American Substance Use Disorder Treatment Is a Predatory Cash Grab

June 15, 2026

Joshua Bennett-Johnson, Author, LADC-II, Licensed Counselor 

Tom O'Connor, Publisher

There has been an increase in predatory practices in the substance use disorder treatment industry. As a therapist in private practice, I work in parallel to the American treatment practice. I've even worked directly within it, in three different clinics over the span of 14 years.

Burn and Rebuild 

I often have clients who require a higher level of care than what I can provide, perpetuating a need to encourage those individuals in the direction of the business of private drug & alcohol treatment. There are a few programs I trust to provide my clients with high-quality care. I can count them on one hand. So, I make the referral while simultaneously wishing I could burn the entire system into a pile of ashes and rebuild it for the good of the community. 

Why? The for-profit model of substance use disorder treatment has transformed a staggering public health crisis into an extremely lucrative money-making machine. Valued at tens of billions of dollars, this healthcare sector prioritizes profit margins over patient outcomes. There are some exceptions, but again, they are few. And I live and work in one of the most progressive and esteemed locations in this nation, Boston, with a strong reputation for "high-quality medical care". 

Rather than delivering evidence-based medical care that helps to create positive, long-term outcomes, the US model amounts to a predatory cash grab. Deceptive marketing, undeliverable promises of guaranteed positive outcomes, unscientific treatment modalities, patient brokering — the industry not only fails to help individuals get well but also stands to perpetuate the very "disease" it claims to cure. It keeps the money train a'rollin'. 

Health Insurance Industry and Substance Use Disorder Treatment

At the core of the for-profit treatment model lies a fundamental, ethical conflict of interest: a "cured patient" ain't gonna earn more money for these programs. Healthy individuals don't wake up one day telling themselves, "Life is going great! I think I'll go check myself into treatment!" 

True recovery requires long-term, ongoing, community-based support: stable housing, mental health care, and often medication-assisted treatment (MAT). 

However, the most profitable segment of the industry is short-term, high-acuity "rehabilitation". The industry refers to them as "residential programs". They typically provide anywhere from 4-6 weeks of stabilization and care. When insurance companies cut their policyholders off due to the high costs of that introduction to care, these same residential programs offer lower-cost outpatient services that allow patients to continue in their programs. 

Insurers will generally feel comfortable allocating markedly less revenue to allow the individual a bit more time to receive care for their difficulties. But rest assured, that time won't last long. They, the insurance companies, decide when a patient has gotten "enough" help, even if the individual is obviously not ready to leave treatment. 

Actual clinicians have ZERO leverage in proving that a person is still in need of more help — the same clinicians who have earned the expertise at the level of master's degrees, doctorates, even MDs, to properly assess how well (or not) the patient is doing within their recovery. It's all up to the insurance companies to determine. They make the rules, break the rules, change the rules. They are the rule. 

They love taking policyholders' money each month, jacking up their premiums & deductibles, but best believe: they don't like giving it back. They're loyal to their shareholders & their bottom-line profit margins. Rest assured: they care not a single fuck about you, me, or anyone struggling with a health crisis. Any health crisis. It's not limited to substance use. 

Substance Use Disorder Spa Facilities

For-profit facilities routinely charge between $20,000 and $80,000 per month for a one-month residential stay. Luxury amenities justify these exorbitant costs. A limousine ride from the airport, resources ranging from equine therapy, private chefs, private rooms with oceanfront views — a veritable spa-like atmosphere, rather than clinical excellence. 

Because commercial insurance typically covers these high rates for only 20 to 30 days, facilities have a financial incentive to maximize intake, exhaust the patient's insurance benefits, and then discharge them with minimal, if any, personalized and possibly effective aftercare.

This dynamic creates the "revolving door" phenomenon. When I was doing per diem group therapy at a highly regarded local program for much of the past year, I asked a client about their experience there. They informed me it was their 3rd go-around receiving treatment there in the past 2 years. 

"Josh, this place is just a revolving door of relapse," they told me, "Most of the people in this group? They've been here multiple times, too."  

When a patient inevitably relapses due to a lack of robust residential and outpatient support, they are often readmitted to the same program, or sometimes a "sister facility" — two facilities that refer patients back and forth to one another, like a game of hot potato, it reignites that highly profitable billing cycle. 

