Questionable Practices, High Costs Still Plague Residential SUD Treatment Space

Even after regulatory crackdowns at the state and federal levels in recent years, many residential treatment programs are still using questionable tactics to recruit individuals for expensive substance use disorder (SUD) services, according to a newly published study in the journal Health Affairs.

For the study, researchers from the Harvard University T.H. Chan School of Public Health conducted an initial audit of 613 residential addiction treatment programs nationwide. Three trained research staff members then posed as uninsured, cash-paying individuals seeking treatment for heroin addiction to collect the data.

The members called programs to inquire about options for acute, short-term care. Ultimately, they uncovered significant differences between pricing and practices at for-profits and nonprofits.


Although many programs required upfront payments, for-profit programs contacted for the study charged twice as much on average ($17,434) as did nonprofits ($5,712). For-profits also made more frequent use of recruitment tactics like travel assistance to sell prospective residents on services, researchers found.

More than 70% of the programs in the study had national accreditation. Even among programs that had third party accreditation and state licenses, high upfront costs and recruitment techniques were commonly used. Plus, a third of all programs offered callers residential admission — usually within a day — before a clinical evaluation was performed.

The nation’s addiction treatment market has become a lucrative one in recent years due to the opioid epidemic, with financial data firm valuing the space at $42 billion. However, amid that growth, the residential treatment space has been dogged by controversy due to some unscrupulous operators engaging in practices like body brokering.


While state and federal governments have attempted to crackdown on such questionable practices in recent years, the study’s findings suggest there’s still more work to be done.

“These findings raise concerns that residential programs, including accredited and licensed ones, may be admitting a clinically and financially vulnerable population for costly treatment without assessing appropriateness for other care settings,” the study’s researchers noted.

The National Association of Addiction Treatment Providers (NAATP), a trade group for the addiction treatment industry, previously addressed similar concerns in a three-year strategic plan published in 2019.

NAATP, in the report, noted that “the treatment field saw a large influx of bad players, profiteers, and patient brokers, all of which required policy responses from leadership” between 2015 and 2018, which necessitated the group to purge a number of its members.

In the wake of the new Health Affairs study, NAATP has reiterated those concerns.

“I do think that it’s still a problem, some of what this article talks about with the hard sells, the deceptive marketing practices [and] fraudulent billing,” Peter Thomas, NAATP’s director of quality assurance, recently told National Public Radio.

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