. And so, about 8 years ago, I was a reporter at Reveal from the Center for Investigative Reporting.
Shoshana Walter: looking at drug courts and diversion court programs, and I just sort of stumbled across this
Shoshana Walter: rehab program that was being utilized by courts throughout Arkansas and Oklahoma, and…
Shoshana Walter: when I started doing a little bit of research on this program.
Shoshana Walter: I learned that it had been founded by a former poultry industry executive, and that the program was sending participants to work without pay at chicken processing plants, where they were making chicken products for KFC and Popeyes and Walmart and PetSmart, and they weren’t getting paid anything, they were working long hours in very
Shoshana Walter: Difficult, injury-prone jobs.
Shoshana Walter: And this was predominantly their sole form of what they were calling treatment, was this uncompensated work.
Shoshana Walter: And, so I was just totally caught by surprise by this, because over the course of the opioid epidemic, I feel like there has been this major shift in our country of…
Shoshana Walter: lawmakers and policymakers, court officials, starting to view addiction as a disease worthy of compassion and worthy of medical care instead of incarceration. That’s the idea behind a lot of these drug court and diversion court programs. So I was really…
Shoshana Walter: Perplexed that
Shoshana Walter: a form of indentured servitude would be considered treatment by so many of these officials. And it made me want to understand how common that is, and…
Shoshana Walter: if that’s a major component of our treatment system, which is something that, yes, I did find it was, you know, what does the rest of our treatment landscape look like, and is it helping people the way that it should, if we want to get more people out of this cycle of addiction?
Jessica Dueñas: That is terrifying to hear, and honestly, it’s also not shocking. I really… I wish I were better informed about the treatment system, and I’m sure you’re gonna shed a little bit of knowledge here today, because
Jessica Dueñas: from the different facilities that I went to when I was struggling, one thing that I definitely noticed was that there was no one type of method. It didn’t seem to be that there was any standardization of practice or, like, what is best for the patients. I experienced very, very different treatments at the different facilities that I went to. So I’m curious, once you started digging.
Jessica Dueñas: What… what did you notice about how these different treatment facilities operate?
Shoshana Walter: Yeah, that’s such a good question, and I kind of am curious. I want to know a little bit more about your different experiences in these treatment programs.
Shoshana Walter: But, you know, as you just explained.
Shoshana Walter: there’s so much variability in treatment, so it’s very hard to break it down into broader categories. But that is… that is kind of… that was kind of my approach with this book, is really understanding what the treatment landscape broadly looks like, and what are the problems in this system that are… that are preventing it from working the way that it really needs to be working.
Shoshana Walter: And so, what I found, and this is specifically for opioid addiction, I know that, Jessica, you had
Shoshana Walter: you had… you had experience with alcohol addiction previously. But with opioid addiction, you know, there’s… there’s, these programs that I was just talking about that are often utilized by the court system.
Shoshana Walter: Or utilized by families that don’t have the financial resources to send one of their loved ones to an insurance-funded program, for example, or a longer-term program.
Shoshana Walter: You have medication-assisted treatments like Suboxone or buprenorphine and methadone, that are very effective for opioid addiction, and
Shoshana Walter: have been proven to reduce overdose deaths by more than 50%, but what I found there is that these medications are really still difficult for patients to access, and also to remain on.
Shoshana Walter: And there’s a long history behind that there. And I also looked at the barriers that exist to treatment for many people, particularly people who are lower income or living in poverty, who don’t have insurance coverage. It can be still incredibly difficult for people to access treatment, despite the fact that the Affordable Care Act expanded treatment coverage
Shoshana Walter: to millions of Americans.
Shoshana Walter: And then the other, kind of.
Shoshana Walter: bucket of treatment, you could say, that I looked at.
Shoshana Walter: were, these insurance-funded programs that really proliferated with the Affordable Care Act. And those are… those are limited by what insurance companies are willing to pay for, and so they’re designed around maximizing billable services.
Shoshana Walter: And oftentimes, the most insurance companies are willing to pay for are these 30-day programs, or programs that last maybe no more than a month or two.
Shoshana Walter: And, the problem that I’ve seen again and again with these programs, especially with opioid addiction, is that people go in, they complete the program, even the most well-intended programs, people complete those programs, they leave, and then they relapse, because they…
Shoshana Walter: Do not have the support to which they grew accustomed in rehab, and that treatment program did not necessarily help those individuals come up with a plan of utilizing and accessing support for once they leave.
Shoshana Walter: And so, we now know from research that has been done that someone who completes a 30-day program is much more likely to overdose and die in the year following treatment than someone who failed to complete that program at all.
