The Hidden Scandal in America’s Rehab System with Shoshana Walter

In this eye-opening episode of The Confident Sober Women podcast, host Shelby John sits down with award-winning investigative journalist Shoshana Walter, author of Rehab: An American Scandal. Together, they uncover the shocking realities of America’s addiction treatment industry—where compassion and healing sometimes collide with corruption, exploitation, and profit.

Shoshana shares the powerful stories behind her groundbreaking reporting for The Marshall Project and Reveal, which exposed how some court-ordered rehab programs forced people struggling with addiction into unpaid labor—working in factories, warehouses, and even processing plants under the guise of “treatment.” Her work sheds light on the systemic failures in the U.S. recovery landscape and the human cost of unregulated programs that prey on the most vulnerable.

Shelby and Shoshana explore:

• How the opioid epidemic reshaped America’s rehab industry—and where it went wrong
• The dark history of “tough love” recovery programs rooted in Synanon and behavioral modification
• Why unregulated and for-profit treatment centers continue to thrive today
• The legal and ethical gray zones surrounding work-based rehab programs
• The critical role of “recovery capital”—the internal and external supports that make lasting sobriety possible
• The devastating gap in treatment options for mothers and families, and what real reform could look like

This conversation is a must-listen for anyone in recovery, professionals in the mental health and addiction fields, and families seeking treatment for a loved one. It’s a raw, informed, and deeply compassionate discussion about what’s broken—and what hope still exists for creating an addiction recovery system that truly heals.

📘 Learn more about Shoshana Walter and her book on her website https://www.shoshanawalter.com/

🌿 Want to take control of your anxiety and build emotional resilience in recovery?
Download Shelby’s free guide, Is Neurofeedback Right for You? at www.shelbyjohn.com
Discover how remote neurofeedback can help you regulate your emotions, sleep better, and feel confident in your sober l

Chapters

• 0:00 Welcome And Episode Setup
• 0:24 Introducing Shoshana And The Book
• 5:36 The Work-Based Rehab Scandal Uncovered
• 12:09 From Synanon To Modern Rehab Practices
• 20:45 What’s Legal Work And What’s Exploitation
• 28:10 Vetting Programs And Red Flags
• 32:36 Recovery Capital And Unequal Access
• 38:00 Mothers, Childcare, And Missing Services
• 45:54 Thirty-Day Models And Oversight Gaps

Transcript

SPEAKER_00: 0:00

Well, hey there, sober ladies. Thank you so much for joining me for the Confident Sober Women podcast. Today I had uh an incredible conversation with my new friend Shoshana. She is the author of a book that I think is going to shock you and anybody who expose this to. It is called Rehab and American Scandal. And she basically did a deep dive into some very specific types of recovery programs that were that are in existence in our country today that are doing some really um unethical, illegal behaviors that are really exploiting the nature of um people's illness of addiction. And it's it's really astounding what she uncovered in her work. And uh we had a really lovely conversation about all of that and um some of the people that she featured in her book and really highlighting the gaps to treatment in for recovery for addiction in our in our country and and kind of where we as individuals might be able to insert ourselves in that. Like, how can we be a force for good? How can we be part of the solution and not a part of the problem? And and oftentimes, you know, being part of the solution just means becoming more knowledgeable, it means it means educating yourself so that you can then spread the message with others. And that's very powerful too. So it doesn't have to look like you know, writing big checks or reading all of the books or things like that. But um, I do think you should read her book. So I am gonna hop off and let you enjoy our conversation and get her new book called Rehab and American Scandal. And grab your big glass of water or your favorite mock tail and enjoy my conversation with Shoshana Walter. Hello and welcome to the Confident Sober Women Podcast. I'm your guide, Shelby John. I'm the mother of three, wife to one, and sober since July 1st, 2002. As sober women, we have something huge in common. And when we share our lives and our stories with each other, we feel that sense of belonging and connection, so we know we are no longer alone. In this podcast, you will hear real life talk about building confidence and transforming your life beyond recovery. So come on, let's talk. Well, hey there, Shoshana. Thank you so much for joining me today for the Confident Sober Women podcast. I'm so excited to dig into your content. I know this is a little non-traditional, everybody, so just kind of hang in there and enjoy the ride. I have no idea where we're going to go, but I do know it's gonna be really interesting. So I'm gonna kind of kick the mic over to you and let you share a little bit more about kind of your story with this particular topic of addictions, um, treatment, and how things are done in our our country and what what you've discovered. Shada, yeah.

