My Son Is Caught in the Cycle of Patient Brokering

My 22-year-old son with addiction has been caught up in the vicious cycle of detox, treatment and relapsing — all perpetuated by a terrible scheme called “patient brokering.”

With the growing number of drug treatment facilities, many unscrupulous players in the treatment industry are participating in kickback schemes known as patient brokering or “body brokering.” In return for referring a patient to a drug treatment facility, the broker receives a generous compensation of $500 to $5,000. Brokers will offer to share these kickbacks with patients or entice them with substances to leave an existing facility and qualify for another because they have relapsed. These brokers troll AA meetings, coffee shops in popular rehab towns and, in my son’s case, detox and rehab facilities.

My son’s recruitment into this darker side of drug treatment occurred when he met a broker about his age at a Florida detox facility. He persuaded my son and a few others to fly to another detox in California, all expenses paid. After a week in California, they decided to go back to Florida where this broker was able to fly them back to another detox, all expenses paid. The night before leaving, he put everyone up at a hotel on the Sunset Strip providing cash so they could party all night on whatever drugs they could find.

The sad truth is that once these kids were entwined in this scheme, they quickly become a highly sought-after commodity. It becomes very difficult for them to break away from this cycle, as it offers them a means of surviving without financial help or oversight from parents. These brokers are preying on people with brain diseases, building false hope and trust, only to set them up for failure. Patient brokering is illegal in many states; however, it is prevalent in Southern California and Florida. It enables the person with addiction, as they believe there will always be another place to land. And it mocks the efforts of true recovery.

This corrupt practice by players with no credentials in drug treatment, other than experience using substances themselves, has been perpetuated by a combination of events. This includes legislature that needs tighter boundaries, more oversight of treatment centers and stronger regulation of sober houses. The Affordable Care Act (ACA) requires insurers to pay for all substance use treatment including drug testing. This benefit has been highly leveraged by unethical treatment facilities opening a floodgate for opportunistic billing practices. My insurance once copied me on a $20,000 claim for a one-time drug test submitted by a lab I had never seen before. My insurance information was likely passed on or sold, just like bank account numbers are for purposes of identity theft.

Well-meaning laws have financed a billion-dollar industry over the past ten years and have created a trail of millionaires who have sold profitable treatment centers to larger health care companies. Being able to keep children on policies up to age 26 has also fed the industry the largest at-risk population to the doorsteps of these treatment facilities and sober houses with the guarantee they can be perpetually cycled through the system. The business model is not recovery. “The business model is relapse,” explains Alan Johnson, chief assistant state attorney for Palm Beach County, in the South Bend Tribune.

My son has been in dozens of residential and detox programs since he graduated from high school over three years ago. Like most young people, his substance use was propelled by mental illness. His depression and anxiety started around middle school and grew worse toward the end of his father’s battle with cancer. After the death of my husband, my son’s substance use escalated from marijuana and alcohol to prescription drugs. He struggled socially even though he had a wonderful sense of humor, intelligence and a warm heart. He showed great promise and enthusiasm for history, music and writing. Adolescence can be a harsh place for those who feel and observe more in life. His increasing anxiety and chronic depression became so debilitating he had to eventually leave school his sophomore year, suffering another bout his senior year. It was a struggle for his teachers and me to get him through to graduation.

In high school, his psychiatrist decided to try ADHD stimulant medications. My son began to assertively campaign to administer these meds himself or asking the psychiatrist for an increased dosage. It was a constant battle to keep him from intentionally misusing them; I knew then that stimulants were his drug of choice. This was one of my earliest mistakes — that I didn’t take him to an addiction specialist. An otherwise competent psychiatrist, who attended a top medical school and trained in New York City, couldn’t recognize a budding substance use disorder. More emphasis on addiction and treatment needs to be taught in medical schools and other health care fields.

When my son wasn’t depressed, his behavior became more egregious when he was home from boarding school. He had multiple incidents of rage and anger that was always substance-fueled. One such episode resulted in a 911 call that began the trail of legal issues that are still unresolved. He received psychiatric care at a well-known facility for 30 days and was discharged with a diagnosis of an addiction disorder. It was “highly recommended” that he go to a pricey long-term treatment facility for young adult men. They never explained to me or my son that this was at least a one-year commitment until he was enrolled.

He called me almost everyday begging to come home. After eight months my son walked out and took a train to New York City. The next day he awoke at New York-Presbyterian Columbia University Medical Center with no recollection of how he got there after stealing and drinking five tall boys of beer at Penn Station.

I desperately wanted him back home but he struggled to stay sober. He did all right the first month going to meetings, enlisting in a local Intensive Outpatient Program (IOP) and holding a part-time job. After noticing he was withdrawing more from his brother and me and not attending meetings, I became suspicious. Shortly thereafter, he tested positive for over-the-counter stimulants and was discharged from the IOP.

At that point, I couldn’t continue the financial bleed of paying for treatment and sent him to a 30-day rehab in Florida that would take my insurance. Although he did attend a few decent programs in Florida, he had difficulty making the transition into sober living. The longest he lasted at one facility was four months. After leaving the highly structured environment of a residential program, his anxiety and depression quickly kicked in and he relapsed.

He bounced back and forth between a sober house that tolerated substance use (which was eventually shut down) in exchange for attending treatment at an affiliated IOP. Eventually I contacted the regional the National Alliance on Mental Illness (NAMI) office, which was very helpful in suggesting a few reputable facilities. He agreed to enter one and I thought he was making real progress but he left before treatment ended for the allure of more substance use and another shady sober house. The pain of doing “the work” and confronting his feelings proved too painful. Tiring of these living conditions, he eventually asked to return home and agreed to try more local options.

After trying detox and a new treatment program, my son was unable to stay sober and eventually fled to California again with the help of his previous broker. He is still in the Los Angeles area, cycling through facilities.

Both my son and I have been victimized by this broken system. I have entrusted professionals with my son’s health and have rarely felt that he received effective care. It seems to be a business fraught with greed, false hope and ridiculous fees that play on parents’ worst fears and anxiety. I’ve also struggled with the guilt and shame I feel about my son. There’s no shortage of people wanting to give me advice or pass judgment. When uninformed family members or friends feel that my son’s addiction could have been quelled by sending him to college, I am discouraged beyond measure for all I have done in hopes of helping him.

There are still many well-intentioned and excellent treatment programs out there. There are plenty that take insurance and the quality of care is no different than those that charge above and beyond insurance. This I’ve learned the hard way. My experience is partly due to my son’s inability to commit and stay the course. I lost a lot of influence over his decisions once he became a legal adult, which is why communication skills are so important. I was lucky to have a local support group led by a parent coach who educated us on the CRAFT approach. It hasn’t stopped my son’s substance use, but it has helped me keep the lines of communication open even in the most contested moments. Parents need to try their best in due diligence in helping their children select a program that gives them their best shot at change. There is always a sense of urgency in making this decision, but doing research can help. The best resource out there is parent support groups. This is where you will get recommendations and honest feedback from others’ experiences.

It has taken me years before I could understand and accept this awful disease on its own terms. I’ve had internal turmoil over how much support to give my son without inadvertently supporting substance use. “Detaching with love” sometimes seems like a convenient excuse to check out and not deal with the chaos anymore, but at times, it seems like the only thing left to do for my own self-care. But to remove myself from helping him is counter-intuitive to being a parent. So, I feel the constant struggle of walking the thin line between helping and enabling.

But I won’t give up on my son.