March 14, 2018 -- The moment someone addicted to alcohol, opioids, or other drugs decides to seek treatment is pivotal.

But the next step -- finding help -- could be fraught with hazards.

"The addiction treatment industry has become very predatory as a whole," says Michael E. Schatman, PhD, director of research and network development at Boston Pain Care. "The consumer seeking help is in a bad position, and he or she is not going to know where to go."

More than 12,000 facilities in the U.S. provide substance abuse services, according to a directory maintained by the Substance Abuse and Mental Health Services Administration. But state licensing requirements differ, and the quality of the programs varies greatly.

Experts say one of the biggest problems is that people seeking addiction treatment rely heavily on Google.

A grand jury in Palm Beach County, FL, issued a report in 2016 citing many offenses that reflect the problems nationwide. Among them, it found that online marketers use Google to hijack the name of reputable centers by buying a Google ad and manipulating the search engine so they show up high in search results. The marketers would then route callers to inept or even dangerous centers, or to centers far from their home, even when nearby treatment was available. The results often led to not just ineffective treatment, but in rare cases human trafficking and other atrocities.

"We call it addiction tourism," says Greg Williams, executive vice president of Facing Addiction with NCADD (National Council on Alcoholism and Drug Dependence), organizations devoted to helping the 45 million people and their loved ones affected by addiction to alcohol and other drugs.

Google's AdWords system puts those with smaller budgets, such as nonprofits and government entities, at a disadvantage, Williams says. His groups and others have been working to stem the abuse, including discussions with Google officials.

Google had already suspended all ads for addiction treatment centers in the U.S. It’s now extended that suspension globally while acknowledging there were more “bad actors taking advantage of those in need,” according to a statement from Google. The statement says the company is continuing to work on the issue and plans to “consult with experts to find a better way to connect people with the treatment they need.”

Besides the AdWords issue, online searching makes it difficult to find out the quality of a program based on its website, says Peter Thomas, a membership and quality assurance officer for the National Association of Addiction Treatment Providers.

Another issue, he says, is that websites that collect information about treatment centers may have direct financial ties to specific treatment providers that are not disclosed. "In these cases, they have a clear incentive to refer within their corporate structure, or to facilities that pay them for leads," he says.

Thomas says his organization views the sale or purchase of leads as unethical. Kurt Isaacson, president and CEO of Spectrum Health Systems, a large addiction treatment organization in Massachusetts, knows about such unethical practices. He says he recently got a call from a referral hotline. "It had no affiliation with any facility and did not provide care," he says. Yet they offered him referrals, guaranteeing 20 to 30 a month for a fee of $50,000.

"We also had an incident where our 800 number was hijacked," Isaacson says. "If you did a Google search on Spectrum Health Systems, up would come a link, and in the link was our 800 number. But when you called it, it went to a call line. It was not easy to get that fixed."

The shame and stigma related to addiction can drive people to use Google or to call 800 numbers, says Williams. There is also the urgency issue -- once an addict agrees to get help, family members typically want to get the person into treatment as soon as possible. "So Google is a natural avenue," he says.

"For any other [health-related] issue, you reach out to your primary care doctor," Williams says. But not for addiction. He says people often spend more time researching a computer purchase than the best addiction treatment program. Another plus for those who don't want to broadcast their need for help: Google searches are private.

Williams applauds Google’s decision to crack down on AdWords abuse. But there are other ways unscrupulous programs can surface, including from a simple search.

"They need to penalize aggregators and other kinds of gaming of the system," Williams says. Google needs to somehow weed out the unscrupulous operators, which he acknowledges is complicated.

A Google representative says the company is working on a long-term solution.

The government could do independent research on addiction treatment centers, Schatman suggests, much like other areas of health. For instance, the CDC  publishes information from U.S. fertility clinics, including information about the number of pregnancies and deliveries a clinic supports.

For addiction treatment, Schatman says, benchmarks such as the percentage of people still "clean" at 6 months, 12 months, and so on could help show how effective a program is.

What can people do to make sure they find a good program? Experts suggest these steps:

  • Get a referral from someone who knows your medical history. If your primary care doctor can't help, find an addiction specialist, Schatman says. Find someone board-certified in addiction medicine, such as through the American Board of Addiction Medicine. The group has a searchable directory on its website. Be sure that person is not affiliated with a specific treatment center.
  • Check out the Substance Abuse and Mental Health Services Administration treatment locator tool on its website. Or visit Facing Addiction's Resource Hub for more. 
  • Find out if a center or program is for-profit or not-for-profit, Schatman says. "I think people are better off looking for a not-for-profit," he says, adding that the odds are also better of finding an effective program if it is linked with a university or teaching hospital.
  • Beware of red flags. "If you make a call to an 800 hotline and it is not connected to a facility," that is a bad sign, Isaacson says. "If they try to put you on a plane and direct you to a facility that is a ways away, that is the next red flag."
  • Seek care in your home community if at all possible, Isaacson says. That will ensure that aftercare, which is crucial, will be available and nearby, too. "You get better outcomes closer to your natural living environment," Williams agrees.
  • Ask questions. Is the program accredited by a reputable organization, such as the Joint Commission or the Commission on Accreditation of Rehabilitation Facilities? "Accreditation is good, but not a panacea," Williams says. His organization is trying to create a certification system.

Addiction programs also need to adopt the model of other health care interventions for aftercare, Williams says. "In oncology clinics, we say, 'What can we do to help you in your recovery?' We don't frame addiction services in that way. We graduate people [from addiction programs] and say, 'Don't drive by a liquor store on your way home.' "

Show Sources

Google representative and statement.Kurt Isaacson, president and CEO, Spectrum Health Systems.Greg Williams, executive vice president, Facing Addiction with NCADD (National Council on Alcoholism and Drug Dependence).Michael E. Schatman, PhD, director of research and network development, Boston Pain Care; adjunct clinical assistant professor, Tufts University School of Medicine.Peter Thomas, membership and quality assurance officer, National Association of Addiction Treatment Providers.Palm Beach County Grand Jury, fall 2016: "Report on the Proliferation of Fraud and Abuse in Florida's Addiction Treatment Industry."

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