Home Newswires
New South of Chicago 100-Bed Facility Approved  E-mail

06/28/2017 -ATIN- The commission that approves new medical surgical and psychiatric facility expansion in Illinois has approved construction of a new psych hospital whose aim reports say is to alleviate epidemic levels of addiction in two counties just south of Chicago.

Link to report...

Treatment Magazine

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Addiction Campuses Opening 150-Bed Ohio Addiction Treatment Facility  E-mail

06/10/2017 -ATIN- Addiction Campuses is well on its way to finishing work on converstion of an Ohio lodge property that will in September become the fifth major treatment facility the Nashville-based provider has opened in as many states over the last several years. Called The Bluffs, the 80-acre property lies just south of Akron in a resort area around Atwood Lake and will have 150 beds when fully operational.

Nashville-based Addiction Campuses was founded four years ago by a group of defecting American Addiction Centers executives led by CEO Brent Clements. The company also operates Turning Point in Southaven Mississippi; The Treehouse, outside of Dallas, Texas; Spring to Life, a faith-based recovery center for men in Woodbury, Tennessee and Swift River in Cummington, Massachusetts. The new Ohio property boasts a 110,000 square foot two-story lodge building, an approximately 3,750 square foot, two-story chalet building and a relatively unusual amenity consisting of a nine-hole golf course. The campus will bring over 200 jobs to the area, including a full medical staff.

Clements told Treatment Magazine that Addiction Campuses will continue to add approximately two treatment facilities to its roster per year for the foreseeable future. There are no firm plans, he said, for a second round of private equity type financing to add to the original $20M venture style financing Clements arranged upon founding Addiction Campuses. He said that so far funds from operations and banks loans leveraging the company's balance sheet have been enough to fund the company's strong growth.

Ted Jackson

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Cliffside Malibu Founder Recruits Top Acadia Exec for CEO Post  E-mail

06/08/2017 -ATIN - In an effort to consolidate its explosive growth in recent years, California's Cliffside Malibu has recruited top executive talent from the world's largest treatment enterprise to become its new CEO. Cliffside Malibu Founder Richard Taite says John Peloquin will take over the chief executive reins amid continued expansion at Cliffside, which Taite says has quadrupled in size over the past three years.

Peloquin was for a short while a top division chief at equally fast growing, NYSE-listed Acadia Healthcare, by far the biggest addiction treatment center operator worldwide. Acadia has been driven by far flung mega acquisitions like its purchase of the U.S.'s largest treatment center owner CRC Health Corp. as well as Great Britain's private treatment behemoth The Priory.  A 13-year veteran of addiction treatment, Peloquin's career stretches back to pioneering stints in the development of California's sober living industry as well as various posts at CRC Health during its highly acquistive period under the leadership of founder Barry Karlin, including serving as CEO of world famous Sierra Tucson in Arizona. He will be focused on building operational ability to execute as well as at the same time maintaining Cliffside's rapid growth trajectory, Peloquin told Treatment Magazine.

While he has been CEO of Cliffside only about a month, Peloquin says he is already in due diligence on a West Coast center acquisition and expects very shortly to be at a similar stage of negociations on several other properties in the region.

Cliffside Malibu has been a stand out success story under the leadership of Richard Taite, who founded the center in 2005. " It is time for new leadership to sustain our ongoing growth and forge new opportunities," Taite said in a prepared statement announcing Peloquin's appointment.

Concerned about prudently managing the scale up of inbound inquiries for treatment amid Cliffside's blistering expansion pace, Peloquin has engaged renowned contact managment outsourcer Salesforce.com as his first major move on the operations side. It's part of an overall effort to partner with key vendors, such as the recent signing of medical software provider Kipu. Peloquin says Cliffside has also made moves in the data warehouse arena as it seeks to manage big increases in records management and outcomes measurement needs.

So far, Cliffisde Malibu has been able to use its own balance sheet to fund growth, according to Peloquin. But he sees a point in the not-too-distant future where a financial partner may likely become necessary. If the current investment climate continues, a high caliber player like Cliffside Malibu should be in the driver's seat when it comes to choosing among the flood of private equity and other financiers interested in addiction treatment. With the appointment of Peloquin, Cliffside is acquiring depth of managment that will only increase its attractiveness as an investment target.

Ted Jackson

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Local Report: NIMBY Hits the Poconos  E-mail
Addiction Treatment Industry Newswire

01/21/2017 - ATIN - Local press out of Pennsylvania's Poconos region is reporting vociverous opposition to a proposal to convert a large resort property in the scenic area that was decades ago an East Coast holiday mecca, but that now is littered with out-of-business resorts.  The Pocono Township Planning Commission has already rejected the project, which investors in the proposed project explained at a recent public hearing  would be a Betty Ford style upscale private center, according to reports.

Vociferous Opposition

Reports said that the planning board had already decided not to reccomend the project, which wouldl convert the former Ceasar's Brookdale Resort in Swiftwater, PA, into a privvately owned and rather large addiction treatment center. Despite it's earlier decision to reject, the board felt it appropriate to hold another public hearing where both sides could air their views.The project is being backed by three individual investors, reports said.

Huge Jailing of Addicts

The report quoted a high state official as saying that as many as 90 percent of addicts in the state that need treatment are languishing in jail due to a lack of access to care,a  proplem that is nationwide. It is doubtful that the proposed center in Swiftwater would do much alleviate this type of problem as their center would be high-end costing as much $50K, very likely for a typical 30-daystay.

NIMBY Huge Impediment to Industry Growth

This is just the latest example of nationwide NIMBY - not-in-my-backyard - local opposition to addiction treatment industry expansion. Residents typically see the gathering of addicts in centers near where they live as a threat when in fact in maany instances new centers can transform neighborhoods for the better. A perfect example is the approximately six acre campus of The Florida House in Deerfield Beach, FL. Owner and fiounder Sherief Abu Moustafa has built one of the largest centers in the country, recently adding a $!2M residential building, that over the last decade has vastly upgraded a neighborhood that was well into a decay spiral. Despite that, he has also had to overcome strong local opposition to his expansion.

Treatment Magazine's Extensive NIMBY Coverage

Treatment Magazine has over the years documenteed dozens of high profile examples of addicction industry NIMBY battles.

Those who might be interested in learning more can go our website www.treatmentmagazine.com and type "NIMBY" into the search function in the upper right of our homepage.