SPEAKER_01: 3:29

Yeah, um, well, thanks so much for having me. Um my name's Shoshada Walter. I'm the author of a recently released book called Rehab, an American Scandal. Um I'm also a longtime investigative reporter, um, mainly focused on the criminal justice and child welfare systems. I'm currently an investigative reporter at the Marshall Project. And um, my book is basically a narrative, nonfiction expose of our addiction treatment system and the ways that it changed over the course of the opioid epidemic, expanded, became more accessible to a lot of people. And also the ways that it's not meeting the needs of people who are mired in addiction in the United States. There's a lot of ways that our treatment system is not providing the opportunity that a lot of people really need in order to sustain, enter and sustain long-term recovery. So my book really focuses on those different aspects. I cover the lives of four different people, each interacting with different aspects of the system. Um, two people struggling with opioid addiction who went through the treatment system and came out the other side. Um, an addiction medicine doctor who tried to offer treatment to patients and then ended up getting arrested and raided by the DEA. Um, and also a treatment advocate, a grandmother from Los Angeles, who decided to root out corruption in the for-profit treatment industry after her own son died of an overdose years ago. Um, and uh that really focuses on the lack of regulation for treatment programs in the United States. So there's definitely a lot of different aspects that I cover in this book. Um, and as for me, I, you know, I don't have a personal experience with addiction. Of course, like any person in the United States, I have family and friends who have struggled with addiction. Um, but I I basically came to this through my many years of covering the criminal justice system. Um about eight years ago, I was an investigative reporter at Reveal from the Center for Investigative Reporting and working on some stories related to drug courts and diversion courts, and just stumbled across this treatment program in Oklahoma and Arkansas that was sending people to work at for-profit chicken processing plants. And uh, when I started doing a little bit of digging with my reporting partner on that story, I learned that it had been founded by a former poultry industry executive and that people getting sent there for rehab were instead working without pay, making chicken products for KFC and Popeyes and Walmart and Petsmart and Rachel Ray New Trish, and they weren't getting paid anything. Um the jobs were dangerous, frequently leading to injury, and if someone was injured and didn't get adequate medical care, they were often sent back to the court that they came from, where they ended up, you know, getting violated and sent to prison and jail oftentimes. So this is my first foray into addiction treatment. I had kind of just assumed that our treatment system was there to help people. And um I realized that it's actually very easy in this country to exploit this population of patients for profit. And um and so that story really made me want to understand how common that is. And, you know, if indentured servit servitude could be considered addiction treatment in this day and age, then what does the rest of our treatment landscape look like? And and is it really helping people the way that it that it should?

SPEAKER_00: 7:26

Hey, it's me, Shelby. Have you ever wondered what's really happening in your brain during recovery? Are you ready to take control of your anxiety, sleep better, and finally feel focused and confident? I want to introduce you to a game changer that's transforming women's recovery. Remote neurofeedback therapy. I want you to think of this as a personal trainer for your brain. It's helping you build new neuropathways right from the comfort of your own home. So if you're dealing with anxiety that just won't quit, if you have ADHD that's making life chaotic, or sleep issues that leave you exhausted, neurofeedback could be your missing piece. It's science-backed brain training that works with your natural healing process, helping you regulate emotions and build lasting confidence. The best part is you don't need to add another appointment to your busy schedule. My remote neurofeedback program brings professional guidance and support right to your living room. Do you want to learn more about neurofeedback therapy? You can go to my website www.shelbyjohn.com to download my free guide. Is neurofeedback right for you? Together, we'll create the calm, confident future you that you deserve. That's www.shelbyjohn.com. Take the first step towards training your brain for lasting change. Thank you so much for sharing that how you kind of got here. I think that's really important for us to all understand. And um, like I mentioned already to all of our listeners, this is a little non-traditional, but I do think it's obviously um heavy-hitting in our population. And it's actually something myself as a mental health provider, I've been in recovery for uh a couple decades now, and you know, I've been around the bend. Um, I'm not heavily involved with the treatment facility aspect of, although I do have relationships with some of our local providers. Um, so I don't have a lot of understanding about what you what you've done. However, I do think in the last couple years, there's been some rumblings. Um, and probably much like you, people are starting to uncover. I I can't remember where I first heard about this. It was a maybe at a conference or on a podcast with somebody else who was kind of uncovering not the indentured servant part, but just some of the other issues related to our addiction treatment, um, like inpatient treatment facilities. And that was the first time I had really heard about it. And so if I, and I'm in the industry, I know that most people probably are really not aware, and as somebody who also does promote these types of facilities to my clients, to people in the community, um, not without some vetting, I would have to say, but um it is a concern. So I'm really curious to dig in a little bit more. And one thing, other question I had is the other thing that kind of came up um a lot maybe in the last four or five years, maybe more to me, is um kind of the wilderness programs. Um and I think that's probably just from the birth of TikTok and social media, people being um out about things. And so I'm wondering if this is a very similar kind of concept to that, if it's related.