Shoshana Walter: So there’s a way that we’re funding treatment in this country that’s actually fueling the problem, contributing to relapse rates.
Shoshana Walter: And that’s also contributing, unfortunately, to many overdose deaths.
Jessica Dueñas: Hmm.
Jessica Dueñas: Now, I’m so curious, with regard to the people who successfully complete a program exit, and they are more likely to die of a drug overdose in that first year. Now, is it because of their tolerance that their body has kind of reset that tolerance in those 30 days that they stayed clean, and so it’s just, when they go out and they relapse, it’s over, essentially?
Shoshana Walter: Exactly, yes, exactly. Someone enters the program. Oftentimes these programs require obstinence from all substances, including, perhaps, addiction treatment medications.
Shoshana Walter: And so that person then stops using the substance they had been using, their tolerance level goes down, and then when they leave the rehab, and they often relapse.
Shoshana Walter: Because their tolerance level has gone down, they use the same amount of opioid that they previously had used, and now it’s too much for them, and it leads to overdose.
Shoshana Walter: And the same is true, also, for stints of incarceration. I think the statistic is something like.
Shoshana Walter: Someone who is recently released from a period of incarceration is 40 times more likely to overdose and die following that period of incarceration than someone from the general population of opioid users.
Shoshana Walter: So, these programs that Segregate and isolate people kind of away from their usual surroundings.
Shoshana Walter: They can be godsends, but also they can lead to increased risk of overdose death, especially when the supports that people need post-rehab are just not there.
Jessica Dueñas: I mean, what you’re saying, honestly, Shoshana, lines up exactly with so many of my lived experiences. So, yes, my personal addiction was to alcohol. However, I was always housed in treatment facilities with people recovering primarily from opiate addiction, some from methamphetamines and other things, but I was in Kentucky, so definitely an area where you’re going to see a lot of opiate addiction there. And, one of the residential
Jessica Dueñas: programs that I was in. It was a 35-day program, and I remember we were sitting, we had,
Jessica Dueñas: throughout the day, we had, like, group, and so in one of the groups, we were being led by a counselor, and I so remember her saying, this is a fortress, and here you’re safe, but when you exit, you know, you’re still taking… everything that you brought in with you is still going back out with you. And really, they were trying to encourage people to, say, consider sober living options and some sort of, like, transitional housing
Jessica Dueñas: before going right back home. But I’ll be honest, you know, like, when I was having those conversations, I was very resistant to the idea, like, I didn’t want to go into sober housing, I just wanted to go home. And of course, I immediately relapsed when I left, but, you know, I drank alcohol, blacked out, and that was… in a sense, that was it for me. I was alright, thankfully. But I… I definitely remember stories of people that I was in treatment with.
Jessica Dueñas: who are not here anymore, because they were told the same thing, they didn’t have that, you know, transitional support, and then they struggled greatly. So I’m curious,
Jessica Dueñas: Do you think that there is a way for people to…
Jessica Dueñas: recover or work through, like, their chronic addiction and transition? Maybe not to full abstinence, as you were mentioning, but is there a way to recover, perhaps without using a treatment facility where you’re not pulled from your environment and you can kind of start to work on some of those processes, or what do you think there?
Shoshana Walter: Yeah, I mean, I think…
Shoshana Walter: It’s really hard to say, because recovery is such a personal, individualized experience, and what may work for one person might not work for another person. I mean, you know, the rehab that I was talking about before, that…
Shoshana Walter: required people to work in chicken plants. You know, there were definitely people that I interviewed at this program who said, you know, that’s what they needed, you know? So, I feel like different things can really work for different people, but I have seen…
Shoshana Walter: that…
Shoshana Walter: In my experience, you know, having interviewed hundreds of people in and out of recovery, it’s often a long-term process of change.
Shoshana Walter: And so, treatment that’s longer term and that provides that ongoing support.
Shoshana Walter: is really incredibly key. And I think this is especially true for people who are the most marginalized, you know, who maybe come into their addictions already
Shoshana Walter: facing the consequences of structural inequality, but also, you know, the longer someone remains in their addiction, the more marginalized they become, because in our country, there are so many consequences that
Shoshana Walter: are caused by being in addiction. I mean, it can come along with additional mental health and physical, trauma.
Shoshana Walter: It can lead to criminal charges and convictions. All of that can lead to, loss of…
Shoshana Walter: voting rights, inability to find a job, inability to find housing, difficulty accessing food and healthcare and transportation. You know, there are these consequences that come along with addiction that just continue to mount the longer you remain in addiction.
Shoshana Walter: And those consequences become as much of a barrier to recovery for a lot of people, as the addiction itself. You know, it can become an obstacle in and of itself.