Ted Jackson

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ODs Continue Skyrocket, NJ Gov Amps Addiction Fight  E-mail

01/21/2017 -ATIN- The atmosphere of crisis surrounding addiction in North America ramped up anotheer notch this week as the province of British Columbia announced a sickening 80 percent jump in overdose deaths within its borders and New Jersey governor Chris Christie declared he would devote the rest of his time in offfice to finding ways to combat the surging levels of death and destruction caused by addiction.

Christie One Step Behind Shumlin

Governor Chris Christie, who was unceremoniously dumped off the Trump train by a close Trump associate seeking revenge against Christie who prosecuted his father while Christie was a U.S. attorney years ago, devoted the bulk of his State of the State address to the ravages of adddiction. In this sense, Gov. Christie is way behind the curve compared to other governors like Vermont's Peter Shumlin who in a 2014 pioneering State of State speech devoted its entirety to the issue of adddiction, the first time in U.S. history a governor had devoted the key annual address to a single topic.

BC Reports Huge Jump in Overdose Fatalities

The province of British Columbia, especially due to its geographic location on the far West Coast of North America and ample availability of highly isolated landing points, is one of the greatest crisis locations as those who experiment with drugs find themselves falling into the bewildering time when the drugs finnally reveal themsleves as your mortal enemy after years of posing as a friend. Official statistics in the Canadian province, who's importance is only eclipsed by the heavily populated Ontario where the country's financial capital of Toronto is located, just reported what might be the largest year-on-year jump anywhere in the Americas. Last year just slightly over 500 people died in overdose deaths in BC, while this year more than 900 did so.

Ted Jackson

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Caron Brings High-End Exec Services to Home Campus  E-mail
Addiction Treatment Industry Newswire

01/20/2017 - ATIN- World famous Caron center has found success with its new high-end executive Grand View Program, CEO Doug Tieman and the program's director told Treatment Magazine on a recent visit to the center's home campus. They say that census is running at close to capacity, which is small at just 10 beds. But when Grand View is combined with its high-profile Ocean Drive super high-end program in South Florida, Caron has established itself as clearly among the nation's leaders in the boutique high-end of the treatment business - among the most profitable and highly competitive sectors of the addiction treatment marketplace.

Maximizing Use of Huge Home Campus

Tieman told Treatment Magazine that in building out the Grand View program, work on which was started about two years ago, Caron spent millions renovating a 19th century mansion that is part of the center's expansive 150 acre home campus near Reading, PA, about an hour's drive from Philadelphia. Part of that start-up spend was also spent on buiding new facilities for housing and renovating other buildings. Despite there being a ton of construction and facility change going on at Caron's home campus, the prinicpal project being the $15M Carol and Ray Neag Medical Center that represents Caron's vision of the incorporation of medical models in to its care, disruption and intrusion for clientele is virtually non-existent.

Executives Deserving of Tailored Care

Many are derisive of executive programs, seeing them as elitist and perhaps over pampering. But Tieman disagrees, seeing executives as deserving as anyone else of the tailored individualized care that is at the core of Caron's clinical approach. "From my experience, I know that executives want to be treated by sophisticated therapists who understand and can address their specific needs," says Tieman. "They want to be with likeminded peers who can relate to similar work, family, and financial issues and to be treated in a program that doesn't compromise their professional responsibilities during or after treatment. Grand View takes a clinically superior approach by addressing these critical elements in a comprehensive treatment setting."

Veteran Caron Clinician Heading Program

Heading the Grand View Program is Samantha Smith, a veteran of nearly a decade moving through and up the Caron clinical ranks. Smith is modest and downplays the importance of her as the choice to run Grand View. But clearly top Caron management must have had a very high degree of confidence in her clinical acumen, management skills and interpersonal skills in dealing with a very demanding class of clientele to put her in charge of the launch of the multi-million dollar investment Grand View represents for Caron.

Ted Jackson

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MAP/Aetna Reveal Collaboration: Baby Steps Toward Paradigm Shift?  E-mail
Addiction Treatment Industry Newswire

01/14/2017 - ATIN - In what could turn out to be a historic discussion of the central issues facing the addiction treatment industry, how to take us to the "next level" and finally rid ourselves of the scourge of "orphan status" within the overall medical system, Austin-based MAP will be holding a webinar in which a discussion will be held that will give at least a glimpse of MAP's years long effort to achieve the industry's long sought after "dream deal" with a major health insurer. CLICK HEREt to Listen to Webinar

Powerhouse Aetna Behavioral Health on Cutting Edge

Joining in the webinar with MAP CEO Jacob Levenson, who has devoted mission-like dedication to this effort and millions of dollars of the Levenson family fortune, will be two of Aetna Behavioral Health's most prominent executives: Tony Rocchino and Mary I Anderson MD. Mr. Rocchino runs network management at Aetna Behavioral Health and Dr. Anderson is Medical Director, National Accounts CMST at Aetna.

Treatment Leasdership Collaboration on Unprecedented Level?

A major goal of the webinar is to wave the carrot of the "dream deal" in front of industry CEOs, treatment center owners, non-profit boards and industry thought leaders to encourage them to finally end what Treatment Magazine has witnessed year-in and year-out to be the petty internecine competitive squabbling that prevents the highly fragmented treatment industry from working together on key issues of common interest. In other words, to encourage collaboration among industry players on a scale never seen before so that, once achieved, the basis for moving to the "next level" can be laid.

The Changing Nature of How You Get Paid

The speakers will discuss why collaboration between payor and provider in the form of value-based care is critical for improving clinical and financial outcomes for behavioral health and addiction treatment. In other words, providers are going to see a shift from transactional, fee-for-service pay structure to a quality driven model supported by outcomes that are generally accepted as genuine industrywide. Important in establishing a solid foundation for the success of value-based care will be to ensure that provider, payor and client are all on the same page. And providers must fully understand, and agree upon, the proper definition of value-based care in order that newly defined quality of care standards be consistent and economic for all players large and small.

Explain why Chronic Disease Model Seems More Expensive, But Actually Will be Far Less So

A major part of the discussion will be about how MAP and Aetna have come to be believe that treating addiction as a chronic disease with strong continuums of care - indeed a lifetime of care if necessary in some cases - may seem at first glance to be more expensive. But the webinar will reveal that when in fact the chronic disease model is properly understood, properly executed and widely adopted it will in fact reduce costs dramatically by boosting outcomes and ending the highly expensive "revolving door" of constant readmission of clients into the most expensive acute levels of addiction care.