SPEAKER_01: 10:52

Yeah, I mean, um the wilderness programs you're probably thinking of um like troubled teen programs, and I think Paris Hilton has really done quite an amazing job getting that conversation out there and in the public consciousness. And um I didn't do a lot of I didn't do a lot of reporting on wilderness programs, but I think that the these troubled teen programs actually have their origins in um a program that I that I do detail the history of in my book um called Cinnanon. Um I don't know if you're familiar with the story of Cinnanon. Um it's kind of like the precursor program to rehab of today in the US. It was founded in 1958 by a former oil salesman named Chuck Diedrick, um, who had struggled with alcoholism. And he f had tried AA and he hated it. He hated the 12-step program, the 12-step groups. He felt like people could go into those meetings and lie about their sobriety, have relapses, slip-ups, and no one would ever know. And he wanted a group, a community where people could confront each other and call each other out. Kind of like a tougher love, a tough love kind of approach. And so he started this small little community on the beach in Santa Monica and ended up growing nationwide. Um, it's a a ton of programs split off from it. Um, copycat programs proliferated. Um, and there were a lot of practices in Cynadon that were replicated by Trouble Teen programs and a lot of other rehabs in the United States, still to this present day. And those include um uh groups called the game, where people would take turns, turns screaming at each other and kind of calling out each other's flaws and um and slip-ups and and problem behaviors. Um there's there's lots of practices that um are still utilized today, like pull-ups, where people have to um essentially tattletale on each other a certain number of times each week. Um and um the way Cynadon operated was mostly without any government funding. The program funded itself by having participants work and all of their work, the compensation from the that they would have received from their work went back into the program. Um it has a very lengthy history and kind of assorted ending because eventually Cynon morphed from this recovery community where people came and kind of transformed themselves into a cult-like group where the founder enriched himself, kind of operated like it was his own fiefdom, um, started ordering people to shave their heads, ordering phasectomies, um, separating children from their parents. Um all these rules. He created a mercenary army that attempted assassinations of critics, including a civil rights attorney who had been suing the program on behalf of people who had been abused in it. Um two of the members of this mercenary group hit a rattlesnake in this lawyer's mailbox and it bit him, and he he ended up surviving that attack but dying of complications just a few years ago. Um and, you know, eventually this nonprofit, what started as a nonprofit recovery group um community ended up getting shut down by the IRS um over various issues, and um and it is no more. But a lot of those practices continue, including the unpaid labor, um, a lot of these behavioral modification techniques. Um and uh and it's very much still with us in the form of these troubled teen programs and a lot of other rehab programs, including one of the rehabs, rehab programs that I cover in my book called the Senecor Foundation.

SPEAKER_00: 15:26

Wow. Um what I was thinking while you were talking, and maybe correct me if I'm wrong, and I'm sure it's from your point of view now, it might be difficult to even see this, but I kind of was feeling like, you know, this is a great example or an example of how something can be starting out for good. You know, for good, like right, this man was having his own struggle. He was dealing with alcoholism, he wanted to serve, you know, he obviously must have gone through some 12-step work. He he got sober, he managed to put together time, and then he wanted to serve others who had the same problem. So his mission was good, right? Yeah.

SPEAKER_01: 16:02

Yes. I I mean, I would think so. I mean, you never know what someone's true intentions might be, but I mean, I think it sounds like a very worthy it interest and intent. Yeah.

SPEAKER_00: 16:15

And then I guess it's just hard to see like, yeah, and I know this is another topic, and I don't really necessarily want us to go down this path, but it you like we start out that good, and he's trying to come up with things that you know he thinks will work, and and and it's and it starts out in a in a positive way, right? And then and then something happens. And I feel like this is just the bane of the existence of many organizations, right? Something happens. There's like a switch that flips, whether it's you know, greed or power or I'm not even sure what, that starts to send somebody down another path. And wow, that is so disturbing because because again, like what started out as something good and a mission that was probably very positive and powerful and helpful to others got down into this horrific kind of way that ended up becoming very harmful. So it's just so sad how that can happen and relatively quickly. So kind of curious, like you when we were talking in the beginning, and I'd love for you to share a little bit more about how you kind of got here. Like, how did your earlier work lead you to this? You mentioned criminal justice, child welfare, drug courts. So tell me some of the specific things that really got you your mind going and wanting to like explore this.