Brilliant Business Model

Brilliant business model for our beloved free-market economic model. Essentially, in a purely capitalistic framework, chronic relapse is not a clinical failure; it is an unending, sustainable business model. It equates to serious wealth at the expense of serious help. 

It's also very often built on deceptive marketing and shady business practices. To maintain a steady influx of insured individuals, the for-profit industry relies on aggressive, ethically compromised marketing strategies. 

After all, with thousands of competitors to contend with, "playing dirty" gives treatment programs an effective edge to "maximize the census", regardless of whether or not their program is a good fit for that particular individual's needs. 

A prominent example is "patient brokering," a practice where call centers and digital marketing firms masquerade as independent addiction helplines. They are the ones with serious dollars to manipulate search engines into placing them at the top of page one when a loved one is searching the web for help for their son, daughter, spouse, beloved friend, and so on. 

Read: What Is Body Brokering In SUD Treatment Centers?

When the vulnerable individual or their family calls seeking help, these BS entities assess the caller's insurance policy first, rather than their actual clinical needs. The patient is then sold to the highest bidder, to put it plainly. Very few individuals will ever scroll past page one on that initial web search. 

It's called search engine optimization (SEO). The big-money players manipulate and hijack local search results for real people seeking real help in real life-and-death crises. Anxious and panicked, a family searching for a local, affordable public health clinic will often be subtly redirected to an out-of-state luxury facility. 

This commodification of human suffering strips patients of their agency and diverts them away from localized, evidence-based care networks. In short: good care, administered by good treaters, and often at a fair price point. Those are the programs that lack the enormous resources to land at the top of page one, because they do the work for the right reasons and honest principles. They want to try to help problematic users truly heal. 

Despite the American Medical Association's (AMA) scientific consensus that addiction is a complex neurobiological "disease", many, if not most, for-profit facilities rely heavily on outdated or unproven treatment methods. They do this on purpose, for the record. 

A significant portion of these centers reject or underutilize FDA-approved medications for opioid use disorders, such as buprenorphine and methadone, which clinical data proves to reduce mortality rates in opioid users by upwards of 50 percent or higher.

Instead, many centers mandate strict abstinence-based, 12-step models as their primary clinical model. While peer-support groups like Alcoholics Anonymous are highly valuable as free, community-based tools, translating them into an expensive, involuntary residential model has ZERO clinical justification. Why? It's not evidence-based care. 

By focusing on experiential therapies and isolating individuals from their real-world environments, these facilities purposely do not address underlying traumas, socioeconomic stressors, and co-occurring mental health difficulties that drive substance use to begin with — this all but assures that the individual in early recovery is going to have a difficult transition when their benefits expire, and they are shown the exit. 

Detoxification

The consequences of this system extend far beyond financial exploitation. The for-profit model of care actively exacerbates and promotes the substance abuse crisis. When a patient undergoes a forced, rapid detoxification in a residential setting, without being able to access long-term MAT or comprehensive and personalized, evidence-based aftercare, their physical tolerance to their substance of choice drops precipitously. In short, it makes them exponentially more at risk for not just relapse, but accidental and often fatal overdose. This is particularly true in the era of highly potent synthetic opioids like fentanyl contaminating the street drug supply. 

By replacing evidence-based medical continuums with fragmented, high-cost interventions, the industry leaves patients more vulnerable than they were before entering treatment. I've had hundreds of clients literally tell me that they felt worse after leaving treatment than when they first arrived seeking help, with a modicum of hope. 

Ultimately, treating drug and alcohol abuse as a commodity rather than a medical condition ensures that public health resources are consumed by corporate profits rather than effective care. Until or unless systemic reforms mandate strict clinical accountability, legislate penalties for predatory marketing, and integrate evidence-based treatment into a regulated healthcare infrastructure, the for-profit rehab industry will remain a perfect, predatory machine that capitalizes on a national tragedy.

And, the owners of these programs? The insurance companies? The shareholders? They love the results. Because, as we've all been conditioned to believe in this American Society, getting filthy fucking rich, no matter the human cost, is the absolute zenith for which we should all be striving. 

As long as it's not happening to them personally, or to someone they love, I suppose…

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Read Joshua's bio by clicking his icon at the start of this article.

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