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NYT, WSJ Editors Hammer on Addiction Crisis Message  E-mail
Addiction Treatment Industry Newswire

01/09/2017 -ATIN- Anyone reading the weekend editions of our nation's two national newspapers, The New York Times and the Wall Street Journal, couldn't help but be left with the impression top editors and news executives have the addiction problem  on the brain - big time. The papers seemed to have finally noticed what has been true for many decades, and even much longer, really, which is that substanvce abuse is this nation's biggest social scourge by far - as it seems to be pretty much everwhere else as well.

WSJ Devoting Extensive Staff Resources

The importance that editors at WSJ are attaching to the addicction surge, mostly focused - and for good reason- on the fentynal-driven opiate overdose death march of late, is the fact that they put a staff reporter on assignment to get an update on whether or not a peak was in sight for ever higher record OD levels, something that was just reported in official Centers for Disease Control stats. The average reader would not understand the importance of a WSJ editor assigning reporter Jon Kamp to do an update on opioid-related fatalities just weeks after release of 2015 official stats showed that it's same story/different day, with OD's far surpasssing auto fatalities etc..But what it shows is that editors are willing to devote scarce and expensive staff reporting resources to get readers news and data on the epidemic addiction crisis in as close to real time as possible. It's akey indicator that at the WSJ addiction has become a very important beat indeed, very often of late getting its reporters major front page play.

Another Multi-Page NYT Opioid Tragedy Take-Out

Frankliy, these multi-page take out pieces the NYT have been running - featuring tatooed miserable looking folks who obviously haven't had a chance to score that day - are getiing to be telling the same story with diferent names every month or so. And given the exhalted demogtaphic that typifies the NYT readership, this type of story might elicit little sympathy.  But at least the NYT seeems to be trying.

Slaughterhouse House Brazil

And then, of course, we had the usual drug war fare, learning that 33 people were murdred all at once in Brazil (too far away to care,  riight?) while in jail. I'lll  let our readers basic intelligence let them figure out who had to know what, paid what, etc... for something like this to happen.....

And round-and-round the endless merry-go-round we go... day after day, week after week, month after month and year after year '....it's the same merry-go-round cause too many have a stake in the status quo and too may turn a blind eye annd to few have the guts to tell the truth.

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Report: VT Center Closes 30-Days on Staff Shortage  E-mail
Addiction Treatment Industry Newswire

01/07/2017 - ATIN - Quite a few years ago Treatment Magazine wrote an extensive report predicting a looming staffing crisis in the addiction treatment industry. One of  the main reasons for  the expectation was an average counselor age of over 50-years-old combined with an inadequate replacement rate by those of youger age groups. Over the past few years the problem has become much worse by a big boom in new treatrment capacity, moving the staff shortage up the food chain into the executivve ranks.

Below is a story out of Vermont we picked up off Google News:

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Addiction Treatment Center to Temporarily Close

Maple Leaf Treatment Center says it will stop accepting new patients for 30 days starting Jan. 15

A Vermont addiction treatment center says it will temporarily close its doors later this month due to a staffing shortage.

Maple Leaf Treatment Center says it will stop accepting new patients for 30 days starting Jan. 15. The closure will only affect its Underhill facility and doesn't include the Colchester outpatient facility.

Source: Addiction Treatment Center to Temporarily Close | NECN http://www.necn.com/news/new-england/Addiction-Treatment-Center-to-Temporarily-Close-409803825.html#ixzz4V7JEYLDm
Follow us: @necn on Twitter | NECN on Facebook

WSJ Exposes VA's Perverse Role in Vet Oxy Rampage  E-mail
Addiction Treatment Industry Newswire

12/31/2016 -ATIN- In a pathbreaking piece of addiction-oriented investigative journalism, the Wall Street Journal has exposed the perverse and highly disturbing role the Veteran's Administration has played in creating a mass of painkiller addicted veterans returning from the seemingly endless Middle East conflicts U.S. armed forces have been engaged in following the two dastardly 2001 terrorist attacks on New York City's World Trade Center.

Excellence and Insight

We here at Treatmant Magazine have nothing to add to the WSJ piece... it's excellence, insight and story-telling speak for themselves...

Same Story, Different Era

We will say this though: from today's contemporary times back to the industrial age, down through the Renaissance and the Middle Ages and even going back to ancient Greek and Roman times, institutions that have been touted as created for the public good and to serve and help the people have often, through either simple mismanagement, outright corruption or even sheer stupidity, wound up doing as much harm as they do good.

Below is the text of the WSJ Article

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The VA Hooked Veterans on Opioids, Then Failed Them Again

The agency overprescribed painkillers to returning soldiers, fueling addiction; now rehab facilities are overwhelmed

By Valerie Bauerlein and Arian Campo-Flores

FAYETTEVILLE, N.C.-Robert Deatherage, a 30-year-old Army veteran who has battled addiction to pain pills and heroin since suffering severe injuries in Afghanistan, says he reached rock bottom a year ago when he holed up in an empty church and tried to kill himself. Twice.

"I was just so sick of being as sick as I was," he says. He put a gun in his mouth and pulled the trigger, but it didn't fire. He says he then used two syringes to shoot all the drugs he had, but didn't overdose.

Mr. Deatherage took the failure as a spiritual sign and walked to the nearby Veterans Affairs Medical Center. The facility didn't have any space and turned him away, offering only a jacket from the lost and found and a phone number for a homeless veterans coordinator. After he picked up his disability check a few days later, he checked into a hotel where he knew other addicts, including veterans.

"It gets discouraging," Mr. Deatherage says. "It makes it easier to just say, ‘F--- it, I'll just keep doing what I'm doing.' "

Shortly after enlisting in the Army, Robert Deatherage was prescribed Percocet for a back injury. Wounds from Afghanistan meant more painkillers.

The U.S. Department of Veterans Affairs acknowledges its role in creating a large population of opioid-addicted veterans by overprescribing painkillers for injuries and post-traumatic stress disorder. After the agency tightened prescribing practices in 2013, many veterans bought pain pills sold illicitly on the streets. When those became too expensive, they sought heroin and fentanyl, a potent synthetic narcotic. The VA is now struggling to undo the damage. Hampered by budgetary and bureaucratic obstacles, it has failed to build a rehabilitation program robust enough to meet the overwhelming demand for treatment from the tens of thousands of veterans with opioid addiction, say analysts who have studied the issue. That has left many veterans to fend for themselves, tapping whatever resources they can find to battle a chronic, complex-and frequently fatal-condition.