SPEAKER_01: 17:28

Yeah, I mean, well, just learning that unpaid labor for for-profit companies could be considered treatment by court officials and prosecutors and people you who you would think would know better just made me want to understand what is going on. I mean, really, you know, over the course of the opioid epidemic, I feel like our country has really undergone this shift. You know, a lot more people have come together around this notion of a desiction of addiction as a disease that's worthy of compassion and medical care and treatment. And so I had just assumed that that was how um treatment programs would approach uh recovery and addiction treatment. And so I was just totally plummoxed and thrown by discovering this program. And um, when I was at Reveal, we continued that reporting and ended up finding similar programs all across the United States operating very similarly. Um, you know, um, there was a program sending people to work at nursing homes and at the zoo, at um uh William Sonoma and Walmart warehouses. And then um we ended up doing this podcast series at reveal called American Rehab multi-part series, where we really dove deep into the origins of this model and and how widespread it is. And we ultimately found that at least 60,000 people, um, which is a massive undercount, go through this type of program every year in the US. And you know, I just um and and the and the reason why people are going into these programs is because they are meeting an unfilled need. You know, these programs tend to be longer term. Um, people live there, they they work there, they have food there. So these programs offer um what you might think of as long-term stability, and that is something that a lot of treatment programs are not necessarily providing right now, especially insurance-funded programs, they tend to be shorter term. So these programs were filling a need uh among people who lack insurance coverage or lack the stability in their lives to reliably have a place to call home or or a roof over their head or food to eat. Um and I think a lot of courts are relying on these programs because um they don't cost the government any money, you know, they they're basically self-funded through this uncompensated labor. Um, what I found again and again is that these programs were often taking that to an extreme. Um, and it's not necessarily uh legal under, you know, US labor laws. Um, but you know, courts could send people to these programs and not have to worry about spending money to to provide treatment to them. So I think that's w how we've gotten to this place with these types of programs. Um and in the book, um, I f while working on this podcast, I met a young man in Louisiana named Chris Kuhn. Um, and uh, you know, he had gone to a program in Baton Rouge who um that sent him to work at unpaid jobs up to 80 hours per week. His compensation was a pack of cigarettes per week. Um, and he had a traumatic experience. And when I first met him, you know, he um hadn't recently left that facility. He was still um going through this emotional experience from recovering from that. Um, but he really wanted this story told, and so he allowed us to meet him outside the welding school where he was attending at the time, and he came out on his lunch break with the died Dr. Pepper from the vending machine and got into the backseat of the car and we talked for a half hour, and then over time, you know, I got to know him really well. I um met his family, I interviewed his his parents who had tried very desperately to get him better for many years, and um and told his story. The story, his story um is in the book, and it's um, you know, uh it's not just a story about this treatment program that was mistreating him and so many others that went through it, but it's a story about what it takes to really recover in the United States. And um, I think uh that was one goal with my book, Rehab an American Scandal, was to show what our treatment system is missing and how people are able to gain recovery.

SPEAKER_00: 22:21

So um wow, I have so many questions, but I don't want to I really want to stay on track because we're I know I apologize throwing a lot at you. Yeah, I do have so many things to ask. So um when you just that last part that you said. So when you um did do do this research, um, because because what's going through my mind too is that so I'm hearing what you're saying, I'm hearing what you're saying about these are kind of specific privately funded programs that don't take insurance. Um, and so it's appealing for the court system, it's appealing to the pro to the patient or the client because they're long-term, which long-term recovery, long-term treatment in our country is not available. It's inaccessible and doesn't exist. It's very, very sad. It's a huge gap. Um, and so that's appealing because you're like, oh, suddenly, you know, parents, um, people would be like, wow, we this is what you need, six to 12 months of like immersed immersion, right? But so so I don't want to get too down this track because and I'm not an attorney, I don't, I don't know, but like the legality part of it you mentioned, because that's how you're talking. I'm thinking, okay, well, you know, well, how did they work around this? So because, you know, if they're basically working to maybe pay for their treatment, right? To pay, they're working to pay for their housing, you know, their food. And so they are being compensated. Let's not like minimize that. It's just that it's not in a traditional way, right?

SPEAKER_01: 23:49

Yeah, I mean, what I learned from reading all the case law, from interviewing Department of Labor officials from over the years and looking at um previous labor department investigations is that um housing, food, that could be considered compensation, but any money made beyond that belongs to the patient. And so what I saw with the program that Chris attended, I was able to get internal financial records from the company, from sources within the company, I should say. And what I could see from those numbers is that these patients were working far more than they needed to and actually in order to actually cover the cost of their stay. I mean, Chris was working up to 80 hours per week, um, making thousands of dollars that all went back to this treatment facility. And, you know, when he entered the program, uh this is where it's I have such sympathy for parents and people looking for treatment because when he entered the program, he was told, you know, you'd you'd live and work here for two years. You'd be able to save money for after you leave the program, which sounds absolutely wonderful because that is so often what people are lacking when they're needed recovery. But he was not able to save, he was there for 18 months. He was none of the money went to him. It all went back to the treatment program. And, you know, he was supposed to receive counseling, medical care. You know, he rarely received counseling. I spoke with this counselor and many other counselors in this program. They were so overworked. Um, you know, she would she told me that she would stick her head into his bedroom at the end of a long day of work, ask him how he was doing, he'd say fine, and then she'd mark that off as a counseling session. So this was an ongoing issue at this program for years that you know regulators had even received complaints about, and yet the practices continued. Right. Although after our podcast series came out, American Rehab, Senecor did decide to end their work program.

