SUD Treatment has to move non-profit ideals

Most of us got into the chemical dependency field to help people, and with the best of intentions. In order to do so we have to have people to help of course, and it seems that the process of generating new admissions is difficult at best and terrifying at worst. I get it, and particularly for those of us in the for-profit segment of the profession we rely on a lot of activity at the front end to ensure the success of our programs.

Traditionally we have looked to organic marketing efforts to generate inquiries. Good old fashioned boots on the the ground relationship marketing. It requires that we get out of our chairs and go meet people, tour programs, look folks in the eye listen to them talk about their program and they about ours. In doing so we develop a "book" of people we can work with, that will refer to us and we learn enough about then to make appropriate referrals ourselves.

In recent years SEO, adwords, pay per click - digital marketing - has risen dramatically. Initially at least this augmented the outreach efforts of our business development folks however as the years rolled by, algorithms changed, competition became more sophisticated and the depth of the pockets grew, not everyone could play in this space. It became the geography of large programs with vast budgets and all others be damned.

We are a resourceful lot, creative, and we tend to adapt as needed. Some of us ignored the direction of our moral compass and began to pay for referrals ($12,500 is to top price I have heard for a paid referral), utilize "patient brokers", commoditize the human life we sought to serve. And some of us too began to rely on call centers to provide us leads. It all amounts to the same thing - affixing a dollar sign to the forehead of each human we come into contact with and thereby inserting the concept of profitability ahead of help into the equation. They necessarily have a value proposition associated with them in this case - we paid for them and now how are we going to get paid back?

So with this in mind, I'd like to make a case as to why this is not only a bad idea, but is potentially ruinous to our profession:

The first point of contact MUST be with a facility that can either help or refer a client to a place that can. When the window opens in which a person is willing to get help, it typically only opens a short distance and for a brief period of time. Adding iterations of contact, either in phone transfers or brokering a client to a facility serves only to lengthen the time before a person receives the help they are dying for. In the worst of it, this person is caught in a phone tree from which they eventually fall or jump, or they're tied up with someone trying to sell them to the highest bidder.
Everyone calling a facility for help is in some sort of crisis. If you have ever worked the admissions line at a treatment facility you know the truth of this. Mom is on the other end of the line, desperately looking for help for her child, terrified she'll be making funeral arrangements before she sees them again. Husband calling for wife, child for parent, coming apart at the seems with grief. Or the addict themselves, beaten into a state of momentary surrender and you're the one that is going to reel them in. If you have not been exposed to this, trained for it and prepared to take on this responsibility you have no business answering the phone.
We are unable to make referrals. We have an unwritten mandate to get out in the field, meet each other, collaborate with each other, learn what each other does in order to ensure the person in need is getting to the place best suited to help them. Not everyone that comes into contact with your admissions department is going to be a good fit for your program and so you are obligated to send them elsewhere. If you are not out in the field learning about the services others provide, you can't make good referrals and this is a failure for the caller and for the profession. You're cheating everyone.
We're giving in to profiteering. Call centers and patient brokers do not care about the people who are seeking help. I don't care what they say. They care simply about turning this vulnerable population into cash flow. Period. They are not providing a service to the client - who is best served finding help direct - they are providing a service to themselves.
It amounts to human trafficking. When we buy and sell people we are trafficking in human life. There's no nicer way to explain it. The person in need is reduced to a number, a dollar sign, not a compilation of causes, conditions and needs that require a host of clinical services. This is a human being - think of your child, sibling, parent, anyone you love deeply and care for beyond articulation. And then ask how much they're worth. How much would you sell them for. Or buy them for.

Now, notice I did not bring up the legality of any of this. Some of it is, some isn't - I think we have a higher authority to answer to however. That authority is the intrinsic value of a human life, a life often unable to save itself. As care givers we pledged first and foremost to stand in the gap with this human, to shoulder some of the struggle and light the way out of the darkness. We can't do that with one hand on their backs and the other on their wallet. There's no other medical field that's engaged in this manner; we're not treating cancer patients this way, those with diabetes or MS. So why should we treat addicts this way?

For the record, I make my living and take care of my family working for for-profit entities in this profession so I don't want to come off as holier than thou. And I think it's ok to make a living in this field provided the needs of the client are well ahead of the financial gain. It's been my experience that with the client as the first and foremost priority the rest of it works out. I've talked to enough others that feel this same way to know I am not the exception.

With all this being said, I'd like to draw your attention to the state of the profession as it stands at present. Never before - at least to my knowledge - have we been under greater scrutiny. The massive gouging that has taken place with urine drug screens has resulted in criminal investigation and prosecution; the manner in which clients get to treatment and are provided services is under the microscope of multiple insurance companies, so much so that reimbursements are being significantly delayed, reduced or denied outright. Communities are railing against us setting up programs within them, city government is getting involved in limitation or elimination of treatment facilities and sober living homes. The very foundation of the work we do is being challenged, called into question, and the proliferation of bad actors and bad action is only growing. It does not take much consideration to realize the likely outcome unless we make a serious and significant change in our behavior.

Finally, and this is a bitter pill to swallow - we did it to ourselves. When the good intention many of us had gave way to greed, when the bar of bad behavior lowered rather than raised, when we decided that human life was negotiable for our own profit we pulled the gun and shot ourselves in our collective foot. Now it's time to staunch the bleeding and contribute to the healing or we'll all be looking at amputation.

Why Pay Per Leads, Call Centers, Patient Brokers and Fixing Dollar Signs to Clients are Horrible Ideas

David Skonezny, CADC-II, ICADC

Behavioral Healthcare Consultant