In Fayetteville, home to Fort Bragg, the largest military installation in the U.S., 47% of opioid prescriptions are abused, according to an April study by Castlight Health Inc., a health enterprise-software company. Yet the VA health system here has no residential addiction-treatment program, no inpatient opioid detoxification facility and only five doctors in a 21-county area able to dispense medications like buprenorphine, used to treat opioid abuse.

"The Fayetteville VA is one of the worst in the country," says Justin Minyard, a retired Army first sergeant who has battled opioid addiction and testified before Congress about the issue. "There's no help for veterans dealing with the addiction they now have." Elizabeth Goolsby, director of the Fayetteville VA Medical Center, says Mr. Deatherage's "is not a typical story." He should have been sent to the local hospital emergency room if the VA's crisis mental health unit was full, she says.

The Fayetteville VA serves the fastest-growing veteran population in the nation, with 70,000 patients last year, up from 42,000 in 2010. It is moving quickly to meet demand, Ms. Goolsby says. It has added facilities and reduced wait times for primary care to four days, from 29 days in 2014, when an audit found the hospital had among the longest wait times of 700 VA facilities in the country.

The VA is working to increase treatment capacity nationwide and expand alternatives to the use of painkillers, such as acupuncture, says Carolyn Clancy, deputy undersecretary for health for organizational excellence at the Veterans Health Administration. The department also is aggressively addressing the supply of prescription opioids. Since 2012, the peak of opioid prescribing, the VA has reduced the number of its patients on long-term or high-dose painkillers by about a third.

"We owe it to the nation's veterans to help them end their dependence on opioids," said Veterans Affairs Secretary Robert McDonald in a September speech, "and break the downward spiral that all too often ends in homelessness, prison or suicide." More than a decade of war in Afghanistan and Iraq produced a flood of veterans with severe physical and mental conditions. Because of advances in battlefield armor and combat care, serious injuries now have 90% survival rates, compared with 40% in the Vietnam War, according to Rollin Gallagher, director of the national pain management program at the VHA. Yet many survivors are returning with permanent damage, such as amputations and spinal-cord injuries.

While many injured veterans required opioids, VA medical centers prescribed the drugs in too many cases, and often for months instead of days or weeks, department officials now say. The VA treated more than 66,000 veterans with opioid-use disorders in fiscal 2016, according to the agency.
The VA's Mr. McDonald said veterans are 10 times as likely as the average American to abuse opioids and that such abuse is the leading factor contributing to veteran homelessness.
A Human Tragedy
More than 300,000 Americans have died from opioid overdoses since the late 1990s

Military communities are magnets for veterans seeking camaraderie. In Fayetteville, the metropolitan population of 349,000 people includes 77,000 soldiers and civilians working at Fort Bragg, 63,000 active-duty family members and 98,000 veterans and their family members. Units based here, including the 82nd Airborne Division, have deployed repeatedly to the Middle East since 9/11, sending home a steady stream of severely injured soldiers.

Fayetteville has had an active drug scene for years, police say, partly because it is bisected by Interstate 95, a trafficking thoroughfare. The district attorney here says the flood of pills from the military was a key cause of the local opioid crisis, which also affects many civilians. Air Force veteran Ken Grady, 45, says the local VA prescribed him OxyContin, Percocet, Vicodin and fentanyl patches in the 2000s because of a series of surgeries for back injuries. "The VA made it so easy," he says. "It was endless, and I abused it."
When he couldn't get prescriptions, Mr. Grady says he could easily obtain opioids on the street. He has been struggling to get clean, and has spent all but 65 days of the past 2-½ years in VA-funded treatment or in jail, as he is currently.

During one stay at the VA's crisis mental health unit, a doctor in another section prescribed him Percocet for his chronic back pain, he says. "Please don't give me that," he says he told the doctor. Mr. Grady says he has sometimes bought drugs from veterans selling just-filled narcotic prescriptions outside VA facilities.
Last month, Mr. Grady had several teeth pulled by a VA contractor, who prescribed him Vicodin for the pain. Mr. Grady says he protested, but "you don't have to twist my arm too much." He relapsed, bought more pills on the street and landed back in jail. He hoped to be out by Christmas but his mother says it is taking longer than expected to find treatment and a place to stay.

Ms. Goolsby, director of the Fayetteville center, says VA facilities are sprawling public places, and it would be regrettable but not unheard of for veterans to sell pills on campus. She also says the VA has improved its record-keeping to better track prescriptions for veterans with substance-use disorder.

The VA system's treatment options are limited. The Fayetteville VA has an outpatient alcohol detox unit but no opioid detox unit. It refers veterans to other local facilities for detox, the initial period of up to about a week when an addict comes off drugs, endures withdrawal and is stabilized. The VA then refers them to its outpatient substance-abuse treatment program, the much longer process of overcoming addiction and underlying issues through therapy, group programs and medication. The outpatient program has 1,000 visits a month, and saw a total of 2,800 new patients from January to October of this year.

Addicted veterans can be referred to one of the VA's 43 inpatient rehab centers around the country, which combined have 906 beds, according to a 2014 VA audit. Waits are usually longer than 30 days, though, which deters referrals, and beds often stay empty because of lack of staffing, the audit said.
The nearest inpatient VA facility to Fayetteville is in Salisbury, N.C., nearly three hours away.
Given the scarcity of VA services, addicted veterans often turn to public and private providers, which typically are also overwhelmed by demand. Cape Fear Valley Health System has a contract to provide mental-health services for the county, and has 16 detox beds, which stay full.
Cape Fear, a not-for-profit hospital system overseen by county commissioners and other local leaders, has no residential treatment. It sees about 8,000 outpatient cases a year involving opioid abuse and employs only three doctors who can provide medication like buprenorphine to treat addiction. They are limited to seeing a combined 160 patients, and have a month-long waiting list, according to Cape Fear.
Users seeking methadone or other medication to treat their addiction mainly rely on a handful of private clinics. The largest is the Carolina Treatment Center, in an office park behind the hospital. The clinic dispenses medication to 600 patients each day, with lines forming before the clinic opens at 5 a.m.