SPEAKER_00: 26:07

Okay. So it's not the the so the program philosophy and structure, even isn't the problem. Like that, that's okay. That's like a legal way to provide long-term care for people, but it was the overworking, the taking of the money that that was above and beyond their care to fund, I guess, the executives or whoever, um, and then not following through, obviously, with promised things like saving the money and things like that. So is that correct?

SPEAKER_01: 26:39

Yeah, it can be considered legal for patients to work in a program and receive compensation in the form of housing or food, but it needs to be done with their consent, and it can only be um the the actual amount of those services. You know, it's a little bit like um someone performing labor on a farm or ranch and receiving housing in a trailer. You know, that's a form of their that's a piece of their compensation, but it's not all of it. And that that's at least what I learned from reading all of the case law from speaking with labor department officials. That is what is legally allowed under the law.

SPEAKER_00: 27:27

And that that makes total sense, you know, and I think this is really helpful for people who are listening who might be in this situation, like literally right now, might be in like investigating themselves, like where can we send our loved one? You know, and so when they're coming across things and like trying to vet them, right? Try to be, and you're dealing with a very emotional situation, often people who have been through the ringer, you know, um, it's not their first rodeo. Um, so we want to make sure that we are clear that like if something comes up like that, it's not necessarily bad, but you do need to look into a little bit deeper. I mean, even when you were sharing, it's almost like the the program kind of AmeriCorps kind of came to my mind, or things like that, where you're not really, you're working, you're doing stuff, but you definitely are not earning, you know, a big living. You're getting a small stipend, probably, and then most of your expenses are covered. So it's kind of like that. Like that's how the legality of it can work. Um, but this above and beyond and not getting the services that you were told you were gonna get is definitely not okay.

SPEAKER_01: 28:25

Um yeah, I think that's that's something that people should keep in mind when they're vetting a program.

SPEAKER_02: 28:31

Yeah.

SPEAKER_01: 28:32

How many hours are they working? If they're, you know, if they're being compensated for their work, how what form does that take? How does that money get to them? Um, what other services are they offering? And, you know, I think the difficulty with Chris and this program is that it also relied on this Cynon model of behavioral modification. Um, and really part of that model entails breaking people down until um until they um completely surrender to build them back up. And I think for Chris and many other people that I talked to for this reporting, um that had the effect of stripping away all of their self-worth. Um and then they were in a situation where they were being exploited and utterly powerless. And so um I think that it's it's really important that when people are vetting treatment programs, they understand that there are these these risks involved, and patients are very vulnerable to this kind of exploitation.

SPEAKER_00: 29:45

And frankly, I think this goes without saying, too, that it this is for any kind of treatment facility that you're gonna invest in. I mean, even there are behavior, um there are um mental health facilities that are uh just focused on mental health. In patient facilities and some of even those teen ones we were talking about, different things that aren't substance abuse related. So, any kind of investment you're making in treatment, you really do need to do your due diligence, you need to get referrals, you need to ask around, dig, dig into it to make sure that you know you're getting what they say you're getting, and that the treatment is proper and humane and compassionate, like you mentioned. So, are these have you been able to, I mean, what has happened, you know, to many have they shut down as a result of your podcast and book, or are what is happening with these things?

SPEAKER_01: 30:39

I would say these types of programs continue to exist because as I said before, they're filling this need for long-term care. Um Chris, um, I will say, you know, he left Senecor. He was badly injured in the program and didn't receive adequate medical care. And he ended up leaving the program early. He had been court ordered there, he assumed he would be sentenced to prison. Instead, he got probation. And one aspect of the book that I um that I uh that I cover is the racial disparities that exist in our criminal justice and treatment systems. And so Chris luckily was sentenced to probation. And then he went home and he came from a middle class family who luckily was able to take him in. Um when Chris felt like he was starting to slip, they helped him pay for Suboxone, which at that time was hard for Chris to find um and to to get covered by insurance. And he started going to school, he started kind of getting his life back together, and um, and he was successful. You know, Chris has now been substance free for many years. He's living in Texas and is married um with two stepchildren. Um that's wonderful. But one of the Yeah, it is it's wonderful. I and I I'll say that one aspect of my book um that I think is really important for people who are looking to get into recovery and really important for treatment practitioners is this concept of recovery capital, um, which is the mixture of internal and external resources that people need in order to enter and sustain recovery. And that can include um social support and community, but it also includes housing, transportation, financial security, food, um uh uh a job, um, all of these aspects and of life, these these um basics that are actually very difficult for people to access when they're early on in the recovery or just trying to come out of their addiction. I mean, the longer that someone is in their addiction in the US, the more marginalized they become, the harder it is to access recovery capital. And what studies show is that the more recovery capital you have, the greater your uh your chance of success at recovery. And so Chris had that recovery capital coming out of Senecor. He came out of Senecore and he didn't have nothing, he had some aspects of recovery capital that really aided him in the long-term recovery process. But there's another person in my book, April Lee, who grew up in poverty. She's a black mama three from Philadelphia who grew up with a mom who was addicted to crack cocaine. And what her story shows is that access to recovery capital in the United States is very unequal. And so when April was just starting her recovery journey, it was much more difficult for her to access that recovery gap capital and gain that stability that she needed in order to stay in long-term recovery.