Shoshana Walter: And so, I think that is also one really important piece that is missing from our treatment system. It’s what researchers refer to as recovery capital.
Shoshana Walter: And that is the mixture of internal and external resources that people need in order to enter and sustain their recovery. And that can include social and community support, but it also includes all these other aspects, you know.
Shoshana Walter: housing, financial stability, job, food, healthcare, transportation, you know, these are the elements that are really going to allow people to sustain their recovery. And these are the elements that are missing for a lot of people when they leave treatment. And so, if those elements are missing, if a treatment program is not addressing those gaps.
Shoshana Walter: Then relapse for many people is very likely.
Jessica Dueñas: Yeah.
Jessica Dueñas: Yeah, and you know, when you were talking about the healthcare piece, I was reading, you know, just learning more about your work. Like I mentioned before we went live on this call, I was reading about the young woman, Jade Dass, whose story you covered starting a few years ago, and, you know, I’d recommend to anyone listening to Google it. I’ll also post a link to some of the resources about this story, but
Jessica Dueñas: This was a both powerful and heartbreaking story about a young woman who struggled with addiction, was
Jessica Dueñas: on a path of recovery was using Suboxone as prescribed appropriately by a medical doctor, and then that was kind of used against her to take the child, her baby, away eventually, who was perfectly healthy, and it’s just kind of been this ongoing custody battle for her to have her child, and then, like, you know, left and right, all these other barriers, like you were just mentioning, Shoshana, were just, like.
Jessica Dueñas: thrown at her, and, you know, in this case, it’s impacting her, not just her recovery, but her ability to be a parent, but yes, like, these barriers pop up, and it becomes very easy to turn around and just say, you know what, I’m done. I give up, because it seems like there are so many barriers coming across people, and I think that it’s so important to look at a whole picture.
Jessica Dueñas: And sometimes I remember in some of these spaces, you know, being told, well, just don’t drink. And it’s not so simple. You know, I wish it was just so simple to put down whatever substance it is that we’re addicted to, but it’s really complex.
Jessica Dueñas: Shoshana, one of the things about my story that really struck me when reading about some of the work that you’re doing.
Jessica Dueñas: When I was in treatment in 2020, I also didn’t have great judgment, and I fell in love with someone who I was in treatment with, and his drug of choice was opiates.
Jessica Dueñas: He did not live, unfortunately, he had a relapse, shortly, you know, once the pandemic started, and we had no supports in place, you know, he did use again, and he didn’t make it, and that made things very difficult.
Jessica Dueñas: But one of the things that I think about with his journey and trying to recover from opiates was the facility that we were in also really kept, pushing us to go to AA meetings.
Jessica Dueñas: And, I mean, you know, for me, sure, with an addiction to alcohol, if I choose to use language like an alcoholic, maybe that could be more applicable to me. I mean, I also don’t think it’s people’s first language, and I don’t personally attend 12-step programs.
Jessica Dueñas: I know it works for a lot of people, though, but I remember when he was still alive, and when he was starting to struggle, I would say, but why are you going to AA? You are not an alcoholic. Your drug of choice is not alcohol. You don’t even.
Shoshana Walter: Right.
Jessica Dueñas: alcohol. And that was really frustrating for me to see, because I remember being in the facility and seeing people who use street drugs being told to go to Alcoholics Anonymous.
Shoshana Walter: It didn’t…
Jessica Dueñas: sense to me, and I don’t know if there’s anything that you’ve read or anything that you’ve seen to make sense of, like, that kind of a recommendation from a facility, or, like, where’s that coming from? I’m curious.
Shoshana Walter: Yeah. I mean, I think there is a huge reliance in a lot of treatment facilities on 12-step curriculum.
Shoshana Walter: And one of the reasons that is, is because in the 70s, there was a hospital chain that provided inpatient hospitalization for alcoholism.
Shoshana Walter: And, that… that facility had psychiatrists and doctors on staff, well…
Shoshana Walter: at one point, they decided they needed to cut costs, and so they got rid of a lot of those, you know, higher-paid, highly qualified staff members, and replaced them with people with lived experience, which is not necessarily a bad thing, and people who were essentially evangelizing the 12 steps. And so…
Shoshana Walter: That is kind of how the 12 steps became introduced into a lot of treatment facilities, is simply, initially, as a way to cut costs.
Shoshana Walter: And so, now a lot of treatment facilities utilize the 12 steps, and I think the evidence shows that that can be very effective for some people, but not for all people. You know, most people benefit from some sort of community recovery support group.