Alan Shay Davis, a moonlighting obstetrician, started filling in as the medical director three years ago after a loved one became addicted to opioids. His clients range from veterans and active-duty soldiers to stay-at-home mothers and blue-collar workers. "I've been a part of the problem for some patients," he says, by prescribing opioids in his obstetric practice. "Hopefully now I'm part of the solution."
One of Dr. Davis's patients at the clinic is Mr. Deatherage, who is taking Vivitrol, a long-acting drug that attaches to receptors in the body and blocks the effects of opioids.
Mr. Deatherage was the youngest of five children raised by a single mother in Tecumseh, Okla. He idolized his grandfather, an Army helicopter pilot in Vietnam who died of cancer when Mr. Deatherage was 10. Mr. Deatherage says he was determined to join the military: "I thought, ‘I want to become somebody. I want to make a big impact in the world.' "
Shortly after enlisting in 2006, Mr. Deatherage was prescribed Percocet for a back injury from paratrooper training. He says he took pills during most of his deployment in Afghanistan in 2009 and 2010. His armored vehicle was bombed repeatedly while clearing roads in remote areas. He suffered back, neck, facial and shoulder injuries, and cracked his skull in an explosion that he later learned caused a traumatic brain injury.
"I got blown up seven times," he says. "I would go see my medic, get bandaged, get Percs and get on with it."

In his spare time Robert Deatherage tattoos himself. The one on his wrist references a PTSD-awareness movement.
Back home, he was prescribed opioids for his injuries while stationed on the West Coast and in Hawaii. As his tolerance increased, he started buying pills from other soldiers. He lost his marriage, his savings and his job, and was medically discharged for substance use in February 2014.
"They threw me out there and said, ‘Take care of yourself,' " he says. "So I did."
Mr. Deatherage says he sought substance-abuse treatment from the VA over the years, including the spring of 2014 when he says he was told there was a four-month wait for residential treatment. The VA continued to prescribe opioids for his injuries. He overdosed six times, once at his mother's house in Oklahoma. She has trained as an emergency medical technician and revived him. "That's how my family found out," he says. "They thought I was just depressed."

His mother, Louise Johnson, 54, says her son had been fooling no one since he came home with a blank stare and a gallon-sized Ziploc bag full of VA prescriptions.
Mr. Deatherage would call home during his 18 months in Afghanistan and tell her horror stories, like cleaning up after a bomb severed his buddy's leg and fatally shooting a civilian whom he feared was carrying a bomb. "The things that he saw and the things that he did hurt him deep," she says. "As time went by and I saw the destruction the medication was doing, I knew why."
She says she was close to finding a VA facility for him to check into when he left town.
Mr. Deatherage says he bounced around Texas awhile before heading to his brother's house west of Fayetteville in early 2015. By then he could no longer get pills from the VA because of tighter prescribing policies. He got kicked out of his brother's house after stealing his nephew's prescription cough syrup and replacing it with Robitussin. He started using heroin, which was cheap and plentiful.
Mr. Deatherage was arrested for theft and other charges, and spent stretches of the past two years homeless or in jail. He was referred earlier this year to one of two area veterans treatment courts, which allow low-level offenders to avoid prison by completing programs that address their underlying conditions.
In court this fall, Mr. Deatherage, looking thin and disheveled, told the judge he was sleeping in his car and spending half of his $3,000 monthly disability check on child support for his two sons, and the other half on heroin. Court staff arranged for him to start medication at Carolina Treatment Center, and to stay at a local halfway house that has a federal contract to serve up to 18 homeless veterans at a time.
There, he made friends with another veteran in the court program, Reggie Scott. In an interview in the fall, Mr. Scott said he was grateful for the VA's help connecting him to treatment. "I'd be dead without them," he said. But he still felt unmoored and prone to relapse.
In October, Mr. Deatherage and Mr. Scott used heroin together, and both went to jail under the terms of the court program.
Mr. Scott got out in October and kept using. He overdosed on heroin on Dec. 9 and went back to jail. He says he's going to drop out of the veterans treatment program and serve his original sentence.

Mr. Deatherage outside the VA's outpatient mental health building in Fayetteville, NC.
In court last week, Mr. Scott shuffled out of a holding cell in shackles to address other addicted veterans, his father and his mother, who was crying in the front row. "I want to give up. I'm done," Mr. Scott said. "I don't know if I'll ever quit using drugs. But I do love y'all, I do."
"Love you, Reggie!" several veterans said.
Mr. Deatherage was in the courtroom. He got out of jail in November and has been sober more than two months. He starts a 10-week training program in January to be a foreman at a natural-gas company.
He is optimistic that he will finally get clean. "I can't worry about Reggie," he says. "I've got to focus on me."

NY Set for Historic Addiction Services Upgrades  E-mail
Addiction Treatment Industry Newswire

12/29/2016 - ATIN - In one of the most significant public policy developments with regards to fighting substance abuse since the inception of the contemporary addiction treatment system almost 75 years ago, New York Governor Andrew M. Cuomo this week announced that new health insurance reforms aimed at combatting New York State's heroin and opioid crisis will go into effect January 1, 2017. These reforms were part of the landmark legislative package that the Governor signed earlier this year. Once in effect, health insurance plans will be required to cover treatment services provided to New Yorkers suffering from opioid addiction, increase access to treatment, expand community prevention strategies, and limit the over-prescription of opioids in New York.

"Landmark Reforms"
"With these landmark reforms fully enacted, we have removed artificial barriers that prevented New Yorkers from receiving the help they need and put into place new safeguards to get these drugs off the street," Governor Cuomo told the Associated Press. "As families and communities across the nation grapple with the devastating effects of this heroin and opioid crisis, New York is leading the fight to stamp out this disease once and for all."

Legislative Package
The legislative package included several best practices and recommendations identified by the Governor's Heroin and Opioid Task Force, and builds on New York's aggressive efforts to break the cycle of heroin and opioid addiction. These new insurance-related protections are the final components of the package to take effect and include four measures to remove burdensome access barriers for inpatient treatment and medication.