SPEAKER_00: 33:59

That's so interesting. I like that term recovery capital. Um, but some of the things you mentioned, I mean, things like family, um, you know, resources like money, um, education, uh, community, um, and then on and on and on, access to things. Um, yes, I mean, I feel like the disparities for sure in our society are just that they are there um in every I think amongst just those things, um, there there are disparities and and and very likely that that will always be the case, right? Because there will always be some that have more, some that have less, some that, you know, live that just don't have the same opportunities. And so um it's not this is not unique to recovery, I guess is my point. Um it's just, you know, you worked a lot with the justice system too. We see this, you know, and it doesn't mean that it's an excuse for anybody to commit crimes. Like when you break the law, like that there are consequences for that. However, um, sometimes people are in situations that are different because and make choices because they don't have that kind of capital, which we're aware of. And so it's kind of challenging because it's not like people, it's not like the country really can do a ton to like create um recovery capital for somebody like April Lee, right? If she doesn't have a stable family environment, if she doesn't have um people in her community that are healthy, that are supportive, that are mentally well, I it's kind of like what are what a what a what are we to do, you know, with that.

SPEAKER_01: 35:40

Yeah, well, I I think that when I think about April Lee, you know, when she was struggling with addiction, which started really with childhood trauma, um and it was exacerbated by sexual assault. She had three kids, she was the sole caregiver for them, the sole support financial support for them. And there was no place for her to go to get treatment. Um, this is one of the findings from my book that low-income mothers have the hardest time, still to this day, accessing treatment out of any group in the United States. And this is a problem we've known about for decades. Um about 70% of women struggling with addiction have children. We know that treatment programs that allow them to bring their children with them have better outcomes for the entire family. Um, during the crack cocaine epidemic, this was enough of a concern that lawmakers actually uh issued guidelines to states to set aside a certain percentage of funds specifically for treatment for women. Um, but over the course of the opioid epidemic, I found that the number of such programs that cater to mothers have actually drastically declined. Um there's now only about 3% of facilities nationwide that allow women to bring their children, and less than 5% that provide child care. So when I think about recovery capital for a mother, a single mother like April, that includes child care. That includes um being able to attend treatment and and care for her own mental health problems without having to abandon her children. Um and because these programs which exist in the United States, there are some programs that in this country that are doing amazing work for mothers, but they're in they're the a a very teeny slim minority. And so what is now happening in the United States is that mothers are being separated from their children, um, they're being incarcerated, um, or they're overdosing and dying. You know, we've started to see overdose deaths take down nationwide, but over the past few years, overdose deaths around among mothers have been skyrocketing. So there, you know there are definitely things that are being done that could be done to provide people with more of a chance at recovery, uh, and in a way that doesn't lead to lifelong trauma in uh for both the mothers and their children who are taken out of their home.

SPEAKER_00: 38:30

Sure. Yeah, and those are some really big system issues, some of which we talked a little bit about before we started the interview. And, you know, it's that's way above my pay grade, right? But you know, these are big system issues involving insurance companies, involving public policy, involving just access to, you know, just funding for these kinds of organizations. And, you know, that's what's a what a great opportunity for us to be advocates for those things, you know, in whatever way we can find find ways to do that. You know, I've I have some connections with organizations like Shatterproof. I love them, they're so great, and they're doing a lot of this sort of advocacy work and um and educational work for families and patients and communities and workplace. You know, I have another friend I've interviewed here too. She's she's um her whole business is basically creating um work. I don't know how she describes it. Basically, she goes into companies to help educate them on addiction and how to talk to their employees about um addiction and what resources we have as a company. Like you work for my company, you have an addiction problem, here's what we can offer you. So there are people that are spearheading in this way. Um, and we have to just keep at it. You know, we have to keep the messages flowing, right? About the disparities that we have in this country that can be addressed from a variety of resources, right? Some of it will be nonprofit, some of it will be the public sector. Um, some of it'll just be maybe your local community or church environments, your, you know, your family systems that are in your little town, you know. Um, so we have to kind of, I think as a communities, we can kind of band together to look for those opportunities, how we can be supportive, whether it's financially or just volunteering time or you know, resources, things like that. Um, that's a wonderful thing. Yeah, yeah. I'm curious if you do any work around any um of the other facilities, like the ones that are more like 30-day or like the kind of typical ones that we know. When we hear rehab, I think we generally think that, you know, the ones that I was referring to earlier. You know, did you look at any of those? Because in my experience personally and like professionally as well, that they are doing, they're not doing any of those things. Um, I'm not saying that they're perfect, you know, for sure that there's definitely some room, you know, for some improvement. But I'm curious what you found.

