Addiction, Health Care, and Corruption in Treatment

It is no big secret that there is a lot of corruption that has happened in drug and alcohol treatment. I worked in the nonprofit treatment industry for twelve or thirteen years. I was not really that exposed to the wider trends of what was happening in drug and alcohol treatment and in mental health treatment. But as I founded my own place I started to be exposed more to the treatment industry as a whole. I do not even like the term.

Changes to Health Insurance

One of the things that happened was in 2009, Obama passed the Affordable Care Act. There were a couple of small but really important facts around Obamacare. One was, insurance companies were no longer allowed to exclude for preconditions. Before that, if you had cancer or if you had a history of “fill-in-the-blank”, an insurance company said, “We will not give you health insurance because of this.” They could no longer do that. 

The other was Parity Laws which meant anything that government healthcare decided to cover private insurance, on Parity, had to cover as well. So suddenly every insurance policy had to cover mental health and substance abuse. Prior to that period, most insurance did not really pay for treatment. You were either getting treatment at the community level or you had money or some really great insurance. 

The vast majority of people actually could not even get mental health and substance abuse treatment except at the community level…until Obamacare. And suddenly if you had a PPO plan  from Blue Cross Blue Shield or whoever, you could go to residential treatment. 

And because of the Parity Laws, at least in the beginning, it would cover full treatment. So suddenly, you could be a middle-class person from Ohio and you can get drug and alcohol treatment in Malibu on the beach. Unbelievable. You would not pay attention to it if you were not working in it. 

Enter Corruption, Greed, and Shady Treatment Practices

And it did a few things. Lots of people suddenly had access to treatment. But we live in a capitalistic society…so what happened was suddenly there is a lot of potential money in the system because now you have a couple of hundred million people who have these insurance cards in their wallet that now could be exchanged for money for treatment. 

Wow…that set off a very interesting chain reaction. So you have entrepreneurial-minded, generally narcissistic, people that somehow get this information. Maybe a very narcissistic client goes through treatment and instead of focusing on his recovery, he is counting how much money the treatment program is making. Then he goes to his narcissistic wealthy father and says, ‘I think we should open a treatment program’. At six months sober, an individual opens a treatment program. 

Then shockingly, because he is shady and he does shady marketing practices, it is successful and lots of people are going there even though the treatment is probably not very good. 

Then private equity and venture capitalists think: wow there is a lot of money in this treatment thing and they partner with the narcissistic owners of treatment programs. 

Next thing you know, you have five thousand treatment programs open up in Los Angeles between 2009 and 2020. Is it a surprise that a lot of them are not offering good treatment and are somewhat corrupt? 

For me, it is a very interesting story because I was supportive of Obamacare. If and when you asked me: Would you like people to be able to get insurance whether they had a precondition or not? I say, yes, I would. 

If you said: Would you like drug and alcohol treatment to be covered? I would say, yes that is great, and kind of calculate the full fallout of that kind of choice. 

Incentives Creating Barriers to Recovery: The Sad Truth

On the patient’s side, you have patients who have no money but possess an insurance card. They could live in the kind of house they never could live in without that insurance card, on the beach in Malibu. But they actually had to be pretty close to being loaded to be able to qualify to live in that house in Malibu. 

So you could imagine that there is a handful–and by a handful, I mean hundreds of thousands of people–who have gone in and out of treatment and continually relapse. They return to these residential and outpatient treatment programs. They have no money, they do not work, they just have this insurance card. 

I am sure some of them are doing it consciously–some unconsciously. It really is a story of bad incentives. It is a bad incentive for treatment providers that treat for profit–making money on people’s suffering. 

It is a bad incentive on the relapse end that if a client relapses, insurance pays more. Not for the insurance companies but for the treatment providers. 

And then it is a bad incentive for clients. I could just live in treatment, go to some groups, and do that for a few years. Then I just relapse. I can go back. I do not have to get a job. I do not have to go through the really arduous task of growing, learning, changing, and recovering. I can take an easy way out as long as I have an insurance card.