Key Measures

The following are some of the key changes that will allow for greater access to addiction services for New Yorkers:

- End Prior Insurance Authorization to Allow for Immediate Access to Inpatient Treatment as Long as Such Treatment is Needed: Insurers must cover necessary inpatient services for the treatment of substance use disorders for as long as an individual needs them. In addition, the legislation establishes that utilization review by insurers can begin only after the first 14 days of treatment, ensuring that every patient receives at least two weeks of uninterrupted care before the insurance company becomes involved.
- End Prior Insurance Authorization to Allow for Greater Access to Drug Treatment Medications: Insurers cannot require prior approval for emergency supplies of drug treatment medications. Similar provisions that also apply to managed care providers treating Medicaid recipients who seek access to buprenorphine and injectable naltrexone took effect in June.
- Require All Insurance Companies Use Objective State-Approved Criteria to Determine the Level of Care for Individuals Suffering from Substance Abuse: All insurers operating in New York State must use objective, state-approved criteria when making coverage determinations for all substance use disorder treatment in order to make sure individuals get the treatment they need.
- Mandate Insurance Coverage for Opioid Overdose-Reversal Medication: Insurance companies must cover the costs of naloxone when prescribed to a person who is addicted to opioids and to his/her family member/s on the same insurance plan.

Applies Only to Plans as of Jan 1
The new insurance coverage requirements apply to small group and large group plans regulated by the Department of Financial Services that are issued or renewed beginning January 1, as well as plans sold to individual consumers. Department of Financial Services Superintendent Maria T. Vullo told the Associated Press, "The Department of Financial Services will make certain all New Yorkers who need treatment services called for under these groundbreaking reforms have access to the insurance coverage they are now entitled to receive."

OASAS Comments
New York State Office of Alcoholism and Substance Abuse Services Arlene Gonzalez Sanchez said, "These new laws will save lives. They will make it possible for New Yorkers in need to get help when they seek it"


- Increasing Evaluation for Individuals Incapacitated by Drugs from 48 to 72-Hours: Families can now seek 72-hours of emergency treatment, an increase from 48-hours, for their loved one so that they can be stabilized and connected to longer-term addiction treatment options while also balancing individual rights of the incapacitated individuals.
- Requiring Hospitals to Provide Follow-Up Treatment Service Options to Individuals Upon Hospital Discharge: Hospital medical staff must provide discharge-planning services to connect patients who have or are at-risk for substance use disorder with nearby treatment options to provide continuous medical care.
- Allowing More Trained Professionals to Administer Life-Saving Overdose-Reversal Medication: Trained professionals can now administer naloxone in emergency situations without risk to their professional license.
- Expanding Wraparound Services to Support Long-Term Recovery: The wraparound program launched in 2014 to provide services is now expanded to individuals completing treatment including education and employment resources; legal services; social services; transportation assistance, childcare services; and peer support groups.

- Reducing Prescription Limits for Opioids from 30-days to Seven Days: The limit for initial opioid prescriptions for acute pain has been reduced from 30-days to no more than a 7-day supply, with exceptions for chronic pain and other conditions.
- Requiring Ongoing Education on Addiction & Pain Management for All Physicians and Prescribers: Health care professionals must complete three hours of education every three years on addiction, pain management, and palliative care.
- Mandating Pharmacists Provide Easy to Understand Information on Risks Associated with Drug Addiction and Abuse: Pharmacists must provide educational materials to consumers about the risk of addiction, including information about local treatment services.
- Requiring Data Collection on Overdoses and Prescriptions to Assist the State in Providing Additional Protections to Combat this Epidemic: The State Commissioner of Health must report county-level data on opioid overdoses and usage of overdose-reversal medication on a quarterly basis.

Questions? Call or Go To:

Consumers with questions about the new insurance-related consumer protections are urged to contact DFS at the agency's toll-free hotline at (800) 342-3736 or at www.dfs.gov.

This article was derived mainly from an Associated Press wire article with editorial input and changes from Treatment Magazine

During the upcoming new year Treatment Magazine will be conducting a series of interviews with top New York center CEOs to show our readers how these historic policy changes are working on the ground and in practice over time... SO STAY TUNED TO OUR ADDICTION TREATMENT INDUSTRY NEWSWIRE FOR MORE ON THIS IMPORTANT STORY!

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Pharma Execs Charged in Fentanyl Pushing Scheme  E-mail
Addiction Treatment Industry Newswire

12/27/2017 - ATIN - Top execs of a US pharmaceutical company have been arrested for allegedly scheming to overprescribe the highly addictive opiate fentanyl, a key and highly powerful narcotic that is increasingly blended into street heroin. Some say that soaring illegal use of fentanyl as an additive to street opiates is a major driving force behind the current national epidemic of drug addiction that has sent overdose rates to record levels in virtually every region of the country.

Charged were former execs and managers of Insys Therapeutics, Inc. who were arrested earlier this month for leading an allegedly illegal scheme to greatly increase prescriptions of fentanyl-based pain medication across the nation. Those arrested include former CEO and President of the company, Michael L Babich.

Insys' "powerful, and potentially dangerous" fentanyl spray, "Subsys," was approved in 2012 only to treat a small market of cancer patients, according to the indictment. Insys bribed medical practitioners with hundreds of thousands of dollars to hand out a large number of Subsys prescriptions, "most often for patients who did not have cancer," the indictment states.

Not surprisingly, Insys "dramatically increased the volume of prescriptions written for the Fentanyl Spray...generating substantial profits," according to federal prosecutors.

The bribes and kickbacks, which allegedly occurred between 2012 and 2015, were usually disguised as payments for the practitioner giving speeches at marketing events, a typical way that pharma companies influence doctor prescribing. Insys also allegedly lied to insurers who were unwilling to grant payment for Subsys being prescribed to non-cancer patients, lies that helped boost sales of the drug dramaticallly, the indictment alleges.

In 2015, Insys sales reached $331 million. And Forbes reported that the company's founder John Kapoor is a billionaire, among  the country's wealthiest people.

Opioid-related deaths in the United States rose 15 percent from 28,647 in 2014 to 33,091 in 2015, according to data from US Center for Health Statistics.

Ted Jackson


NY Addictions Nurse Charged W Raping Male Patient  E-mail
Addiction Treatment Industry Newswire

12/26/2016 - ATIN-   A Saranac Lake nurse has been indicted on charges that she raped a male resident in her care.

According to published reports, authorities have accused Jessica Dresser, 31, of Plattsburgh, was employed by St. Joseph's Addiction Treatment and Recovery Centers in Saranac Lake.

