Rehab An American scandal

On-site overdoses, abusive disciplinary methods, and patients outsourced as unpaid labor are some of the shocking revelations levied against the U.S. addiction treatment industry in this stunning debut investigation. Pulitzer finalist Walter shines a light on the "$53 billion per year" network of mismanaged treatment centers and "overcrowded" sober-living homes--some "infested with bed bugs"--that are concerned mainly with maximizing profit. Particularly galling is that seemingly positive policy changes--like the Affordable Care Act's expansion of Medicaid's coverage for rehab and new rules for sentencing low-level drug offenders to treatment rather than prison--have rendered the industry more lucrative and rife for exploitation. Walter tracks individuals navigating the industry, among them a mother whose son died at a sober-living home and an addict sentenced to a notorious Baton Rouge in-patient facility, where he endured such punishments as the "verbal haircut," in which another patient screamed at him for every "minor rule infraction," and suffered a devastating workplace injury while being compensated only in cigarettes. The book also sheds light on the government's mishandling of Suboxone, a vital treatment for opioid addiction that the DEA instead treated liked a narcotic--even arresting as some sort of drug kingpin ("the Pablo Escobar of... Indiana") a doctor who prescribed the life-saving drug to his many opioid-addicted patients. It adds up to a horrific indictment of America's profit-driven healthcare system. (Aug.)

Examining failures of the addiction-treatment industry through real-life stories. Journalist Walter takes readers on a tour of what addiction treatment looks like in the United States. We meet Chris, a white Louisianan who works 80 hours a week and has no time or energy for counseling; April, a Black Philadelphian who struggles to get herself straight and her children back; Larry, a white doctor in Indiana who builds a practice around a newly approved medication for addiction; and Wendy, a white Californian whose son died at a recovery center. The book's chapters rotate among the four narratives, walking the reader through the harrowing and the hopeful. Their stories are as compelling as they are hard to read, because Walter scrutinizes a largely hidden world that over-promises and under-delivers. The book is well written and strikes a good balance between the personal narratives and the broader racial and political contexts in which they play out. Readers are faced with a litany of ironies, such as 28-day programs, which can help people detox but also put them at higher risk of death should they relapse. Prescribing rules allow doctors to dole out Oxycontin, a pain medication that has contributed to the addiction crisis, to any number of their patients but drastically limit dispensing Suboxone, a treatment drug. The Affordable Care Act helped boost the recovery industry, which was sorely needed, but also allowed rapid growth of for-profit treatment centers that were more focused on making money than on making people better. Walter examines practices that are at odds with research evidence, such as the fact that most people go through multiple attempts at recovery before they reach lasting sobriety, suggesting that intakes should be easier and that efforts to boost post-treatment care, including housing and employment, should be part of the mix. A nuanced and deeply reported exposé of America's $53 billion addiction-treatment industry and how it harms all of us. Copyright (c) Kirkus Reviews, used with permission.