Shoshana Walter: But it’s not always going to be AA, and I think in a lot of cases, it actually, can make people feel,
Shoshana Walter: alienated to join when they join a group that doesn’t… that is not the right fit for them. And that’s what I found in reporting my book, Rehab in American Scandal. You know, there’s one person in my book, April Lee, who did find
Shoshana Walter: great benefits in joining 12-step groups, in her recovery. But there was another person, Chris Coon, who got back from a very dramatic experience in an exploitative rehab program, and he did not want to join.
Shoshana Walter: a 12-step group. He did not want to identify himself as… a forever addict, as,
Shoshana Walter: As, and he didn’t… and he didn’t want to just hold on to kind of this…
Shoshana Walter: this, sense of himself as addiction being a core piece of his identity. You know, he really just wanted to move on, and he was able to, thankfully, because he had recovery capital, he had a middle-class
Shoshana Walter: households. His parents helped him get on Suboxone.
Shoshana Walter: They helped support him with housing as he attended school to get a welding certificate. He was able to get a job. He applied for a number of jobs that actually rejected him because he was on Suboxone, but he eventually did find a job that allowed him to support himself.
Shoshana Walter: And he was able to move on with his life. So I think there are different pathways for different people, and that is one of the most… that is one of the scariest pieces of recovery, especially early recovery, is when the stakes are so high.
Shoshana Walter: Particularly with opioid addiction, when it can lead to overdose, you know, how do you find the type of support that’s going to work for you?
Shoshana Walter: And I think that’s why it’s incredibly important when you’re in a treatment facility that that facility help you identify what is going to be the right fit for you. How do you find that support? What makes the most sense for you personally as an individual versus…
Shoshana Walter: What makes the most sense for… You know, billable services.
Jessica Dueñas: Yeah. And you know, that’s…
Jessica Dueñas: That’s so incredibly powerful, and I do see how that does not happen, you know, because I think about whether it was, you know, when I was in the facility, how I was thinking, or again, seeing my peers who were addicted to opiates and other substances. When we’re in those spaces, and we’re, like, on day zero or day one.
Jessica Dueñas: the… we’re the farthest from trusting ourselves, right? And so, I feel like we’re in that space where we’re almost ready to just do as we’re told, as opposed to looking inwardly to be like, huh.
Jessica Dueñas: what feels right for me? What would be the pathway that feels most beneficial to us? And sometimes, when I think about, like, the guest speakers who would come into these facilities with their many years of lived experience, some of them are very intimidating, and some of them are just like, sit down, shut up, you know.
Shoshana Walter: Oh my goodness.
Jessica Dueñas: Cotton out your ears and put it in your mouth, and, you know, just do as you’re told.
Jessica Dueñas: And when some of that is the messaging that we’re receiving early on when we’re in these facilities and, you know, people are going through their different types of withdrawal from whatever they’re coming off of, it… it can be really hard to be told, like, look inwardly and trust, like, let’s help you find what works for you. So I can see.
Shoshana Walter: Yes.
Jessica Dueñas: exactly how people can find themselves being exploited, which I know that’s some of what you discuss in your book.
Shoshana Walter: Yes, yeah, what you just described just so resonates, because I talked with so many people who, for my book, who attended some of these exploitative rehab programs.
Shoshana Walter: that we’re really using people to make a profit. And that is exactly the situation that so many of them found themselves in. You know, it’s such a vulnerable moment in so many people’s lives.
Shoshana Walter: They feel depressed, like, the self-worth is so low, they lack confidence and, and trust in their own instincts.
Shoshana Walter: And so… and then you enter a program that is incredibly prescriptive. You’re being told exactly what you just said. You can’t trust your own instincts. Your family members are being told. Don’t trust anything that they say.
Shoshana Walter: So you’re completely isolated, and so that’s how, you know, Chris Kuhn, for example, ended up in this…
Shoshana Walter: treatment program where he was supposed to live and work for 2 years. He was told he would be able to save up money for after he left rehab, that he would get counseling and medical care. And instead, what he discovered when he got to this facility is that he’d be working up to 80 hours per week
Shoshana Walter: And really, Hard, manual labor jobs, you know.
Shoshana Walter: building scaffolding at chemical plants, laying asphalt in broiling Louisiana heat, cleaning up after LSU football games, and he wasn’t getting paid. All of the money that he was earning was going back to the rehab program. He was getting a pack of cigarettes per week as his compensation.
Shoshana Walter: And he barely ever had any time for counseling. You know, I spoke with his counselor, who said that she would poke her head into his room at the end of a long workday.
Shoshana Walter: ask him how he was doing, he’d say fine, and she’d mark that off as a counseling session. So, you know, you can really see how easily this population of people can be exploited, and no one
Shoshana Walter: Almost no one believes it, because your family’s being told not to listen to you.