SPEAKER_01: 40:54

Yeah, I mean, what I found with 30-day programs, especially, is that um oftentimes um, and and in particular I looked in Southern California, which has become kind of like a rehab capital of the United States. Um and uh what I found is that the programs are often so short term that and lack ongoing support. So once people leave, um relapse is often very likely. Um and we actually know from studies now that someone who completes a 30-day treatment program is much more likely to overdose and die in the year following treatment than someone who fails to complete a treatment, a 30-day treatment program. So I think that there is a real issue with insurance companies not providing funding for longer-term support. And um and that unfortunately is putting a lot of people at risk. Um, one of the people that I follow in my book, Wendy McIntyre, I mentioned her earlier, she's a grandmother from Los Angeles who became an advocate for better oversight of treatment. You know, she um there was one program in her own backyard in the mountains of San Bernardino that um was over medicating patients to the point of impairment. And um, and I found uh several patients who died in this program after receiving really strong cocktails of detox meds that were not appropriate for the substance issues that they were having, um, that records showed were not even prescribed to them by a doctor. And um, you know, what what I found, what Wendy showed me through her investigations, is that these are the types of programs that really proliferated in the aftermath of the Affordable Care Act. And it's um an amazing thing that people have far more access to treatment than they ever did before. But these types of programs also um are have totally overwhelmed regulators. And um, today in Southern California, where the majority of treatment programs are located in the state, um, there's only five investigators tasked with responding to complaints. Um, it can take months, sometimes years to resolve a complaint, even involving a death of a patient. So the oversight of these facilities, and I'm not saying that every 30-day treatment program is is there are plenty of wonderful, well-intentioned programs, but the oversight of these facilities is just not there. And insurance companies are not covering the length of treatment that many people need in order to really benefit from that treatment. And so, you know, I I interviewed one treatment company owner who referred to it as a cycler. You know, the the patient comes in, they stay for 30 days, they leave, they relapse, and then they come back in. And unfortunately, I think that has become a part of the business model for treatment. You know, this this program in the San Bernardino Mountains, their aftercare program involved calling former patients, finding out if they relapsed, and then bringing them back into care if they had. What does this patient need that they're not getting in our program?

SPEAKER_00: 44:28

I totally agree with that. And I think that is actually where I started to get some information around people becoming alarmed with the treatment facilities and well, the treatment model in our country. And again, I don't have all the answers. I mean, I have I have the pipe dream answers. I'm great at the strategic planning and the vision, but as far as like actually how that would practically work out in our country, I, you know, that's above my pay grade or ability, but I'm sure we could definitely be doing a better job because one of the things that has come up lately is that it's a revolving door. You know, the statistics that I I heard maybe 10 years ago, even were that it takes opiate addiction, opiate addicts seven to ten times to try, you know, and that's a that's a lot. I mean, these facilities are 30,000 plus a month, you know, maybe so like that's a lot of money flowing through this. And I'm and I'm for it. I'm for treatment, I'm for advocating for what people need, but there's a definitely a missing link. And I totally believe, agree with you that it's the aftercare piece. I go to a um, I'm a part of the mental health and addictions like task force here in my little local community. I live in Maryland, and we meet every other month and we talk about um, you know, gaps, and there's all kinds of people in the room, stakeholders of all kinds, government, private people, police, lawyers, all kinds of people. And we've been brainstorming. I've been, I think I've been a part of for several years now, and it's been very interesting, but that's literally the thing I write on the paper all the time: long-term treatment, long-term treatment. We need long-term treatment because you cannot expect people, uh anybody, whether it's opiate addicts, alcohol, drug as a drug, to leave after 28 days. And even if you tell them all the things and you connect them with even if they had a stacked recovery capital bank. Right. They're not all gonna absolutely they're not gonna do it. The recidivism rate in addiction has just always been high. It's always been so the lack of support for aftercare is a huge gap. And again, I don't have all the answers for that, but I wish we could spend more time on just figuring that out. And also things like, you know, in my community, we have no public transportation here. You know, we have a very big housing problem. We don't even have a shelter right in my county. Totally. I mean, so like, so like there's just a lot of barriers and and and um it sucks, you know, that's just the only way to say it. It just really sucks for the people who have to deal with that um because there just aren't the resources here. I mean, I worked in child welfare in the beginning of my career for 10 years, and like all of our kids in Harvard County had to go elsewhere to Baltimore City, to Frederick, to uh down on the Eastern Shore because there were no group homes, you know, and I'm not I'm not saying we need group homes everywhere, but I'm just saying we didn't have a lot of placement options for a lot of our kids. So I spent my time going around the state visiting these kids because we're required to see them once a month, all over the place, sometimes three hours away, because you know, like they're just you know, there wasn't a placement for them. And so yeah, you know, even in the best of the circumstances, even if you had all the recovery capital in the world, there's just some barriers in some communities, you know, that are just going to be a thing. So I think what we can do to reduce that in whatever way, personally or professionally, just educating people like your podcast and just bringing this to light, you know. And again, you know, I'm not here to say like rehabs are bad. I mentioned that in the beginning. Like, I don't, you know, I think it's I think actually I think rehab is great in a lot of ways, the right ones for removing you from your environment, for making you focus on yourself, for getting some very intense therapy and education on what addiction is, what it isn't, bringing in the family for a family program. There's a lot of value in 28 day programs. I'm a believer. Um, but I also think that um the revolving door model, even the metal, the medical maintenance model, these things are harmful to people. Like they were designed for being short-term fixes to help people in the beginning, in the crisis, and they've become long-term pipelines for drug companies to make billions of dollars off of some of our most vulnerable people. And it's really sad. It makes my heart hurt every day when I think about that. I that's why I can't get behind some of that. And I understand some people are really saved by it, but it's not being used properly. And I don't think most Americans understand that. They don't understand who's really benefiting from that, who's really benefiting from keeping your personal and suboxone for life. There's no act, there's no plan. I said to one of my clients one time, hey, when you go, like and they talk to you about like um, you know, what's next or how to get you out, and they're like, Oh, yeah, no, they don't, they never talk about that. And I'm like, what? What? Like, this isn't supposed to be a forever drug. It's just supposed to be a let's help you get through the crisis drug. That's how it was originally designed. Um, yeah, and it's taken on as well.

