5 things John Oliver got wrong about ‘rehabs’ | Behavioral Healthcare Executive Skip to content Skip to navigation

5 things John Oliver got wrong about ‘rehabs’

Perspectives
May 25, 2018
by Deni Carise, PhD
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John Oliver can be very funny. His show, “Last Week Tonight” cuts up everything from federal fundraising to the royal wedding to cryptocurrencies. I get it. I even like him. I previously applauded his 2016 segment on the behavioral health industry when he said we needed “more investment in treatment programs.”

While I know that comments on his show are made purely to engage television viewers—not to report any news with accuracy—there are many things in his riff this week on “rehabs” that deserve clarification.  

1. Let’s start with a term “rehabs,” which he used intentionally.

Yes, John, there is no definition for “rehab,” and maybe that’s why there’s also no “set definition of what it should consist of.”  The term “rehab” is a colloquialism referring to all manner of treatment for substance use disorders, such as residential treatment, detoxification, outpatient treatment and more.

The specific forms of treatment do indeed have extensive definitions and service expectations. Just check out the American Society of Addiction Medicine for the most often used criteria. These treatment programs—not “rehabs”—meet criteria from state and federal agencies, and the best are accredited by the Joint Commission, which is the gold standard in accreditation of all types of healthcare organizations.

2. It’s clear that the interviews shown in the segment are not done by John Oliver or his staff but are edited excerpts from other sources.

What is unclear to viewers is how he strings interviews together to present information in a misleading way. The one closest to my heart is a clip of Tom McLellan, PhD, the founder and chairman of the board at the Treatment Research Institute, in an interview where he is talking about his lack of knowledge of treatment programs back when he thought his teenage son had a drug problem. What is left out is the context indicating that the scenario happened more than two decades ago. That issue was the reason why McLellan, a true icon in our field, started the Treatment Research Institute to transform the research done in academic settings into information that could transfer how we deliver, evaluate and measure treatment in the real world.

Let’s not pretend that something that happened more than 20 years ago happened just this week.

3. Another example of poor representation is John Oliver’s clips of Richard Taite as the owner of Cliffside Malibu and several review websites. 

Yes, the clips are not flattering for Taite, and I bet he wished he was more eloquent describing his programming and its benefits. However, Taite doesn’t even own Cliffside Malibu anymore. My point is that Oliver is picking and choosing outdated material to enhance the hyperbole of his comedy show.

4. Oliver takes issue with Marvin Ventrell, the executive director of the National Association of Addiction Treatment Providers (NAATP).

Oliver picks up a quote stating that the operation of addiction treatment “in some sectors, is out of control.”  I actually applaud Ventrell’s honesty as well as NAATP’s focus on resolving industry issues. What Oliver fails to mention is that the vast majority of treatment centers are ethical, compliant healthcare operations, and NAATP and others are actively involved in educating consumers on what to look for.

The few bad operators do not represent the industry.

5. Oliver just further stigmatized addiction and recovery.

We all know is that this profoundly stigmatized field is full of thousands of good people dedicated to and passionate about helping those struggling with substance use disorders. We all know that the treatment programs of today grew out of a para-professional system of one person with this problem helping another, and that it’s only recently that substance use disorder treatment has had the benefit of numerous evidence-based practices. We now have the research showing that this is a disease that changes the way the brain works, and insurance coverage for this disease finally approximates the coverage for other medical disorders. 

You can’t help but wonder how many people watching Oliver’s show decided to give up on seeking treatment. It’s a tragedy. The viewers who rely on his sarcastic satire weren’t given the opportunity to see the success stories of the many people who are living wonderful lives in recovery, thanks to the hard work and dedication of those of us who work in  “rehabs.”

Deni Carise, PhD, is chief scientific officer, Recovery Centers of America and adjunct assistant clinical professor at the University of Pennsylvania. She will be speaking at the National Conference on Alcohol & Addiction Disorders, August 18-22 at Disneyland in California.

 

 

Addiction professionals annually convene at the National Conference on Addiction Disorders to share what’s working: Clinicians hear from thought leaders on delivering treatment, while executives of behavioral healthcare organizations learn how to run more effective, more efficient, and ethically minded businesses.

August 19 - 22, 2018 | Disneyland, CA

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Comments

The Joint Commission has plenty of issues itself, as exposed in the documentary film that Oliver used many clips from, 'The Business of Recovery.' So even the "gold standard" is questionable. Additionally, the Surgeon General's report from 2016 highlighted MANY issues with addiction treatment and specifically called for individualized treatment over standardized programs. However, standardized programs continue to be the norm across all levels of care. Lastly, abstinence-only treatment continues to maintain a monopoly on the industry despite a vast body of empirical support for harm-reduction and moderation methods. Oliver's take is largely accurate, all the way down to stating that addiction is LIKENED to a disease rather than saying that it IS a disease.

If you're going to make a claim as bold as stating that the issue of addiction being a disease is settled, it would be good to ensure that your hyperlink works. Even the Surgeon General's report from 2016 states that only the most severe form of substance use disorders (addiction) qualifies as a disease, meaning that most substance use disorders are a behavioral problem NOT a disease. There are great minds on both sides of the 'disease' debate and the truth is that the issue is far from settled.

The plain fact is that nearly all programs are 12-step, abstinence-only programs and that is not the best fit at least 1/2 of the people who seek treatment according to NESARC. The 12-steps are free and support groups are widely available. Shuffling people around to educational groups run by minimally trained drug counselors is a great business model but hardly qualifies as treatment. The majority of treatment centers at all continuums of care require frequent urine testing and Oliver's information on the insurance scams for drug tests was absolutely accurate.

