The Ethics of Reciprocity and other Business Development Practices in Addiction Treatment
Reciprocity is a very common business practice in a variety of industries and on the surface, it makes sense, in terms of growing and expanding one’s business. Regardless of the industry; governmental, not for profit agencies, businesses of all sizes use reciprocity to leverage their relationships with others and increase their bottom line. In other words, you refer to me I’ll refer to you. In most industries, this works without crossing ethical boundaries. However, in the addiction industry the practice of reciprocity is both unethical and in some cases can have deadly consequences.
I have a background in organizational leadership and ethics, non-profit management, business consulting, as well as extensive clinical training in treating a variety of addictions, substance use disorders, process addictions, intimacy and psychiatric disorders and trauma. Unfortunately, there are some disturbing trends in my own industry which has prompted me to share this information, in order that consumers can know what to look for, what to avoid, and what questions to ask of treatment consultants, interventionists, sober companions and of course addiction treatment centers.
Many families that find themselves in crisis when a loved one is struggling with an addiction or mental health issue, have no idea where to turn, so oftentimes they begin with a search of the internet. Starting with an internet search makes sense to me, because it provides an abundance of information. However, if you don’t know what to look for or what questions to ask it can feel daunting and quickly become overwhelming.
FACT: Consumers are easily deceived by unscrupulous treatment centers that use deceptive trade practices in order to bait and switch. In other words, even if you are looking for a particular treatment center by name on the internet (via google or another search engine), you can oftentimes find yourself on the phone with an “Intake Specialist”, or “Treatment Consultant” located in a call center working for another treatment center.
A family in crisis may contact their primary care doctor, for a referral. Unfortunately, physicians learn very little about addictions while in medical school, and, most have no idea, either how to treat or who to refer to. When they do provide a referral, it is often to a marketing representative from a particular treatment center. The physician is relying on the word of the marketing representative, whose job is to simply get admissions.
A family in crisis may also contact a psychiatrist for a referral. Again, unless a psychiatrist works in the addiction field, he or she may be unaware of how or where to refer someone to a higher level of care or residential treatment. Many psychiatrists will give a referral to a family of the last marketer that stopped by to drop off some brochures, or cupcakes, without much knowledge about that particular treatment center, only what they’ve been told by their salesperson.
It’s also not uncommon to ask our friends for recommendations, but again, although a friend may have had a positive experience with a particular treatment center, this doesn’t mean that program would necessarily be a good fit for your loved one.
Professionals in the addiction or mental health field have a variety of titles such as business development director, territory manager, treatment consultant or adviser, peer recovery support specialist, Intake Specialist, Admission Director, etc. and these titles themselves can be confusing, especially for someone in crisis.
Most treatment centers employ business development or sales people who are responsible for marketing their programs and driving admissions. Many will use call centers staffed by poorly trained sales people, whose bottom line is “heads in beds”. Many lack training in the complexities of mental health issues or trauma that often underlie addictions. Unfortunately, when working with a family in crisis many of these professionals will over promise what they can actually provide in their program in order to sell their program to a family.
In addition, many treatment centers have “preferred provider” interventionists that they work with whose primary mission is also to generate “heads in beds”. These preferred provider interventionists have become “preferred” because they operate using the reciprocity model for doing business. Meaning, you refer to me, I’ll bring the person to your program and some will even receive kickbacks from the treatment centers, in addition to the fee’s the interventionist has charged the family.
Many of these interventionists, treatment specialists or advisers do not have any kind of clinical training, some interventionists have no other training other than their own personal experience of getting sober.
So how do you go about finding a treatment consultant to work with that you can trust?
You start by asking a lot of questions.
- If you are speaking to a treatment consultant or advisor or interventionist ask them who they work for? Who pays them for their services?
- Ask if they are paid finders fees for referrals by treatment centers (yes, this happens).
- Ask about their credentials, mental health training, licensing, ask if they are in recovery themselves, ask if you can speak with family members that they have already worked with.
- There is no such thing as a “licensed interventionist”. Professionals that are licensed are therapists, counselors, psychologists, psychiatrists, MD’s. Some interventionists are licensed, but their license does not cover their “interventionist” title, it covers the discipline they are licensed under.
- If you suspect they are over stating their credentials, their experience or qualifications, trust your gut! (Many interventionists have very professional looking websites, but when you look with a keen eye, you will see that they don’t tell you much about themselves, rather they are telling you what you want to hear!)
- Ask what type of intervention approach they use, and what the family can expect in terms of follow up after an intervention, if any.
- Ask them if something happens, or goes wrong while their loved one is in treatment, who should you call? Where does their responsibility end? Many consultants, advisors, or interventionists are only interested in getting the person into treatment, and there is no follow up following admission, or if the individual leaves treatment against medical advice (AMA).