SPEAKER_01: 49:17

I I know there are some people who benefit from short-term placement on Suboxone. Absolutely. But there are a lot of people who benefit from long-term maintenance on Suboxone, and Chris Kuhn is one of them. I mean, he is doing incredibly well today, and he remains on Suboxone and he knows he needs it. I mean, I think what it comes down to is what does the individual person need in order to sustain their long-term recovery? Some people might need that medication and other people don't.

SPEAKER_00: 49:48

Well, I think what we all need is a layered approach. You know, we need a layered approach. We need we need some really good recovery work. We might need 12-step, we might need books, we might need spiritual programs, we might need rehab, we might need community, we might need therapy, we need all like complimentary, we might need some acupuncture, you know, maybe you need some supplements, you need nutrition education. Like we need a layered approach to healing, whether it's a mental health problem only or it's a dual diagnosis with mental health and substance abuse, which we know substance abuse is a mental health problem, we don't need to separate the two. Um, and what we need most in all of that is compassion. We need compassion where we look people in the eye, we use their names, we call them by their name, we say we love you. Unfortunately, you can't like scream at me or kick or bite or hit me. Yes, of course, those behaviors aren't appropriate, but we still are gonna work with you and love you through this, and we're gonna have boundaries and help you. But uh there's definitely some places in the in society where that's just lacking. So your work is so powerful and important. I'm so thankful that we got connected. I feel like I want to have another episode with you because there's just like so much more. Um there's a lot to talk about. It's true. We barely scratched the surface. So let's maybe we should schedule that and do another one and follow like a follow-up, just like a part two, like, hey, this is what else you found, and and maybe even some follow-ups from your work. Like I'm sure you are following up too, like on just what's being done, what's what's still the gaps, or where is the good work being done? You know, who's doing the good work? I like to highlight that too.

SPEAKER_01: 51:16

So yeah, absolutely.

SPEAKER_00: 51:18

Where can people find you if they want to reach out?

SPEAKER_01: 51:21

Um, Google Rehab and American Scandal. It's available on Amazon and wherever you buy your books. Um, I also have a website, shoshanawalter.com, um, where you can find me my contact information and all my social media links. But yeah, rehab and American Scandal. My name is a tricky one to spell.

SPEAKER_00: 51:41

So I will link all that in the show notes below. So thank you again so much. And I really loved our time together. So um a fantastic day, and I look forward to our crowds crossing again for two.

SPEAKER_01: 51:53

Absolutely. Nice to meet you. Thanks for having me. You're welcome.

SPEAKER_00: 52:00

Thank you for joining me for this week's episode of Confident Sober Women. If you enjoyed this conversation, hit the subscribe button above so you won't miss any upcoming episodes. And hey, if you really loved it, leave me a review. You can learn more about the Sober Freedom Inner Circle membership at www.shaltejoncoaching.com forward slash inner circle. See you next time.