Why and How the For-Profit Treatment Industry Is Perpetuating More Harm Than Good
For nearly 14 years, I've helped individuals navigate the complex landscape of addiction in order to achieve recovery. Nicknamed "The Casual Counselor", my approach is unconventional but undeniably effective.
Ah, the American treatment industry. As a treater in private practice, I work parallel to it. I’ve even worked directly within it, in three different clinics over the span of 14 years. I often have clients who require a higher level of care than I can provide, creating a need to encourage those individuals toward the business of private drug and alcohol treatment. There are a few programs I trust to provide my clients with high-quality care. I can count them on one hand. So, I make the referral while simultaneously wishing I could burn the entire system into a pile of ashes and rebuild it for the good of the community.
Why? The for-profit model of treatment has transformed a staggering public health crisis into an insanely lucrative money-making machine. Valued at tens of billions of dollars, this healthcare sector prioritizes profit margins over patient outcomes. There are some exceptions, but again, they are few. I live and work in one of the most progressive and esteemed locations in this nation, with a reputation for high-quality medical care.
Rather than delivering evidence-based medical care that helps create positive, long-term outcomes, the US model really just amounts to a predatory cash grab. Deceptive marketing, undeliverable promises of guaranteed positive outcomes, unscientific treatment modalities, patient brokering, the industry not only fails to help individuals get well, but actually perpetuates the very “disease” it claims to cure. It keeps the train rolling.
At the core of the for-profit treatment model lies a fundamental ethical conflict of interest, a “cured patient” does not earn more money for these programs. Healthy individuals do not wake up one day telling themselves, “Life is going great! I think I’ll go check myself into treatment!”
True recovery requires long-term, ongoing, community-based support, stable housing, mental health care, and often Medication-Assisted Treatment (MAT).
However, the most profitable segment of the industry is short-term, high-acuity rehabilitation. They are referred to by the industry as “residential programs.” They typically provide anywhere from 4–6 weeks of stabilization and care. When insurance companies cut policyholders off from the high costs of that introduction to care, these same residential programs offer lower-cost outpatient services, allowing patients to continue under their umbrella of programming.
Insurers generally feel comfortable allocating markedly less revenue to allow the individual a bit more time to receive care. But rest assured, that time won’t last long. Insurance companies decide when a patient has received “enough” help, even if the individual is obviously not ready to leave treatment.
Actual clinicians have zero leverage in proving that a person still needs more help. These are the same clinicians who have earned expertise at the level of master’s degrees, doctorates, and MDs to properly assess how well, or not, the patient is doing within their recovery. It is all up to the insurance companies to determine. They make the rules, break the rules, change the rules. They are the rule.
They love taking policyholders’ money each month, jacking up their premiums and deductibles. But they do not like giving it back. They are loyal to their shareholders and bottom-line profit margins. Rest assured, they care not a single bit about you, me, or anyone struggling with a health crisis. Any health crisis. It is not limited to substance use.
For-profit facilities routinely charge between $20,000 and $80,000 per month for a residential stay. One month. These exorbitant costs are justified by luxury amenities, equine therapy, private chefs, private rooms with oceanfront views, a spa-like atmosphere, rather than clinical excellence.
Because commercial insurance typically covers these high rates for only 20 to 30 days, facilities face a financial incentive to maximize intake, exhaust the patient’s insurance benefits, and then discharge them with minimal, if any, personalized or possibly effective aftercare.
This dynamic creates the “revolving door” phenomenon. When I was doing per diem group therapy at a highly regarded local program for much of the past year, I asked a client about their personal experience there. They informed me it was their third time receiving treatment at that program in the past two years.
“Josh, this place is just a revolving door of relapse,” they told me. “Most of the people in this group? They’ve been here multiple times, too.”
When a patient inevitably relapses due to a lack of robust residential and outpatient support, they are often readmitted to the same program, or sometimes a “sister facility.” Two facilities refer patients back and forth to one another, like a game of hot potato. It reignites that highly profitable billing cycle.
Brilliant business model for our beloved free-market economic model. Essentially, in a purely capitalistic framework, chronic relapse is not a clinical failure, it is an unending, sustainable business model. It equates to serious wealth at the expense of serious help.