Dresser faces numerous charges, including two counts of third-degree rapeand four counts of sexual misconduct. She also faces a charge of criminal possession of a controlled substance.

Investigators said the case stems from incidents in February. The victim was receiving inpatient treatment for an opioid addiction.

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Ace Adolescent Center Entrepreneur Scott Sowle In Expansion  E-mail

12/23/2016 -ATIN - Ace adolescent treatment center entrepreneur Scott Sowle will be adding additional residential capacity to his already highly successful Muir Woods youth oriented facility, a center located in Northern California that is backed by San Francisco private equity investors. Sowle has been associated on a founding level with some of the most successful adolescent centers ever on the West Coast, including the pioneering Visions center in Malibu.

Sowle told his alumni and friends through an email blast that in 2017 Muir Woods would be opening yet another residential center. Muir Woods, like the vast majority of centers in recent decades throughout California employs the "six-bed-model" that was started by treatment empresario Richard Rogg with Promises Malibu in the 1990s.

Sowle said the residential expamsion would be through the purchase of the house pictured in this article.

Sowle did not return and email from Treatment Magazine seeking comment.

Ted Jackson


READ OUR SPECIAL REPORT "CALIFORNIA'S SIX-BED MODEL" in our "Special Report" section of the website

New Designer Drug Floods NYC With People in "Zombie" State  E-mail
Florida FBI Sober Living Task Force Strikes  E-mail
Addiction Treatment Industry Newswire

12/22//2016 -ATIN - Under intense pressure due to mounting reports of myriad abuses of all types throughout South Florida's previously unregulated and enormous sober living industry, where there are now likely thousands of sober homes operating in Miami-Dade, Broward and Palm Beach couties, a special and highly secretive FBI task force was created to look into the sober living business in Florida.

Two days ago, the task force made it first arrest and the account is one of the horrific abuse detailed in this particular case involving the first arrest. With a budget of some $225K, the task force has been given the mandate to produce a report by January recommending legislative changes for the state sober living industry, which soon is likely to become a relatively highly regulated industry.

Go to www.pbpost.com...(Palm Beach Post Newspaper)

The story is at the top the "most read" section near the bottom of the newspaper's home page.

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China Oxy Experience Mirroring U.S. Plague  E-mail
Addiction Treatment Industry Newswire - Newswires
12/20/2016 - ATIN - With its tough drug sentencing and long history of devastating and endemic opium addiction in the 1800s, one would think that China might have avoided the kind of OxyContin abuse outbreak that has plagued the U.S. in recent years, .

mundipharma_headquarters.jpgBut in China, due to skyrocketing cancer rates and a big increase in the geriatric age group, the powerful painkiller OxyContin is selling like hotcakes. And using the usual pharma marketing tricks to boost sales, the pharma that manufactures the brand is giving sales a lift through an outreach plan to doctors and even by working with the Chinese government itself.

OxyContin is sold in China by Mundipharma (China) Pharmaceutical Co, a local concern allied with U.S.company Purdue Pharma, which has come under harsh criticism here for its aggresive sales tactics when it comes to OxyContin throughout the U.S..

U.S. Billionaire Sackler Family Big in Oxy

Both company's are part of a global conglomeration of intertwined private enterprises owned by trusts controlled by the the Sackler family, which Forbes says is worth $13B and among the very wealthiest families in the coiuntry.

And now that the reach of the painkiller widens in China, the government is facing the big problems and challenges that come with ever greater use of dangerously addictiive opiates like OxyContin, especially within its vast state-controlled health care system.

In a blatant display of medical and pharma manipulation, doctor training in China regarding drugs like OxyContin uses decades-old reports and research that then downplayed what are now known as the very high addictive risks of strong opiates like OxyContin. Chinese Oxy pharma Mundipharma provides financing for some of this training, as does some on the company's online platforms. This traing reaches tens of thousands of local doctors, often promoting the superiority of OxyContin.

Skyrocketing Synthetic Opiate Sales

While Mundipharma said in published reports that it did not prepare the materials itself, the company may have benefited from its participation in the government's pain management program. Studies on prescription data show that OxyContin sales soared in some Chinese hospitals that adopted the program.

Mundipharma says it has a 60 per cent share of the China market for cancer pain therapies.

In 2007, Purdue Pharma and former and current executives pleaded guilty and paid US$634.5 million to settle criminal and civil actions that said they misled doctors as to the addictiveness of OxyContin.

The above article originally appeared in Bloomberg News and was edited and expanded upon by Treatment Magazine.

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AAC Opens Detox, Residential in New Orleans  E-mail
Addiction Treatment Industry Newswire

12/13/2016 -ATIN - AAC Holdings, Inc., known more commonly as American Addictions Centers, has leased one floor from New Orleans East Hospital to operate 36 in-network beds that will provide detoxification and residential treatment services. The beds are expected to be operational in the first half of 2017, subject to receiving licensure, and will be operated by American Addiction Centers' Townsend clinical staff.

No financial information surrounding the lease nor AAC's estimated costs for setting up the center have been disclosed.

Built in 2014, the 80-bed New Orleans East Hospital is situated on the site of the former Pendleton Memorial Methodist Hospital that was devastated by Hurricane Katrina in 2005. The hospital is operated by Louisiana Children's Medical Center.

"New Orleans East Hospital has filled a critical role in the eastern New Orleans community since its opening, and we're proud to work with them to meet the addiction treatment needs in the greater New Orleans area," said Michael Cartwright, Chairman and Chief Executive Officer of AAC Holdings in a prepared statement.

"This agreement is a new structure for us, and one that we believe can be replicated in other communities across the country. This additional inpatient detoxification and residential capacity enables us to support Townsend's inpatient and outpatient centers as well as other treatment providers in Louisiana."

AAC is the only publicly traded "pure play" addiction treatment investment for investors who want to get exposure to what has been a fast growing sector of the healthcare marketplace, with mergers and acquisitions being highly active currently in the $35B addiction treatment marketplace.

Ted Jackson


Employess Buy Cornerstone NY Using ESOP  E-mail
Addiction Treatment Industry Newswire

12/11/2016 - ATIN - Cornerstone Treatment Facilities Network, more commonly known in the treatment industry as Cornerstone NY, has been sold to its employees using an employee stock ownership plan structure, or ESOP. While Cornerstone NY executives would not provide any financial details of the private transaction, published reports said Connecticutt-based Webster Bank seperately announced it had provided $20M in financing for the transaction.

