What is “Notes from the Field”?

“Notes from the Field” is your backstage pass to the challenges, triumphs, and transformative moments we witness firsthand in our community. At WakeUp Carolina, we are committed to sharing insights, information, and stories that resonate with the hearts of our community members. Our goal is to foster understanding, ignite conversations, and inspire change.

As advocates for ethical and transparent addiction recovery practices, WakeUp Carolina stands committed to shedding light on the challenges and triumphs within our community. With the recent release of the American Society of Addiction Medicine’s public policy statement, “Government Strategies to Foster Ethical Addiction Treatment,” on January 18, 2024, it’s crucial to address the ethical dilemmas that plague the recovery industry. At WakeUp Carolina, we believe in providing solutions that promote integrity, compassion, and genuine healing for individuals and families navigating the journey of recovery.

Unveiling the Truth Behind Online Resources

In today’s digital age, the search for recovery resources often leads individuals to a maze of misleading advertisements and misrepresented services.

Just because a treatment center bids on these search terms to advertise in your local area, does not mean they’re a good facility for you or your family member.

Facilities know that if they list that they offer more “wrap-around services,” more people will be interested in their facility. Wrap-around services could include child care, employment assistance, or mental health counseling. Facilities know individuals are seeking these conveniences if they go to treatment. Unfortunately, we’ve witnessed some facilities “offer” these services and not deliver them.

In our opinion, facilities that offer a 10-minute psychiatry consult during a 30-day treatment would not be considered a dual diagnosis facility. Still, several will state they take dual-diagnosis patients based on a brief telehealth consult. The truth is that finding an addiction psychiatrist is difficult and an additional expense if they do find someone.

At WakeUp Carolina, we recognize the importance of navigating this complex landscape with clarity and authenticity. Through our platform, we strive to offer curated resources and guidance that empower individuals to make informed decisions about their recovery.

Solution: Empowering Informed Choices

By providing comprehensive, vetted resources and guidance, WakeUp Carolina equips individuals and families with the knowledge they need to make empowered decisions about their recovery journey. Our commitment to transparency ensures that individuals can access genuine services and avoid falling victim to deceptive practices.

Navigating Key Performance Indicators (KPIs)

In the pursuit of profit, some treatment centers prioritize sales over ethical considerations. For example, a business development representative may be evaluated on specific KPIs to earn a quarterly bonus. Depending on where they work, it would look like: having 80 face-to-face meetings with “vertical” accounts, 10 monthly admissions, 20 drop-ins to providers without appointments, and 10 cold calls. Suppose a representative doesn’t hit his or her goals as a team. In that case, the entire team can be prevented from receiving their quarterly bonuses, leading to the misplacement of individuals into unsuitable programs.

We’ve witnessed firsthand when admission coordinators overpromise to someone in crisis, and then once they get to treatment, some of the things they said would happen – don’t. Until this model drastically revamps, organizations like WakeUp Carolina, which advocates for accountability and integrity in the treatment industry, can help navigate this complicated piece.

Solution: Advocating for Ethical Accountability

Through advocacy and awareness efforts, WakeUp Carolina promotes ethical accountability within treatment centers. By advocating for transparent practices and patient-centered care, we work to ensure that individuals receive appropriate treatment tailored to their needs, free from manipulative tactics or misrepresentation. As a 501c3 non-profit, we’re able to hold these facilities accountable due to not having the financial need for reciprocity.

Addressing Insurance-Driven Practices

At WakeUp Carolina, we advocate for policies that prioritize patient outcomes over financial considerations. While insurance coverage has expanded access to treatment, it has also prompted a focus on cost minimization, sometimes at the expense of quality care.

For example, if you go to a treatment facility for detoxification and a residential stay, your insurance company will determine if you “need” the benefits at each care level. The insurance company aims to get you into the lowest level of care as fast as possible so they can stop paying higher rates for your treatment.

In the past ten years, treatment facilities have hired “Utilization Review” staff members whose main objective is to extend treatment days from insurance providers. If your assigned clinician, while at a facility, states that you’re improving, your insurance company may declare you need to drop into a lower care level. Conversely, your clinician could explain your struggle and acquire more certified dates so that you remain in treatment. Substance use is complex, and you may feel good one day and crave your substance of choice the next day. It’s paramount that the clinicians at the facility you choose are up-to-date with the best practices so you can maximize the benefits of your treatment.

Solution: Prioritizing Patient-Centered Care

WakeUp Carolina advocates for policies that prioritize patient outcomes and individualized treatment plans over financial incentives. By emphasizing evidence-based care and ethical practices, we strive to ensure that individuals receive the comprehensive support they need for lasting recovery.

