The Addiction-Treatment Industry Is in an Ethics Crisis

Dr. Robin Barnett, EdD, LCSW, LCADC, CSAT

Nearly everyone in America knows that our country is living through an opioid epidemic that is addicting and killing millions of our people. In addition to looking at why that is and how we can curb its growth, the more immediate need is to treat those affected by addictions of all kinds.

And more than a few people have stepped up to the plate to “help”.

The problem is, many of those who have moved into the addiction treatment industry have done so without any training or, it would appear, scruples. In a purely opportunistic move, they are taking advantage of both the Mental Health Parity and Addiction Equity Act (which ensures equal funding for mental health treatment—ostensibly a very good thing) and the seemingly endless line of people who need help.

Let’s break that down into the specifics starting with the Mental Health Parity and Addiction Equity Act. The intention behind it is to ensure that those who need mental health care (under which addictions treatment falls) can get it, regardless of their income. Given the millions of Americans who suffer from mental health disorders, this is a much-needed provision.

However, there is little regulation around providers for substance abuse treatment, so the opportunity to defraud the system is terribly easy. One common fraud is the pee scam trend seen among unethical caregivers who bill patients’ insurance for urine tests they don’t actually give. They can bill as much as they like and get paid over and over, sometimes without even meeting with the patient in person.

An even more insidious trend among the morally bankrupt who prey on the thousands of people suffering from drug and alcohol addiction is patient brokering. This has, at times, been compared to human trafficking, and in some cases, this is an accurate description.

In its less sinister form, patient brokering is when a person receives a kickback—referral fees or other compensation—for sending a patient to a specific treatment center with whom they have an agreement. This practice has become so prevalent that sometimes patients themselves are offered cash or, in some cases, even drugs to enter a certain facility.

In its worst form, patients with good insurance or wealthy families who live far from the treatment center (and are, therefore, unable to monitor their loved one’s treatment) are trafficked from sober living home to sober living home, each person facilitating the transfer receiving compensation. Horror stories about patient mistreatment in the most disreputable “treatment” centers include lack of basic personal hygiene supplies, food, and a proper room to live in. Sadly, it is not uncommon for patients to continue to use drugs in these settings—often supplied by the people who run the facilities—and die. Yet prior to their deaths, their families had no concept of where their loved one really was and how they were treated.

The National Association of Addiction Treatment Providers has responded to this rampant unethical treatment by establishing a firm anti-patient brokering component to their Code of Ethics. It says: “Patient brokering is prohibited. No financial rewards, substantive gifts, or other remuneration may be offered for patient referrals. NAATP members must not provide compensation for a patient referral. A NAATP member must not charge or receive compensation for providing a referral.”

Other individual treatment providers who have dedicated decades of ethical treatment to those who suffer from substance use disorders have also written clear and strict codes of ethics for others in their industry who want to protect the integrity of this profession.

Still, with little to no serious regulation (or enforcement of any regulation) around drug and alcohol treatment and unscrupulous people happy to take advantage of the broken system, patients will continue to die as they slip between the cracks. If you are seeking addictions treatment for you or someone you love, do you your homework and thoroughly vet any provider or facility you’re considering. Visit it in person and never accept any gifts as an enticement to enter a program. Remember, if it sounds too good to be true, it is.


  1. Maryland Addiction Recovery Center. (2016). The Underbelly of Addiction Treatment: A look at the Unethical and Illegal Practices of “Saving Lives”.
  2. The National Association of Addiction Treatment Providers. (2017). Code of Ethics.


Dr. Robin Barnett, EdD, LCSW, LCADC, CCS, CSAT is a Licensed Clinical Social Worker, Licensed Clinical Alcohol and Drug Counselor, Certified Clinical Supervisor, and Certified Sex Addiction Therapist. She is involved in the fabric of several TV shows, and has appeared on FOX, MTV, CNN, CBS, and NBC. She is currently seen on the Steve Wilkos Show as an Addictions Expert. Her book, “Addict in The House: A No Nonsense Family Guide Through Addiction and Recovery” is the “Go-to” book for thousands of families trapped in this dangerous dysfunction.  Following a successful private practice, Dr. Robin co-founded a highly respected Addictions Treatment Center. She now brings her years of experience and education to the world through her various tv appearances, public speaking, educational and e-therapy services.