Written by Marchelle Abrahams,
For decades, addiction was treated as a criminal problem. And then research suggested that we view it as a medical condition and address it as such.
This understanding is now helping rehab centers take a more holistic approach in treating millions of people with a substance use disorder (SUD). But the divide remains.
Even with all the evidence pointing towards addiction as a moral failing, many experts believe that SUDs and crime are inextricably connected. Add physician and author Dr. Gabor Maté’s unshakable views as a coping mechanism for unresolved trauma, and the discourse becomes deafening.
It doesn’t matter which hypothesis you subscribe to: criminal, medical or trauma. The question is how you treat it. Rehabs are at the center of this paradigm. And treatment is an industry too.
A Broken System?
Talk to enough people in recovery, and a common thread emerges: one where patients feel misled, pressured, or exploited.
This isn’t a reputational issue. It’s a clinical one. As a rehab counselor, you know that when trust diminishes, outcomes suffer. Dropout rates rise. Relapse risk increases.
Oftentimes, patients feel taken advantage of in treatment centers. So, what can you do to fix it?
The Trust Gap: Where It Starts
A study published in the National Institutes of Health sought to identify barriers to optimal inpatient rehabilitation outcomes among patients with spatial neglect (SN).
It was determined that specific needs, such as family support, training, and treatment engagement, were strong predictors of recovery outcomes. However, engagement depends heavily on trust. And trust is what many patients say is missing.
Across forums like Reddit, a recurring theme appears: “I don’t know who to trust.” That uncertainty influences every interaction from intake to discharge.
One Redditor posted a desperate plea to find a real treatment program that wasn’t “predatory.” The responses ranged from empathy to helpful advice to join a program that offers CBT, trauma work, and relapse prevention.
Lack of Transparency Around Costs and Insurance
Patients regularly enter treatment without understanding what their insurance will cover. Or what they’ll owe out of pocket.
Unexpected bills can put them back, psychologically. Cases involving lawsuits reinforce this perception.
Case Study
A 32-year-old patient enters a residential program believing her insurance covers 30 days. She’s discharged after 10 due to coverage limits. She receives a bill for the remaining balance. The patient leaves feeling misled, even if the provider followed policy.
The Fix
- Walk through insurance coverage line-by-line before admission.
- Provide written cost estimates (and update them as needed).
- Assign a financial liaison patients can reach.
Transparency upfront reduces resentment later. It’s that simple.
Forced or Coerced Treatment
In some states, civil commitment laws allow individuals to be placed in treatment without consent.
In Idaho, for instance, only a peace officer or qualifying members of medical staff can initiate an emergency evaluation, per Idaho Code 66-326. The Treatment Advocacy Center (TAC) recommends that family members directly file an emergency court order for court-ordered treatment.
Case Study
A young adult in Ada County is admitted under family pressure. They feel stripped of autonomy and resist participation. Even after transitioning to voluntary care, they remain disengaged.
The Fix
- Acknowledge the patient’s lack of control openly.
- Share programs for mandated treatment in Ada County with the family.
- Shift toward collaborative goal-setting as early as possible.
- Reinforce autonomy in small ways.
Icarus Wellness and Recovery advises counselors to use involuntary commitment laws as a guideline to obtain court-approved treatment providers.
Patient Brokering and Questionable Referrals
Patient brokering, where individuals are referred to specific facilities in exchange for financial incentives, has become a major concern.
Families report being steered toward programs that benefit the referrer rather than the patient.
Case Study
A parent seeking help for their son is contacted by multiple “advisors.” Each pushes a different facility, sometimes in another state. The son cycles through programs without improvement. The family later learns those referrals were financially motivated.
The Fix
- Be transparent about referral relationships.
- Avoid commission-based referral structures.
- Focus on clinical fit over bed availability.
Patients can sense when they’re being “placed” instead of helped. Counselors should make clinical reasoning visible.
General Treatment Plans
Patients report feeling like they’re being pushed through a system rather than treated as individuals.
Standardized approaches don’t work for everyone.
Case Study
Two patients with different trauma histories receive identical treatment schedules. One engages. The other shuts down.
The Fix
- Tailor treatment plans to individual histories and goals.
- Adjust pacing and modalities based on response.
- Involve patients in treatment decisions.
Personalization now becomes a requirement for buy-in.
Poor Communication from Staff
Confusion around rules. Expectations and progress. When these aren’t communicated to them, patients get stressed and anxious. And that leads to mistrust.
Patient satisfaction impacts recovery outcomes, patient adherence, and the facility’s reputation.
Case Study
A patient violates a rule they didn’t fully understand and faces consequences. They interpret this as unfair treatment instead of a misunderstanding.
The Fix
- Set clear expectations from day one.
- Repeat key information regularly.
- Encourage questions without judgment.
Clarity builds safety, which builds trust.
The ‘Revolving Door’ Experience
Some patients cycle through multiple programs without lasting results.
The New York Times recently reviewed a book by investigative reporter Shoshana Walter on systemic issues in parts of the rehab industry, including profit-driven practices.
Case Study
A patient attends three facilities in two years. Each promises a fresh start. None address underlying trauma. The patient begins to believe rehab itself is the problem.
The Fix
- Concentrate on continuity of care beyond discharge.
- Build realistic expectations about recovery timelines.
- Address root causes, not symptoms.
Recovery isn’t a 30-day event. Treating it like one sets patients up for failure.
FAQs
1. Why do patients distrust rehab programs?
Many patients report unclear costs, inconsistent communication, and feeling like decisions are made for them rather than with them.
2. Does forced rehab work?
It can stabilize individuals in the short-term, but long-term success improves when patients transition to voluntary, engaged participation.
3. How can counselors improve patient engagement?
By involving patients in decisions, setting expectations, and showing measurable progress throughout treatment.
4. What is patient brokering, and why is it harmful?
Patient brokering involves referrals driven by financial incentives rather than clinical need, which can lead to poor treatment matches and repeated relapse cycles.
Key Facts at a Glance
| Insight | Source |
| Treatment engagement is a key predictor of recovery success | NIH (2021) |
| Patient satisfaction improves with better communication | Net Health |
| Patient brokering continues to impact treatment quality | Partnership to End Addiction |
| Outcome tracking improves care effectiveness | NIH (2024) |
What Counselors Can Do Differently
Fixing these issues starts with small changes.
Be transparent, even when the truth is uncomfortable. Treat patients as partners, not participants. Prioritize long-term outcomes over short-term metrics. Build trust intentionally, not passively.
Patients don’t expect perfection. They expect honesty.
Author Bio:
Writer by day, dream catcher by night. Marchelle Abrahams cut her teeth during the infancy of the internet when the dial sound of the modem was more than a soundbite at a rave. Not a Millennial and not a Boomer, Marchelle is an in-betweener, making her a special breed of human. As a qualified journalist, Marchelle believes her superpower is stringing a few words together and people reading them. That, and the ability to take her kids on with her unique brand of gnarly comebacks.
Please also review AIHCP’s Substance Abuse Certification program and our CE courses as well, to see if they meet your academic and professional goals. These programs are online and independent study and open to qualified professionals seeking a four year certification