Balancing Corporate Ownership

Corporate ownership of treatment facilities presents opportunities for resource allocation but also risks of profit-driven decision-making. WakeUp Carolina recognizes the importance of upholding ethical leadership principles within corporate structures.

When corporations are bought by large investment firms, it can change a patient-driven facility into a budget-driven facility almost overnight. This includes cutting required staff, eliminating recreational activities, or purchasing lower-quality food to benefit their profit and loss reports.

The CEOs of corporately owned facilities get bonuses based on the revenue they drive, which can be good or bad depending on how it’s handled internally. They may begin cutting corners on facility maintenance or staff to get bonuses.

When large corporately owned treatment facilities are in acquisition mode, each satellite treatment facility will receive less corporate supervision. The company becomes focused on acquiring more rather than investing in what they have. We’ve noticed corporately owned facilities begin with four facilities and grow upward of 40 in just over five years. This means that the other facilities need to run on lean budgets to invest dollars into new acquisitions. This also means the supervision for facility management can fall to the bottom of the priority list if they’re producing revenue.

Solution: Upholding Ethical Leadership

Through advocacy and education, WakeUp Carolina promotes ethical leadership principles within corporate-owned treatment facilities. By prioritizing patient care and employee well-being, we advocate for a culture of accountability and compassion that prioritizes ethical standards.

Navigating Privately Owned Facilities

Privately owned facilities may offer a sense of familial support, but they are not immune to ethical lapses since they also have owners who need to make their business profitable.

Have you heard of Synanon, originally known as Tender Loving Care? We suggest you watch the documentary about it. Most organizations start with the intent to help people, but over time, this can deteriorate into something resembling a cult if the proper precautions aren’t taken.

Whereas corporately owned facilities have policies, procedures, and attorneys protecting the entirety of the company, privately owned facilities may have something similar in place but aren’t held accountable by “upper management” to stick to these designated rules and guidelines. Additionally, private facilities can also be as misleading as corporations when advertising their services from a medical, clinical, and psychiatric standpoint.

In the privately owned sector, we hear more about patients being taken advantage of for things like free labor or suffering sexual harassment. There is a power distinction that exists between patients and staff. Most patients are there because they’re unwell and need professionals to help them recover. This distinction is sacred and should not be taken advantage of by staff.

Organizations like WakeUp Carolina can help you navigate this from a neutral perspective.

Solution: Strengthening Regulatory Oversight

WakeUp Carolina calls for enhanced regulatory oversight and accountability mechanisms for privately owned facilities. By enforcing adherence to industry standards and promoting transparency, we strive to safeguard vulnerable individuals from unethical practices.

Cult of Personality & Ethical Dilemmas

In the realm of addiction recovery, the emergence of a cult of personality within treatment facilities can present troubling ethical pitfalls. This phenomenon occurs when patients idealize leaders within these facilities, placing unwavering trust in their guidance and subscribing blindly to their beliefs. Whether at corporately managed or privately owned centers, without robust accountability measures in place, this dynamic can easily take root.

Patients, in their vulnerable pursuit of wellness, may begin to view staff members as infallible sources of wisdom and authority. While it’s natural to look up to role models, there’s a delicate balance between admiration and surrendering autonomy. Those overseeing these facilities are, fundamentally, ordinary individuals with specialized training in addiction recovery, therapy, and management. Yet, when unchecked, this authority can be exploited for personal gain under the guise of fostering sobriety and wellness.

Instances of ethical breaches can range from sexual advances toward patients to exploitation of labor, such as coercing individuals to perform household chores or work for the facility without compensation while still undergoing treatment. Unfortunately, such abuses have been witnessed over the years, particularly in rural treatment settings where oversight may be less stringent.

Solution: Ethical Safeguards & Ensuring Integrity

Firstly, clear codes of conduct should be established to delineate appropriate staff-patient interactions and prevent abuses of power. Regular staff training and supervision are essential to reinforce ethical standards and ensure adherence to best practices. Independent oversight committees comprising professionals from diverse backgrounds can provide impartial evaluations of facility practices and address concerns regarding ethical breaches. Encouraging patient advocacy and feedback through anonymous channels empowers individuals to report misconduct without fear of reprisal. Lastly, promoting transparency in operational aspects, including financial management and staff-patient interactions, fosters trust and accountability among all stakeholders.

At WakeUp Carolina, we remain steadfast in advocating for ethical and transparent practices within the addiction recovery industry. By empowering individuals with knowledge, advocating for accountability, and promoting patient-centered care, we strive to create a recovery landscape guided by integrity, compassion, and genuine healing. Together, we can navigate the complexities of addiction recovery with clarity, authenticity, and hope.