It’s also very often built on deceptive marketing and shady business practices. To maintain a steady influx of insured individuals, the for-profit industry relies on aggressive, ethically compromised marketing strategies.
After all, with thousands of competitors to contend with, “playing dirty” gives treatment programs an effective edge to “maximize the census,” regardless of whether their program is a good fit for that particular individual’s needs.
A prominent example is "patient brokering," a practice where call centers and digital marketing firms masquerade as independent addiction helplines. They have serious dollars to manipulate search engines into placing them at the top of page one when a loved one is searching the web for help for their son, daughter, spouse, or friend.
When the vulnerable individual or their family calls seeking help, these entities assess the caller’s insurance policy first, rather than their actual clinical needs. The patient is then sold to the highest bidder, to put it plainly. Very few individuals will ever scroll past page one on that initial web search.
It’s called search engine optimization (SEO). The big money players manipulate and hijack local search results for real people seeking real help for life-and-death crises. Anxious and panicked, a family searching for a local, affordable public health clinic will often be subtly redirected to an out-of-state luxury facility.
This commodification of human suffering strips patients of their agency and diverts them away from localized, evidence-based care networks. In short, good care, administered by skilled treaters and often at a fair price point, belongs to programs that lack the enormous resources to land at the top of page one because they do the work for the right reasons and with honest principles. These are the programs that genuinely want to help individuals truly heal.
Despite the American Medical Association’s (AMA) scientific consensus that addiction is a complex neurobiological disease, many, if not most, for-profit facilities rely heavily on outdated or unproven treatment methods. They do this on purpose, for the record.
A significant portion of these centers reject or underutilize FDA-approved medications for opioid use disorders, such as buprenorphine and methadone, which clinical data show reduce mortality rates in opioid users by upwards of 50 percent.
Instead, many centers mandate strict abstinence-based 12-step models as their primary clinical approach. While peer-support groups like Alcoholics Anonymous are highly valuable as free, community-based tools, translating them into an expensive, involuntary residential model has zero clinical justification. Why? It’s not evidence-based care.
By focusing on experiential therapies and isolating individuals from their real-world environments, these facilities purposely fail to address underlying traumas, socioeconomic stressors, and co-occurring mental health difficulties that drive substance use. This almost guarantees that individuals in early recovery will have a difficult transition when their benefits expire, and they are shown the exit.
The consequences of this system extend far beyond financial exploitation. For-profit care actively exacerbates and promotes the substance abuse crisis. When a patient undergoes a forced, rapid detoxification in a residential setting without access to long-term MAT or comprehensive, evidence-based aftercare, their physical tolerance to their substance of choice drops precipitously. This increases the risk not just for relapse but for accidental and often fatal overdose. This is particularly true in the era of highly potent synthetic opioids, like fentanyl, contaminating the street drug supply.
By replacing evidence-based medical continuums with fragmented, high-cost interventions, the industry leaves patients more vulnerable than they were before entering treatment. I have had literally hundreds of clients tell me they felt worse after leaving treatment than when they first arrived seeking help, with a modicum of hope.
Ultimately, treating drug and alcohol abuse as a commodity rather than a medical condition ensures that public health resources are consumed by corporate profits rather than effective care. Until systemic reforms mandate strict clinical accountability, legislate penalties for predatory marketing, and integrate evidence-based treatment into a regulated healthcare infrastructure, the for-profit rehab industry will remain a perfect, predatory machine that capitalizes on a national tragedy.
The owners of these programs, the insurance companies, the shareholders? They love the results. Because, as we’ve all been conditioned to believe in this American society, getting filthy rich, no matter the human cost, is considered the ultimate achievement. As long as it’s not happening to them personally, or to someone they love, I suppose.
Read more from Joshua Bennett-Johnson
Joshua Bennett-Johnson, Licensed Counselor & Owner of JBJ Counseling
After working for 7 years in an amazing clinic, I launched into private practice in 2018. I love my job. I can say that without reservation. Watching people rebuild their lives is something that is worth more than any dollar amount.