- Ask about transport services. If they are transporting do they deliver to the airport, or directly to the treatment center? If they are “handing off” your loved one to a driver, is this driver trained in addressing a crisis?
- Ask them about their fee, and specifically what their fee covers.
- If an interventionist has a website and is making a lot of claims about their training, expertise or certification, the specific trainings, education, certifications, and licensure should be listed on their website. If it’s vague, or doesn’t exist, beware.
- Ask the interventionist/treatment consultant/treatment specialist about their training, their credentials, then check out what they tell you.
- If they make any kind of guarantee’s or promises about their services, that seem too good to be true, they are probably too good to be true.
- If you are speaking with anyone and feel you are being pressured or bullied in some way, please hang up. This is especially true when you reach a call center. Again, a “treatment specialist” working at a call center for a particular treatment center is interested in getting your loved one into their program.
- Ask the interventionist what other work they do besides interventions. Are they running a sober living home? Are they a sober companion – charging a fee for spending time with a person in recovery?
I recently received a referral from an interventionist that said the case, “needed a woman’s touch”. What this interventionist didn’t say was that his inexperience, lack of clinical training, and fear about practicing out of the scope of his knowledge base was why he was referring the case to me. It had nothing to do with the case “needing a woman’s touch”.
Unfortunately, and it saddens me to say this – there is a lot of fraud and corruption within the addiction treatment industry today and there are unscrupulous people taking advantage of families, especially when they are in the midst of a crisis.
Many people that are sober from substances have decided to work in our field and for that I am grateful, as they bring a lot of experience, strength and hope to those that are new in recovery and these folks can help to show them the way. However, there are also a lot of people that may or may not be in recovery, that are simply in this industry to make money, that are inexperienced, lack training and they will over promise and under deliver time and time again, and take advantage of families in crisis. Unfortunately, as the addiction treatment industry is not regulated (unless you are licensed professional) unsuspecting families are easy targets.
REFERRING TO TRUSTED PROVIDERS
There are a lot of excellent treatment centers, interventionists, and clinicians that do a great job of providing good, quality treatment. I see no problem with referring to trusted providers in the health and wellness industry that have demonstrated expertise and experience in treating a variety of addictions or mental health disorders. I do this all the time and I have never, ever expected a treatment center or other provider (therapist, IOP (Intensive Outpatient Program), PHP (Partial Hospitalization Program) to refer back to me, Never!
Now many of the programs I’ve referred to, do refer back to me, and the reason is simple, because it’s in the best interest of the client. But if a client can be better served elsewhere I am in full support of that and I will assist in helping them find another provider.
Some may wonder why I don’t participate in reciprocity – it’s simple, I am always going to be focused on what is in the best interest of the client, period. Not so with other interventionists or treatment providers. Remember there is an expectation, “I’ll scratch your back if you scratch mine”. The problem with this expectation of reciprocity is, the person in need of treatment is not the focus of this exchange, getting a head in the bed is what drives reciprocity.
CURRENT INDUSTRY TREND
Today, venture capitalist firms are heavily invested in addiction treatment centers, as there is a huge profit margin in addiction treatment. Unfortunately, these “VC’s” are making business decisions about how healthcare should be delivered, what clinical modalities to offer, clinical staffing, etc. The problem with investors making these decisions, rather than behavioral health experts, is that the services your loved one actually receives in treatment are often from an inexperienced master’s level clinician that may or may not be licensed. A treatment center will not necessarily publish this on their website, in fact it may often appear that your family member will be seen by a psychiatrist, or psychologist daily, when in reality that is not what is happening.
NAADAC (National Association of Alcohol/Drug Addiction Counselors) is an organization that has members in most states. This is a good start to find help. But beware, just because someone is a member of NAADAC does not mean that they are a licensed professional. Please do your due diligence and go to the NAADAC site, to confirm if the person is currently licensed.
NII (Network of Independent Interventionists) is an association of interventionists located across the US and abroad. Members are all vetted by their credentials, training, experience and by peers in the industry. Not all members of NII are licensed.
CIP (Certified Intervention Professional) is an organization that certifies qualified interventionists. Again, just because an interventionist has a CIP designation does not mean they are a licensed professional. CIP Guidelines state that an interventionist that holds the CIP certification is not a marketer or recruiter for a treatment center. If you are working with a treatment center that is using a preferred provider (interventionist), ask how the interventionist will be paid.
I have many colleagues in the addiction recovery industry that believe reciprocity is a standard and customary business practice and that there is nothing wrong with using this model to drive business to their treatment centers. I believe that treatment consultants, interventionists, and addiction treatment centers should have the best interest of a client as their primary focus, rather than allowing profits to drive a decision for treatment. It is my hope that this article will prompt a discussion among treatment consultants, VC’s and others that can lead to necessary changes in the addiction treatment industry. Lives depend on it.