It is really problematic. It started to change, the government started to crack down and the treatment community. Obviously, it is not all treatment programs, but it is a really important lesson at the policy level that affects everybody in their daily lives, particularly those people seeking recovery and suffering from addiction.

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Mental Health: The Next Global Crisis

A while ago, I was having a conversation with a friend. We were looking at–this was pre-Covid–at the future. What do we think of the big crises that are going to happen? 

He talked about a possible war with China and kind of what we saw down the line for society. 

I said, “You know, I do not think it is any of that. I think that the world is so interconnected that it will not be some kind of us-against-them type of thing…I think it will actually be a global mental health crisis.

Mental Health Issues Are on the Rise 

If you look at the rates of anxiety, depression, and suicide–particularly in the US, but globally, too–they keep rising. 

And I actually do not have to look at the rates. I can watch my own mental health and well-being, as time passes and then go, am I okay? I know the amount of effort, work, and consciousness that it takes for me to feel whole and good every day. And I have support, privilege, and a lot of different things in my life going for me. 

And so there is this kind of huge question, why are people suffering so much with issues around mental health, substance abuse, and at its extreme… suicide? What is going on? 

Is Technology Taking Its Toll on Our Mental Health?

Very simple question. And I think that technology is a big component of it. 

We are probably taking somewhere between twenty to thirty-five percent of our conscious energy absorbed on our phones, computers, and televisions. That is a lot of energy and attention on moving pictures and content consumption. 

All different kinds of colorful information. Manipulated information to keep you on there. 

So there is the whole addiction aspect of technology. There is also the unknown of what it does to the nervous system…but I think we are starting to find out. 

We become addicted to instant gratification. We become addicted to looking at something. We do not know how to just be. We always need to be doing something.

So we create turning to technology as an option to fill in the gaps when we used to just simply be. What kind of energy and attention are we putting on our phones and our computers, etc.? And what is that doing over the long term to our nervous system? We have no idea. 

Smartphones have only existed for like 15 years. Maybe a little less, right? So it means we have no idea what that means but we are getting a taste of it.

So technology is one huge component that everybody focuses on. It is like to me technology is nested in this larger context of the age that we live in.

Is Our Lack of Consciousness Contributing to Mental Health Issues? 

I come from a kind of philosophical background, a historical background. And so I could tell a story about there was a period of time in the West when everybody had religious consciousness. People then were thinking about being a good or bad person. 

I don’t even know if people think about that anymore. Now, we are thinking, “Do I feel good or not,” or whatever we think. 

People used to think about am I good or am I a bad person in relationship to God. In relationship, if you are Christian, to heaven and hell, right? And in relationships as the idea of being saintly or God-like or Jesus-like, right? So for eight hundred years that is the way people walked around constructing their existence. 

It seems kind of foreign to us now, but that was quite recently.

It was up until, I think the 1600s, and then continues to transition. Back then you had the enlightenment come along in the 1600s with modern science. The beginning of nation-states, the idea of the self. Out of that enlightenment came an idea of psychology. 

We started to think about what is happening. Who am I? What is going on in here? It was not so cosmically God, religious focused. It was more about, who am I? 

Descartes said,I think therefore I am. And he opened up this Pandora’s Box about who are we and where we are from and maybe there is no God. And we entered into the secular age, right?

A New Era of “Enlightenment”?

There was a pretty solid religious tradition that we came from. Prior to that, it was more of a tribal and agricultural existence. It was pretty predictable. Each generation, the same as the one before, generally, not a lot of “progress”. 

Then suddenly you have rapid progress, you have the throwing off of religion and then eventually you have the enlightenment. Which says through rationale and reason, if we all can be reasonable, we all could figure out how to create a utopian world.

 It is not about God. It is about reason, universal reason. What is the truth? If we all know what the truth is: scientifically speaking, philosophically speaking, we all agree on it. Then we can all agree and we can have built a utopian society that we all agree upon. Everybody in the world. 