Shoshana Walter: You know, whoever put you there, maybe it’s a judge or a prosecutor, believes you deserve what you’re getting.
Shoshana Walter: And there’s kind of a lack of trust of the experience of the person who’s going through this. And, it can be really devastating, and there is really so much exploitation in this industry, it’s very disturbing.
Jessica Dueñas: So, I know you’ve made mention of a couple of ways in which people are exploited financially. Did you find any evidence of other ways in which people are taking advantage of when they’re in these facilities?
Shoshana Walter: Yeah,
Shoshana Walter: I found… so there’s a lot of problems with oversight in… with treatment facilities. You know, every state regulates these systems differently. In a lot of states, there are certain programs and facilities that are totally exempt from licensure.
Shoshana Walter: So, and oversight, so you have programs that identify themselves as faith-based, that are typically exempt from licensure and oversight.
Shoshana Walter: Oftentimes, if a program is, 12-step based, and not offering medical care, and not allowing
Shoshana Walter: medications of any kind, even psychiatric medications, they’re exempt from licensure. And then you have sober living homes that also are not typically regulated. And in California, for example, outpatient programs are not required to be licensed or certified.
Shoshana Walter: So, there are a lot of gaps in oversight in this system.
Shoshana Walter: And, and so I found that there were often, there was often exploitation happening in these programs that lacked any kind of oversight. So, for example, April, one of the people that I, that I followed in my book.
Shoshana Walter: You know, when she was struggling with addiction, she couldn’t find treatment, her children were taken away from her.
Shoshana Walter: She ended up, going to this 30-day program. Immediately afterwards, she relapsed, and she had nowhere to go, and so she ended up at this, recovery home.
Shoshana Walter: That required her to… to pray.
Shoshana Walter: That was essentially what she was allowed to do in this program. And, she was allowed to take her detox medications, but one day, when they discovered her taking them a little bit early, they punished her by forcing her to sit in a corner on her knees and pray for 4 hours straight.
Shoshana Walter: And so, as you can imagine, that led April to want to leave, and she did. She fled the program. She ended up homeless in Kensington, in Philadelphia, where she really devol- got worse in her addiction.
Shoshana Walter: She, she’s started relying on sex work to support herself.
Shoshana Walter: And she was desperate to stop, you know? She desperately wanted to be reunited with her kids, and she could not find any help. The only help that she could find, in her view, was to get herself arrested.
Shoshana Walter: So that’s what she did in order to stop her cycle of addiction. She got herself arrested, she entered jail.
Shoshana Walter: And then that was the start of her recovery process, which took a very long time, because April grew up in poverty and really lacked that recovery capital that we were talking about earlier.
Shoshana Walter: And then there’s another person that I follow in my book named Wendy McIntyre. She is… she became kind of an activist, obsessively rooting out corruption in the for-profit treatment industry.
Shoshana Walter: after she lost her son to overdose when he was in a sober living home. And, Wendy, you know, when I met Wendy.
Shoshana Walter: I learned that she basically investigates rehabs in her spare time, and she is so, persistent and aggressive in this pursuit. The first time I met her, I…
Shoshana Walter: entered her house, and the floor was basically carpeted in boxes of her investigations. I mean, she is, relentless. And so one of the programs that Wendy investigated was located in the San Bernardino Mountains, not far from her own home.
Shoshana Walter: And, it was one of these short-term residential programs. And what Wendy discovered is that this program was…
Shoshana Walter: Over-medicating people, often to the point of impairment, basically giving everyone the same
Shoshana Walter: a mixture of detox medications, even when it wasn’t appropriate for them. You know, for example, giving someone Suboxone who had a meth addiction. You know, there was no reason for them to be on that medication. And in multiple instances, people died after receiving these cocktail of meds.
Shoshana Walter: That were not appropriate for them, and that the record showed had not actually been prescribed to them by a doctor. And, Wendy…
Shoshana Walter: tried so hard to get this facility shut down. I mean, she filed hundreds of complaints.
Shoshana Walter: Called law enforcement and regulators constantly. The rehab filed a restraining order against her, and filed a libel lawsuit against her to get her to stop what she was doing, and she didn’t.
Shoshana Walter: And nonetheless, people continue to die, and…
Shoshana Walter: No legal authorities ever made a substantial effort to shut this facility down. The only reason it eventually shut down is because the owner went into debt after a series of wrongful death lawsuits.
Shoshana Walter: And he was making a lot of money through this program for many years. I mean, he got into it because he had been in construction, he had a bunch of empty homes that were not being put to use, and despite having no training or background with addiction.
