The subtitle of “Rehab,” Shoshana Walter’s book about the collective failure in this country regarding widespread drug addiction, says it all: “An American Scandal.”
The Oakland-based Walter examines everything from what she describes as misguided drug laws that long prevented doctors from helping addicts to executives who Walter says profit off the suffering of those addicts and their families.
SEE ALSO: Rehab Riviera: An Investigation into the Southern California rehab industry
While Walter provides history and plenty of politics and policy detail, she does it through individual stories: a doctor who bends the rules as he tries to fight the system, a White middle-class young man who gets treatment in lieu of jail time but then learns that the facility — which forces him into hard labor — may be even worse, and a Black woman who gets no such option and is sent to jail.
The fourth story centers on a California woman, Wendy McEntyre, who lost her son to an overdose and finds purpose in helping others. Throughout the book, she goes to battle with the Above It All Treatment Center in San Bernardino County after learning of the death of a 21-year-old addict in their care. As she seeks justice, Walter catalogs the many obstacles McEntyre faces in every aspect of California’s system.
Walter spoke recently by video about the book. This interview has been edited for length and clarity.
SEE ALSO: When addiction recovery means leaving a pet behind, this Palm Springs nonprofit steps in
Q. You take readers through decades of what you see as misguided policies. Why does it matter today?
If we really want to build a system that is going to help, then we need to understand what’s not working about our current system and how we could potentially fix it.
Personal responsibility and willpower matter, but the research shows that the feeling of having control over your own life is super-important for someone trying to enter recovery. If people don’t have access to the resources they need to make a change in their lives — housing, jobs, food, community — it’s very difficult to recover and it’s not just a matter of willpower. And we’re failing a lot of people in that way.
Many people have been unwilling to let go of this idea that addiction has to be punished.
One of the first federal drug laws in the United States essentially barred doctors from prescribing narcotics to people known to be addicted. Within a few years, about 25,000 doctors were arrested for trying to treat addicted patients with narcotics. So our addiction treatment system was developed in this silo, totally divorced from the mainstream medical system; that’s how we’ve ended up with strange addiction treatment practices, like the attack therapy, where people get together in groups and scream at each other and confront each other about their deficits.
Q. You also write about how structural racism distorts who gets help.
There are racial disparities in treatment access, treatment duration and access to recovery capital, things like housing, transportation, food, economic security and community. These are all things that people really need in order to recover from their addictions.
And I suspect the racial disparity will grow worse because we’re going to see more people cut off from their addiction treatment coverage, covered by Medicaid. And there’s a lot of harm reduction funding that’s been cut.
SEE ALSO: Journalist and convicted murderer John J. Lennon takes on true crime in new book
Q. You write about unintended consequences of the Affordable Care Act, which did much overall, but incentivized the for-profit rehab situation we are now stuck with. Can it be fixed?
When programs exploit patients for profit, there’s a lack of action by regulators to shut down those programs or prevent these things from happening again. There’s this major gap in oversight. There are now well over 2,000 licensed and certified treatment facilities in the state of California, but I believe only about five analysts or inspectors in Southern California, where a huge number of these treatment facilities are located. So they’re vastly outnumbered.
The response rates are glacial and the action that they take is often not enough to actually stop abuse from happening repeatedly. It’s a little slap on the wrist, and there are so many loopholes to getting past that oversight.
It’s also very easy to get away with insurance fraud, with overbilling insurance companies for unnecessary services, for paying people to refer patients into rehab programs that may not have their best interests at heart. In the treatment program that I write about, they were overmedicating patients to the point of impairment, contributing to their deaths, and sometimes providing medications not prescribed to those patients. And yet the program remained open, and there have not been really any serious consequences.
SEE ALSO: Detox can end in death at some ‘non-medical’ Southern California rehabs
Q. Who should be delivering those consequences?
In California, the Department of Health Care Services is the regulatory agency that oversees rehabilitation programs. They issue the licenses, investigate complaints, and do inspections. Insurance companies have the ability to monitor billing and services provided, as well as investigate complaints. And then there’s state and local law enforcement. The parents of some who died in this program reached out repeatedly to the San Bernardino Sheriff’s office, the district attorney’s office, and the state Department of Justice. And from what I gather, none of those agencies did anything of significance in response.
California is so massive, we have so many people here and the state serves more people with addiction than a lot of other places where treatment programs are scarce. But that’s overwhelmed the system, so the oversight over these treatment programs is poor, and that’s harming people.
SEE ALSO: Like books? Get our free Book Pages newsletter about bestsellers, authors and more
Q. Did working on this book leave you hopeful or pessimistic?
It’s a mixed bag.
Overdose deaths are down, but the numbers are still incredibly high. And then there’s the number of people who remain stuck in active addiction or in this cycle: two-thirds of American families say they or a family member or friend has struggled with addiction. I think that is perhaps an even more important metric than the number of overdose deaths. Their families have put all their money or effort into helping them. Their kids are traumatized. Their communities are traumatized.
The system is really not working the way it should, and a lot of people are dying. But there’s a lot of hope in the resilience of people. I think people are becoming more comfortable talking about addiction and acknowledging addiction. And a lot of lawmakers are no longer viewing punishment as the knee-jerk reaction to addiction.
There are still barriers to accessing those medications that help fight addiction. So we’ve seen a lot of positive developments, but there are still a lot of problems that remain.