Richard Taites exist in high concentrations in the addiction treatment industry (see Sovereign Health for one of countless examples). The reality is that the addiction treatment industry earned the stigma it bears, unlike the people it "treats" who are relentlessly assaulted with confrontational, shaming tactics that often make substance use problems worse rather than better. The time is ripe for self-empowering approaches like SMART Recovery to become widely available. Oliver's honest depiction is long overdue and might finally help propel a movement for human decency in treating people with substance use problems.

Bravo TJ!! Thank you for your response to Ms. Deni Chapman’s rebuttal which was filled with absurd attempts to discredit the accurate information the John Oliver Show put forth. While most of the interviews the Oliver show used were taken from Greg Horvath’s “The Business of Recovery Documentary” which is only a few years old, the facts were definitely accurate. This predominately lopsided unregulated mainstream “treatment” industry has far more charlatans and system wide manipulators than imaginable. Including a lot of the PhD’s such as Deni acting as experts keeping clients in the dark about their choices to view addiction from both sides of the disease model bias. I couldn’t agree with you more that JACHO is far from being a neutral accreditation. They have rubber stamped businesses I would never send a client to seek help. Clients and their families have a right to understand ALL their options and to be presented with every possible avenue so they can make informed decisions that will work for them. The days of delivering pious top down information to vulnerable people in crises under the name of “treatment” is beyond negligent.

It would appear the negative reactions to John Oliver's episode on 'Rehabs' are all coming from doctors, reps, bloggers, and healthcare executives who financially benefit from more patients requiring stints in rehab. Instead of providing patients with the best possible treatment you are all determined to pressure the sick and their families into a system that could very well kill them. This is John Oliver's point, NOT that rehab is necessarily bad. LISTEN AGAIN...He specifically indicates the difficulty in trying to find the appropriate facility for a suffering patient. Anyone who profits off increasing the numbers, transferring patients from one facility to another within their own network with little research, and rationalizes their actions under the umbrella of life saving treatment is pathetic and a sorry excuse for a doctor or healthcare professional. These thinking fallacies will be your demise in the end.

Ted

Marv’s email to the J Oliver Producer

Hope you’re well and working on a fun story. I thought you might like my reaction to the “rehab” piece. It aired during our national conference and created quite a buzz. I’ve been asked, “Marvin, what are you going to do about the John Oliver story?” Well, nothing really. He’s a comedian and it was mostly funny and accurate I say.
 
Anyway, here are my thoughts:
 
1. It was good, I liked it.
2. It was pretty accurate, but not entirely.
3. It’s good to point out that the industry has some really bad actors who need to be stopped. That’s our whole Quality Assurance Initiative. That’s what WE are working on.
4. It’s a shame to tell the story without providing context as to the industry at large and noting there are really good caring values-based and evidence-based practitioners who provide great health care and save people’s lives every day! I’m one of those people who got proper addiction treatment at a good center that provided me with the health care I needed for this disease. These are many thousands of us. And NAATP is distributing the Outcomes Measurement Toolkit this year so centers can track outcomes.
5. Steering people away from treatment with fear is wrong and results in people not getting the help they need. If people don’t seek treatment because they only hear that “rehab” is bad, they will suffer, and many will die. Let me be clear on this point: people will ****ing die if they don’t get treatment and scaring them away from good care is hugely irresponsible and potentially complicit!
6. Using the Tom McLellan video was cheap and wrong. I’m mad at you about that. That video is very old, and it is nonsense. Tom has made important contributions to our field, but this is not one of them. Tom suffered a terrible loss and I have sympathy for that. His statement that he didn’t know where to get treatment is silly. He knows very well where good treatment is, and to say treatment doesn’t work and hurts is absolutely unsupportable. I said publicly at the NAATP national conference “Tom: you are not helping by making such statements.”  I believe he knows that now and would not say it again.
7. Some folks have construed your mention of NAATP as a criticism of me and NAATP. I did not see it that way. I saw it as simply telling folks that even the national trade association for this work acknowledges the problem. We do. That’s a good thing and we are dedicated to fixing it. A bad thing would be if we denied that there is a problem.
8. And BTW, these charlatans who run bad centers are NOT NAATP members!
9. Am I using enough exclamation marks yet? (!)
10. Anyway, I really like you guys and I’ve enjoyed talking to you. I hope we can talk some more. In particular, I’d like to talk to you about doing a follow up segment on the good care. I’m sure John can make it funny; he’s a funny dude!
11. Please take a look at this link and see the slides from the conference where I talk about all this mess. I focused on this message: the problems of the field are rooted in separateness and selfishness. The solution is community. We also need to talk about RECOVERY, not just treatment and certainly not this ridiculous word “rehab.” This is health care folks! 
See the NAATP National Presentation Slides here! https://www.naatp.org/training/national-addiction-leadership-conference/2018-conference-information
12. Also, I really want to be on the show!! Call me!
 
Take care,
 
Marv
 
Marvin Ventrell
Executive Director
1120 Lincoln Street, Suite 1303
Denver, CO 80203
888.574.1008
info@naatp.org
naatp.org

Marv!

Outstanding reply. We certainly hope you are on the show!

Thank you for the excellent comment and contribution to the discussion.

-BHE Editors