Shoshana Walter: He decided to start this treatment facility because it was a moneymaker.
Shoshana Walter: And it… it led to people dying due to the inadequate care.
Jessica Dueñas: Oh my goodness, I mean, it’s… it’s terrifying, and again, I hate to say that it’s not shocking that it was very… like, that she wasn’t able to get it shut down, that it took the owner self-shutting down because of debt. I mean, I think a big part of it, Shoshana, is that
Jessica Dueñas: though there’s been lots of strides in how addiction is viewed, and, you know, I’ve seen some of your interviews in other spaces where you’ve said that, you know, like, in the 80s.
Jessica Dueñas: you know, drug addiction was certainly criminalized, right? When you had predominantly Black and brown bodies that were struggling with the addiction, and then with the transition to opiate addiction, you know, now it’s like, oh no, this is a disease, we need to, like, treat it, we need to care for these folks, right?
Jessica Dueñas: But I still think at the end of the day, there’s a huge stigma, and I think that, you know, there’s still this, like, lesser-than view of the person who is struggling with an addiction, especially if it’s anything that is, like, taken off of the street, right? Because I still think, like, sometimes people who struggle with alcohol abuse, you know, there’s…
Jessica Dueñas: it’s just, people are treated so differently, and I feel like sometimes people really don’t care, and they don’t see the human who’s struggling
Jessica Dueñas: behind the addiction, and so, well, if… if there’s some casualties, I can see that attitude being of, like, oh, well, you know, we’ve got other things to worry about. Right. So that… that is incredibly heartbreaking.
Jessica Dueñas: So, as you’ve been, like, looking through these, doing your research, and investigating.
Jessica Dueñas: Have you found any kind of programs that you feel are somewhat effective? Like, let’s say if you had a loved one, or a friend with a loved one struggling, and they needed help, what would you suggest, considering how broken so many of these spaces are?
Shoshana Walter: Yeah. I mean, I did a lot of shadowing of providers when I was working on my book,
Shoshana Walter: to really get a sense for what addiction treatment looks like, especially when it’s really helping people. And so one of the programs that I, that I shadowed for several months
Shoshana Walter: It’s called the Bridge Clinic. It’s at, it’s at a hospital here in Oakland, California, where I’m based.
Shoshana Walter: And, it predominantly focuses on treating patients who are more marginalized and often unhoused. And, and I saw, and it’s a low-barrier clinic, meaning,
Shoshana Walter: anyone can come and get treatment. There’s no… there’s no wait, you don’t even have to set up an appointment, you can just show up.
Shoshana Walter: And… and if you’re still using, or you relapse during the course of your time in the clinic.
Shoshana Walter: you can still remain a patient. I mean, that’s a very common problem in treatment, too, is someone relapses while in treatment, they’re kicked out.
Shoshana Walter: So in this clinic, people are allowed to remain in care. And so they’re… and so they can show up at the clinic anytime for an appointment. They don’t need to make an appointment, they can just
Shoshana Walter: come and see a doctor, and they get medical care, they get addiction treatment medications, and they also get counseling. There’s a counselor there, a social worker there, who helps people work through some of these other issues that are going on in their lives.
Shoshana Walter: And I just saw… In real time, how beneficial that was.
Shoshana Walter: To some of these patients. I mean, I remember one patient in particular who was in his 60s, he’d been struggling with addiction for decades, he’d been homeless for a very long time, and he decided to…
Shoshana Walter: Start his recovery process when he realized that he had turned the same age that his own dad had been when he died from his addiction.
Shoshana Walter: And so, he started going to this clinic, and he didn’t even have to go in person, but he wanted to. And it’s kind of a haul to get to this place, and he would just walk there.
Shoshana Walter: to go to the clinic. He would pick flowers from people’s front yards along the way, and then by the time he got to the clinic, he would have, like, a bouquet of flowers that he would present to the receptionist.
Shoshana Walter: And, and even though he still struggled intermittently with using, I could see how much better it was for him to be on this medication, have access to these resources.
Shoshana Walter: And because that prevented him from… from dying from his addiction. It kept him in better health, and it allowed him to make ongoing improvements and changes in his life. And it was a lifeline to…
Shoshana Walter: a phone that he could use to call people he needed to, to medical care to address the other physical ailments that were going on in his body. The one thing that I will say about this program is, even though it was so beneficial to the patients from what I could see.
Shoshana Walter: There was still a limitation to what healthcare providers could provide, you know? There’s a housing, shortage in the Bay Area, and so the social worker, you know.
