This article was written by Andrew Walsh. He is a grad student of mine at the Rutgers School of Social Work. This is the first of three articles that he is writing under my guidance this year.
In response to the increased demand for substance abuse treatment, several facilities have created addiction hotlines as a means of steering clients to their facilities. Over the last two years, there has been a dramatic increase in both print and radio advertisement regarding those hotlines. These advertisements assure the viewers and the listeners that help is a phone call away. This increased focus on advertisement is a response to legislation being drafted in New Jersey that will make substance abuse treatment more accessible and provide longer stays. With the passage of this legislation, substance abuse treatment will become an even bigger business in the state of New Jersey (but to be clear, the abuses by the for-profit treatment industries’ addiction hotlines is a national problem).
To gain an inside perspectives of how these hotlines operate and the services they provide, I decided to call a few, posing as a twenty-seven-year-old individual looking for substance abuse treatment. Every intake specialist followed a similar script:
- Seeks to befriend
- Asks about insurance
- Asks about substance use
- Diagnoses as dual diagnosis
- Asks about family psychiatric history
- Pressures to get into treatment immediately
The first hotline I came across was from a simple google search for “addiction hotline.” I was brought to a website that provided a twenty-four-hour hotline which promised free help. I browsed the website but was unable to determine which facility it was associated with. Having exhausted my search of the website, I picked up the phone. I was not prepared for what followed. As the phone rang I assumed the mindset of an individual who was struggling with alcohol addiction; scared and lost. I was greeted by an individual who identified himself as Jay. He started by asking how he could help me and why I decided to call in. I described how I was struggling with dealing with the pressures of full-time work and full-time graduate school and how my alcohol consumption had increased dramatically in recent months. Within the first two minutes of our conversation Jay was inquiring about whether I had insurance or would pay for treatment out of pocket. Upon verifying my insurance, he informed me that my drinking was not my problem, but rather that alcohol, “was not a bottle in my hand but rather Tylenol.” Jay detailed how I needed a dual diagnosis facility because I was suffering from a substance use disorder and a psychiatric disorder. Jay made this diagnosis after talking to me for less than five minutes. In the next few minutes, Jay went through questions ranging from my history of substance use to my family history of psychiatric disorders. Ten minutes after our conversation started, he was detailing the facilities that they had in New Jersey, California, Florida, Nevada, Louisiana, and Missouri. I expressed a desire to stay in New Jersey, and Jay readily assured me that this was possible. He was thrilled to hear that I was seeking treatment immediately and took my information so he could contact me after speaking with the facility in New Jersey. As our conversation ended, I asked Jay if I would be able to get in the next few days. He assured me that I would, stating, “If it was me I would start doing laundry”. Fifteen minutes after I picked up the phone, I was diagnosed as needing an in-patient stay in a dual diagnosis facility by an individual who I had never spoken to in my life before.
The next company I investigated specializes in recovery villages. Within two minutes of getting onto the website I received a live chat message from an employee. There was a message on top that stated, “Don’t wait another day. Help is a phone call away.” The message provided the hotline number to call. As I dialed the number I again assumed the mindset of an individual struggling with drug addiction. My phone call was answered by Trevor, an intake specialist. As I explained that I was calling because I was struggling with alcohol abuse, he congratulated me for having the courage to pick up the phone. Trevor quickly asked about my insurance and I provided him with the details. He then described the various locations they had facilities: Colorado, Florida, and Washington. Trevor also asked me a list of questions ranging from history of substance use to my family history. He assured me that he was only there to provide options to individuals seeking treatment and that the average length of stay was 30 to 45 days. Trevor believed that the facility in Colorado was a good fit for me and inquired if I would purchase my own airline ticket or whether I would need the facility to purchase my ticket and bill me later for it. He told me that the cost of an airline ticket would not prevent me from receiving treatment at their facilities. Trevor detailed how the staff in Colorado all had master’s degrees and were in recovery themselves. He went as far as to offer to speak to my mother to inform her of how I was struggling and needed an in-patient stay for substance abuse. Our call ended with Trevor telling me how he was proud of me for reaching out for help.
For the final program, I was on the facility website when I received a live chat message from an employee named Chris. As I was browsing the available locations, I decided to engage with Chris and inquired if they have any facilities in New Jersey. He responded that they have facilities all over the country with placement determined by the medical staff. When I told Chris that I was seeking services for myself he stated, “I am so proud of you for reaching out!” I told him that I could not talk on the phone currently but wanted to continue our conversation via live chat. After a delay, he responded that he was happy to continue. At this juncture, our conversation took a negative turn. Chris apparently forgot that I was inquiring about treatment for myself and instead continued to reference the individual looking for treatment as “he.” Chris’s focus moving forward in our conversation was solely based on my insurance coverage. He did not inquire about my substance use, about any psychiatric issues I was struggling with, or any personal information about me. Every message he sent me was about my insurance coverage. I asked Chris explicitly a second time if they had any facilities in New Jersey and he replied, “Remember, we are all over the country. Let’s leave this up to our doctor to determine the kind of care that is needed.” He then wrote, “Trust me, you are in very good hands.” I found this to be both frustrating and alarming since he would not answer my direct question, especially since I had researched the company before our conversation started and knew with certainty that his company did not have any facilities in New Jersey. Chris instructed me to call him later and our conversation ended.
From my conversations, I identified several areas of concerns:
- Each intake specialist acted as a friend, quite often exhibiting unprofessional behavior
- On every phone call I was relentlessly asked about my insurance coverage
- All the intake specialists were quick to diagnosis me after only speaking to me for a few minutes (this brings up another issue: are they qualified to diagnose?)
- During the subsequent days following my conversations I received dozens of phone calls, voicemails, and text messages regarding treatment options
- Not only were these calls from intake specialists that I spoke with, but also from people and facilities I never spoke with
These trends underscore the take away from this exercise. Every single intake specialist I spoke with and their respective facilities viewed me as a source of revenue instead of as a person.
|Act Like Friend||Asks About Insurance Within 1st Minute of Conversation||Asks About Substance Abuse||Diagnosed with Dual Diagnosis||Asks About Family Psych History||Excessive Follow Up Phone Calls|
This exercise helped illustrate the behavior of intake specialists working for hotlines. These intake specialists are not acting illegally. Their actions and processes are an industry wide practice. Intake specialists are diagnosing over the phone after a five minute assessment without clear credentials. Interaction with the intake specialists at these hotlines is reminiscent of dealing with a used car salesperson; the client feels that they have been worked over. One last step I took was calling all the hotlines again, this time posing as a twenty-six-year-old with no insurance or money seeking substance abuse treatment. The longest phone call lasted three minutes. I was provided a referral to the SAMHSA hotline. Unsurprisingly, I have yet to receive a voicemail or a text message from any of the intake specialists looking to check in on their “buddy” now that I do not have insurance.
Andrew Walsh, MHRM, MSW Intern, is an addiction triage specialist for Carrier Clinic. He is currently pursuing his MSW and LADC at Rutgers University. Prior to returning to Rutgers, he worked in the Gulf of Mexico oilfield as an internal business consultant. Andrew is a lover of books, cuisine, and theater.