Then the huge backlash…postmodernism comes. What about black people, what about women, what about that? The biggest deal was World War One and World War Two. Wait a minute; I thought we are all reasonable. Suddenly, we just killed a hundred million people in the most reasonable society we ever had. And it started in the most reasonable culture, the German culture, which was the most “advanced” culture of the time. 

But yet that culture, at least in World War II, decided they were going to try to kill twenty million people. And so it just destroyed this dream of building the foundations of society on reason.

Cultural Containers Are Dissolving

So I am telling the stories but it is really to understand that throughout all of human history there has been what I would just call cultural containers. I understand who I am supposed to be based on what my parents pass on to me from the culture, from their parents and from the environment. And that that culture has been rapidly changing and no period has been faster than the last hundred years. 

And so the most basic things that were fundamental of our society like, I am a man you are a woman, we now question. Well, is gender even real you know. What does it mean to be sane? What does it mean to be insane? What does it mean to be good? Who can be president? What are the job qualifications there? I mean the most basic notions have fallen by the wayside or have been questioned and deconstructed and torn apart.

Now, if you are born into the world, you really have no idea exactly how you are supposed to be. You are very distant from ideas of morality and religion. You are very distant from when psychology was a living, breathing, brand new way of being in the world.

Now, it is more of a marketing everyday thing that everybody is doing and so where is the moral authority? Where is the ground of being? Where is the moral authority that exists in society right now?

Technology is Just a Product of Changing Times

So in my mind, technology is actually nested in the fact that everything has changed. And there is so much change so fast that there is no stability. And so everybody, of course, is going to be on their phones because we want to be distracted from the fact that we have no idea what the f— we are doing. 

We had an idea when we knew that we were going to go to heaven. We had an idea when we knew we are trying to build a utopian society, be good American citizens and do good for our country. All of that got wiped away.

What are we doing now? We are posting YouTube videos and trying to make a buck and hope that I can find somebody I care about.

 So I think there is a larger story here about mental health. I tend to be an optimist against my better judgment. Which is to say, I do view this time period as a transition. I do think it is going to get worse before it gets better. But I think it is a transition into something else. I could not possibly say what that something else is but we are living in a very rapid time of transition.

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The Stigma of Addiction: Pros and Cons

One of the things that has been a great concern to the population at large when it comes to addiction–definitely the media, definitely the progressive end–is how we think about the world of addiction and the people going through the suffering involved with addiction. It is this stigma that comes along with the word “addict” or “alcoholic.” 

There are a lot of campaigns I see online like End the Stigma and people talking about their sobriety and what they have been through. Generally, I do not know if I would say I am a fan of that…but I definitely like people to do what they feel is right, whatever makes you feel good about yourself.

What Actually Creates the Stigma of Addiction?

I think that there is a misunderstanding of where the stigma from addiction comes from. 

What I would say is that the stigma from addiction does not come from the word “addict.” The stigma comes from when your brother steals your car battery out of your car because he has an addiction problem, and it pisses you off. 

So, the reason why there is a stigma around addiction is because the behaviors that come along, not all the time, for all eternity, but a lot of the behaviors that come along with a lot of people that have addictions are horrid. You cannot trust people. They steal from you. They lie to you. 

You try to have an authentic relationship, but they are incapable of having an authentic relationship. It is a giant pain in the ass to have a relationship with somebody that has an active addiction. 

That is where the stigma comes from. It is not the word “addict.” You can change the words all you want, but the reality of it is until addiction is not a pain in the ass, there is going to be a stigma associated with it.

Can the “Addiction Stigma” Be Useful?

Now, on the other hand, I understand what people mean because you want people to be able to overcome their shame of having addiction by being able to say, “I have this problem,” so they can get better. 

I agree with that, but on the other hand, you do kind of want some stigma against addiction. 

I am raising children in this world, and is it the worst thing if my kids think that to be addicted is not that great? 

I want my children to know addiction is not that great. So, I think we have a lot of confusion about what we mean when we talk about stigma, and even what exactly our goals are when we say “Bring down the stigma.” 

Does Changing Terminology Make a Difference?

Clearly, the goals are to be able to help people get better. I mean, that is simple, but I do not think we are going to do that by playing with language. 