Shoshana Walter: was unable to find, housing for him. So, even though he was attending this program in the long term, he was still unhoused, and that had an effect on his stability and had an impact on his addiction. And so, I think when I…
Shoshana Walter: when I think about our larger treatment system.
Shoshana Walter: I think a lot about the fact that there are limitations to our healthcare system in being able to provide the resources that people need in order to
Shoshana Walter: actually sustain their recovery. And so that’s a broader problem, I think, for our society to really address and solve. It’s not something that
Shoshana Walter: It’s gonna be solved with just our healthcare system alone.
Jessica Dueñas: Sure, I mean, you know, I think of, like, Maslow’s hierarchy of needs, right? And it’s just, like, just the basic safety, housing, you know.
Shoshana Walter: Yes, the basics.
Jessica Dueñas: Yeah, like, if we don’t have those basics, it’s going to be really hard to stay sober, to stay clean.
Shoshana Walter: Exactly.
Shoshana Walter: Exactly, Jessica.
Jessica Dueñas: Yeah, so…
Jessica Dueñas: So, I mean, this is fascinating. This is a fascinating and heartbreaking conversation, and again, for anyone listening.
Jessica Dueñas: I just hope that it helps us just make better decisions in terms of the care that we are seeking. So, what might be some red flags that families might need to look for if they’re looking to either… if someone’s looking to place themselves in a facility, or a loved one that needs to go into a facility, what are some things that you would recommend people pay attention to before, you know, as they’re looking
Jessica Dueñas: For maybe an intake interview, etc.
Shoshana Walter: Yeah, that’s a really good question. You know, I would want to know what are the qualifications of the people who work at that program? You know, if… is the program…
Shoshana Walter: providing not just, care for addiction via, you know, groups, but are they also providing access to medical care, to addiction treatment medications, and to mental health care, to psychiatric care? You know, if someone needs medication, for example, for a mental health condition.
Shoshana Walter: Will they be able to also address that in the program?
Shoshana Walter: I would ask about what,
Shoshana Walter: what are the common features of the program on a daily basis. I think one big red flag for me with any program would be how often are they drug testing participants? I think drug testing can be a very valuable tool.
Shoshana Walter: But if the program is drug testing people every day or every other day, that’s not necessary, and it’s excessive, and it may be a sign that that program
Shoshana Walter: is, is providing unnecessary services in order to bill insurance companies for more money. I’d also ask, you know, what does the program’s approach to aftercare look like?
Shoshana Walter: How do they involve the family?
Shoshana Walter: And how do they work with the patient to determine what the next step should be following treatment? How do they help guide that patient through the process of identifying
Shoshana Walter: The supports that they need following treatment, and what kind of resources they might need to access in order to support themselves following treatment.
Shoshana Walter: There was one program, this is the one that I was telling you about earlier, that had been over-medicating patients.
Shoshana Walter: you know, I spoke with this treatment facility owner, and he… he actually was frustrated by the insurance companies covering such short bursts of treatment, because he… even he acknowledged that…
Shoshana Walter: it can be, counterproductive. He referred to it as a cycler, like, people go into the program, they come out, they relapse, and then they come back in. And he was criticizing this, but at the same time, he is among many other treatment programs that have now made this kind of a part of their business model, where, like, the relapse is a part
Shoshana Walter: of… Of ensuring a…
Shoshana Walter: steady customer base, for lack of a better term. And so he employed people in his quote-unquote aftercare program.
Shoshana Walter: who would call former patients, find out if they relapsed, and then re-enroll them if they did. And so I think if that is what a rehab is considering their aftercare program.
Shoshana Walter: that’s likely going to be insufficient for patients, and so I would, if I were looking for a treatment program, I would try to determine how robust that… that aftercare program is, actually. You know, what are they actually doing for patients once they leave?
Jessica Dueñas: And, you know, the relapse thing, it’s fascinating to hear you say that, that they call and are just like, hey, do you want to come back? Because at the end of the day, when someone is discharged, they do…
Jessica Dueñas: a big part of being in recovery is learning how to live in the world, right? And, you know, if a person… obviously with opiates, right, the problem with the relapse there is that it can be deadly. With alcohol, not always, unless, you know, someone
Jessica Dueñas: goes overboard or gets into a car, hurts themself, etc. But there are times when the person uses a substance again, whatever it is. It’s also a learning opportunity, where we can talk about, well, what set you off, what triggered you?
Jessica Dueñas: how can you adjust your environment? Like, how can you… you know, there’s, like, this whole, like, relapse prevention education that can happen that does not necessarily need to happen behind the walls of a treatment facility where you’re charging someone thousands of dollars a day, right? But if they look at that moment, like, oh, you used again, time to go back in, and, like, let’s start this all over again, you really are perpetuating a cycle where someone’s not learning and not growing.
