An individual in long-term recovery who worked in the treatment field teamed up in 2011 with a filmmaker with no previous exposure to the subject of addiction to examine the practices of the treatment industry. The result of their work, a documentary that will have its official premiere April 26 at a film festival in California, paints an altogether unflattering picture, arguing that the nation's substance use problems have worsened at the same time as the field's revenues have soared.
“The Business of Recovery,” which was shown in March at the Phoenix Film Festival and will be featured twice next week at the Newport Beach Film Festival, features interviews with treatment center executives, research experts, and addicts and their family members who sought to navigate what they often saw as an uncaring and money-driven treatment system. Producer Greg Horvath says he started working on the film four years ago with director Adam Finberg because “I started to question a lot of what we do. You can only see it so many times not working.”
Some of the family members who appear in the documentary say their loved ones endured numerous frustrating treatment experiences from many providers. Susan Colasurdo, whose young adult son Michael died of a heroin overdose three months after he was interviewed for the documentary, said in the film in reference to the facilities her son had visited, “Not one of them has done anything different from the others.” Being left in the dark about what their expenses were paying for is a frequently cited complaint among the family members interviewed for the film.
The documentary reserves some of its strongest criticism for 12-Step approaches to treatment, citing that while a 1998 national sample of private facilities found that 90% based their treatment on a 12-Step model, only around 5 to 10% of patients are substantially helped by this approach (the latter figure is stated in the film by retired Harvard Medical School professor and 12-Step critic Lance Dodes, MD).
Prescription for improvement
While Horvath and Finberg tell Behavioral Healthcare that the film does not set out to offer a solution to shortcomings in the field (they say they prefer to let viewers judge what they see), the documentary does offer hints to some alternative strategies. Presented by interviewed sources such as Dodes; addiction medicine specialist Stuart Finkelstein, MD; University of New Mexico emeritus professor and Motivational Interviewing (MI) expert William Miller, PhD, and SMART Recovery president Tom Horvath, PhD (no relation to the film's producer), these suggestions include:
More of a strict science-based approach to treatment. Miller says in the movie that some addiction field leaders will call a treatment “evidence-based” if just one study shows a basis for it—even if dozens of other studies call the approach into question. Greg Horvath says too much of what happens in addiction treatment is based on “passion and belief,” adding, “We don't treat cancer that way.”
A commitment by government to regulate the industry more closely if it will not police itself better. The film offers sharp criticism of sober home operators in this regard, with Michael Colasurdo saying “They're not so sober” and acknowledging that one home where he stayed conducted no drug testing and routinely allowed residents to leave the premises on evenings and weekends.
Stronger education and credentialing requirements for clinicians. Dee-Dee Stout, a consultant and counseling professional, admits in the film that the fact that she herself started working with addicted patients after she had just nine months of sobriety and no educational background in the field amounts to a “scary thought.”
Clinical services that are less heavy on educational lectures and coercion and look more at the factors that motivate individual patients.
A more systematic approach to measuring the success of treatment, moving away from efforts that rely solely on patient self-report. “I don't understand how an industry that has never defined what success means can be allowed to cite success rates,” says Greg Horvath.
Tom Horvath tells Behavioral Healthcare that the movie is “upsetting,” adding, “It is a reminder of the abuses in the substance abuse treatment industry that I have been aware of for so long that I have been desensitized to them.” He says, “Fundamentally it's an appeal to ethics and science.”
The producers compare increasing death rates from drug overdoses to declining death rates from cancer, stating that the latter field's work is paying off for patients because it is governed by science. The film also cites statistics on climbing revenues in the addiction treatment industry, and lists the high salaries of some nonprofit facility executives.
The filmmakers say they are currently planning next steps following the Newport Beach event, as they have received numerous requests to screen the documentary and also are looking to reach a distribution deal.