I will give my funny example of this, “housekeeper.” It is an interesting word. To keep the house, I guess, is what it means. It is somewhat old-fashioned. It is not as old as “maid.” I very rarely hear people say, “Oh, this is my maid.” They say, “This is my housekeeper.” Now, the word changed somewhere from the ’80s and ’90s to now from “maid” to “housekeeper.” Prior to that, there was another word people used to use, it was called “servant,” right? Or the “help.” 

So, these words changed, but the reality of other people cleaning up other people’s shit for their whole lives is still the same. Do you want to reduce the stigma of the word “housekeeper”? Well, I do not know. Maybe we should take a look at whether it is cool that we have a society where a certain class of people, often of a certain race, spend their entire lives serving another class of people often of another race, if we really want to deal with the problem.

Is Language Distancing Us from What’s Really Happening?

I feel the same way about addiction. Addiction is a human phenomenon. People have been addicts and alcoholics for as long as people have been. 

So, yes, we want to acknowledge this is not a normal human part of life. We also want to acknowledge when it becomes a destructive addiction, it is not a good thing, and it should be somewhat stigmatized. 

There is another reason why I would not be so quick to get rid of the terms “addict” or “alcoholic”. 

We are in a time now with trigger warnings and people being very afraid of offending people with words–which is strange because we are in the most offensive times, in my opinion, that one could live in, but that is the hypocrisy of the time. 

So, people have a hard time identifying as: “Hi, my name is Shy. I am an alcoholic.” or “Hi, my name is Shy. I am an addict.” 

Whatever that is, and they go, “I do not want to identify because I am more than just an addict.” Of course, you are more than just an addict. I think everybody knows that, but what is the importance of identifying?

Well, in my mind, people are distancing themselves through language from the reality of what is actually happening. 

When I was in active addiction, it was not a thing that I suffered from, meaning it actually was in the realm of the anti-logical, of the being of me, not the just doing of me. 

I will give an example of this. My cousin Jason has been playing baseball since he was 5 years old. People that play baseball, people that really love baseball, could spot a baseball player even when they are not playing baseball. They go, “You are a baseball player.” Then he will go, “You are someone who often plays baseball.” “No, you are actually a baseball player. I see the way you walk, the way you talk, the way you wear your hat, in the ‘being’ sense of it is like a baseball player.”

I would say if you have ever met somebody who is a really bad junkie, it has invaded more than just their activity. It has to do with their being. There is something kind of almost essential there where you go like, “Man, the way this person’s posture is and the way he kind of looks up at me It is like, he is kind of an archetypal junkie.” 

I am not saying that is great, and I realize that is probably somewhat offensive to go, “No, actually you are a junkie.” But I think it is that realization that you have, “Oh my God, I am a drug addict,” or at least “I am becoming a drug addict. I do not want to be that.” 

Not: “I do not want to do that anymore.” 

I do not want to BE that. I want to be someone else or something better.” 

So, I think when we get rid of those words, we are sort of white-washing the situation. 

I have sat with people with sleeve tattoos, out of the penitentiary, and in addiction programs, and I am like, “Hey, what are you here for? What is your drug of choice?” 

They go, “I am opiate-dependent.” 

I am like, “Opiate-dependent? Okay, doctor. What does that mean, you shoot heroin? You shoot dope? You do opium, right?” 

 I am not saying that to be offensive, I am saying it to get that person to connect to the reality of where they are at, and what they are becoming.

Being Comfortable with BEING

So, I think that… Because we live as a psychological society, we think about everything psychologically. We think about everything in kind of this far distance. We actually move away from the actuality of the being. 

Like, “No, I am an addict.”

And: “Guess what? Right now, I am not an addict. I have been sober 17 years. My ways of being who I am in the fibers, over time working on myself…I have not used for a long time.”

“I am no longer an addict. I can identify as I am an addict in recovery.” 

Or, “I am Shy. I am in recovery.” 

That is part of my being, too. I am a person in recovery. I am not doing recovery.

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