Jessica Dueñas: In their journey, honestly.
Shoshana Walter: Totally, Jessica, I think that’s such a good point. Like, that’s information that is really valuable to have once you’re out in the world, and I think that is the time to really
Shoshana Walter: to really focus on that challenge. And it’s where… it’s the time period in which people need the most support. Not when they’re in the confines of this program, but when they’re out of the program and surrounded by all the triggers that accompany, you know.
Shoshana Walter: The recovery process.
Jessica Dueñas: Yeah, absolutely. So, Shoshana, with your text, when people pick it up, whether it’s someone who is just a casual reader, someone in recovery, or maybe a practitioner, or even a policymaker.
Jessica Dueñas: What do you hope people will maybe do differently after they engage with your book? It sounds like it’s full of individual people’s stories, as well as patterns that you’ve noticed that are occurring on a systemic level. What do you hope people do differently with that information?
Shoshana Walter: Yeah, well…
Shoshana Walter: it really depends on who’s reading it. You know, I… for the book, which is called Rehab and American Scandal, I followed four different people very closely through different facets of our treatment system.
Shoshana Walter: And, I did that because I feel like, in order to really understand the system and the problems that people, confront.
Shoshana Walter: you really have to view it through the eyes of someone who’s experienced it. I think stories are really powerful. So I hope that people, that policymakers and lawmakers who might read it
Shoshana Walter: Read the book and understand for the first time, perhaps, that this system that our country has set up to, help stop this drug crisis is really not working the way it was intended to work.
Shoshana Walter: And there need to be some significant changes in order for it to actually help more people. I hope that, people struggling with addiction and their family members read it and, and, maybe feel validated or seen.
Shoshana Walter: because… and I’ve heard from so many families since the book came out who’ve… who do feel like it really, accurately reflects their own experiences, and so often those experiences are totally ignored by the authorities. And so, I hope that people read this and feel…
Shoshana Walter: Heard and seen, and perhaps empowered to speak up about their own experiences.
Shoshana Walter: And I also… this was not necessarily my initial thinking behind
Shoshana Walter: putting out these books, but since the book came out, I’ve also heard from a lot of treatment practitioners. I think there are a lot of people working in the treatment industry who want to see the system improve.
Shoshana Walter: And so there’s been a lot of really hopeful, what I view as hopeful conversation going on around the book, and around changes that, this industry can make to really help people. And so, I hope that that is another piece of impact that occurs, is…
Shoshana Walter: Just, treatment facilities, looking for ways to improve.
Shoshana Walter: The programs that they have, and also perhaps putting a little more pressure on insurance companies to change how treatment is incentivized.
Jessica Dueñas: Yeah, absolutely. When you speak about the insurance companies, I also always remember, having to turn in attendance sheets in order… there was one program that I was in that I had to turn in attendance sheets for attending 12-step program meetings in person, and that was the only way that, like, insurance was going to continue my… this was an outpatient program that I was approved for. But if I didn’t go, like, let’s say if I would have been like.
Shoshana Walter: to explore another community, that was not going to be an option, and so I would have been so limited in what I could have done at that time. Wow.
Jessica Dueñas: Yeah.
Shoshana Walter: That’s… yeah, that’s it in a nutshell, right, Jessica? Like, maybe that wasn’t the right community for you, and it sounds like that’s not where you found the most support, right? And so…
Shoshana Walter: that really limited your options. I mean, I’m sure it would have been helpful to maybe try out a different group at that time.
Jessica Dueñas: Yeah, absolutely, absolutely. Oh, well, I mean, Shoshana, I want to thank you so much for joining me today, and again, just so much for this powerful work that you’re doing. Again, I… having witnessed it myself, there are definitely…
Jessica Dueñas: many, many areas of growth in the treatment system that exists today, and I’m just so grateful that people like you are shining the light on this, for sure. Now, can you tell us more about how people can find you, how people can find your book, when it is out, if it’s not out already, all those great details?
Shoshana Walter: Yeah, yes. I have a website, ShoshanaWalter.com, where you can find all…
Shoshana Walter: different ways to contact me, but I’m also on Instagram at Walt Show, S-H-O, and LinkedIn, under my name, Shoshana Walter, and Facebook.
Shoshana Walter: And yes, the book is out now, it’s called Rehab, an American Scandal. You can find it wherever you buy your books, AmazonBookshop.org, or your local bookseller. And thank you so much for having me, Jessica. I really appreciate it. It’s such a pleasure.
Jessica Dueñas: Yes, thank you, thank you so much.
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