"Proceeds of the ESOP transaction funded the redemption and sale of shares to the ESOP and a concurrent acquisition of an inpatient treatment facility from a related party. Webster Bank, as sole lender, provided $20 million in senior debt along with $2 million in mezzanine notes from Oxer Capital," wrote ABL Advisor in a recent article published online about Webster Bank's financing of the employee buyout of Conerstone NY. ABL Advisor is a highly specialized publication aimed at the banking industry, according its website.

In an interview with Treatment Magazine, a top Cornerstone NY executive said that Conerstone NY "reached out" to the accounting firm of O'Connor Davies, which the executive said has considerable expertise in structuring company sales to employees using the ESOP structure.

The first ESOP was created in the 1950s by a California newspaper owner who wanted a way to transfer ownership of his company to employees. ESOPs got a big boost in the 1970s when Congress enacted tax breaks to encourage their use. The structure involves the transfer of ownership of company stock into a trust. Banks or other finacial concerns typically finance the transaction in a manner similar to which Webster Bank financed the Conerstone NY deal.

Conerstone was founded by East Coast treatment entrepreneur Norman Sokolow, who has been the treatment enterprise's CEO and had a large stake in the company along with other investors, said Conerstone NY executives who spoke with Treatment Magazine. While Cornerstone NY has been among the most successful for-profit addiction treatment concerns of the last few decades, it has not been without its problems.

According to published reports, Conerstone's Eagle Hill facility near Danbury, CT was put into foreclosure proceedings about 15 years ago by Lutheran General Behavioral of Chicago. Lutheran General Behavioral in the 1980s acted as a major consolidator of treatment centers accross the nation. The attempt by Lutheran General at a treatment industry "roll up" ultimately collapsed amidst a pile of debt when managed care slammed treatment revenues in the early 1990s.

Prior to the foreclosure, Cornerstone's Eagle Hill facility was closed for more than a year by order of state health regulators for failure to follow regulations required under state licensure, according to published reports. Cornerstone NY bought Eagle Hill from Lutheran General, which also financed a portion of its own sale of Eagle Hill to Sokolow and Cornerstone NY, the reports say.

Cornerstone NY currently has large residential centers in Fresh Meadows, NY and Rhinebeck, NY with a total of 260 beds, according to company spokesperson Paul Creary. Cornerstone NY also offers a full continuum of care beyond just residemtial, Creary said.

Advising the Cornerstone NY management team in the transaction was Prairie Capital Advisors, a Chicago-based investment bank with offices throughout the Mid-West and the South, confirmed Prairie Capital marketing exec Wendy Gugora.

Ted Jackson


One-Third Prescribed Opiates Become Addicted  E-mail

12/09/2016 -ATIN - One-third of Americans who have taken  prescription opioids for at least two months say they’ve developed an addiction to the drugs, according to a new Washington Post-Kaiser Family Foundation poll.

In the poll, more than 95 percent of all users initially were prescribed pain killers by a doctor, but less than a third spoke with a doctor about a plan to get off the medication. Opioid addiction and abuse has reached epidemic levels in the United States, with the surgeon general in recent weeks issuing an unprecedented and high-profile report on the growing addiction crisis.


Patrice A. Harris, chairwoman of the American Medical Association’s Board of Trustees and chair of its task force to reduce opioid abuse, told The Washington Post that doctors could do more to work with patients to avoid opioid abuse.

Still, about three-quarters of respondents who initially received their prescription from a doctor said they thought their provider had given enough information about the possible risks of addiction and side effects.

Prescription drug abuse was a major issue for lawmakers and the Obama administration over the past year. Congress passed the Comprehensive Addiction and Recovery Act, authorizing programs to treat and prevent opioid abuse. Funding for the law was included in the 21st Century Cures Act, which is set to be signed into law next week.

Ted Jackson


Execs Red Flag Soaring Addiction Treatment Marketing Costs  E-mail
Addiction Treatment Industry Newswire

12/07/2016 - ATIN- Soaring marketing costs, especially in out-of-network payment modelled treatment centers, have become a key risk factor flagged by the growing swell of institutional money that has been descending on the addiction treatment sector of the healthcare business in recent years.

These marketing costs have become among the very biggest cost and management issues faced by owners of treatment centers as they seek to navigate a treatment market that seems to get more competitive by the day," say treatmet center owners who have have talked to Treatment Magazine.

"Marketing costs are for many centers becoming an existential level crisis," says Alan Stevens, a former top Behaviorial Health of the Palm Beaches executive with direct report to co-owner Jack Coscia, who co-founded the $60M-a-year for-profit with the late Don Mullaney. In fact, Stevens is now advising on a consulting basis a top for-profit center on a range of issues with a particular emphasis on marketing, especially Internet marketing.

Private equity in particular have been active buyers of treatment centers recently, with dozens of transactions closing over the past five years. The trend of private equity interest goes back nearly 20 years, the hallmark early transaction being Bain Capital's 1990s $750M purchase of CRC Health Corp., then the largest treatment center in the nation. Bain cashed out of its treatment play by selling CRC recently to Acadia Healthcare, the publicly traded behavioral health company founded by Psychiatric Solutions founder Joey Jacobs.

High marketing costs are nothing new in the higher end, private insurance pay and private pay sector of the treatment market, a sector that likely represents 10 percent to 20 percent of the $35B-a-year treatment business. At the root of these costs are centers' inability to wrestle themselves out of the monopoly grasp of Google, specifically Google's iron hold on Internet pay-per-click.

It's a vicious circle type thing, with huge $125+ per click prices for top addiction search terms in recent years. Higher and higher marketing costs drive higher prices that are passed on to consumers and insurers, and on an on. Its an issue that has enormous policy implications given the epidemic, high publicity nature of the addiction problem in the U.S. One big center owner revealed to Treatment Magazine a couple of years ago that it cost his center as much as $7K to acquire a single client on an out-of-network or private pay basis.

That the higher end of the treatment business had high client acquisition costs - driven paradoxically by the enormous $40K to $60K monthly stay charges that Malibu centers, for example, routinely get - is not new. When people talk about the treatment "boom" in recent years, they are referring to what has been prinicipally a boom in capacity without a corresponding boom in revenues - a dangerous economic mismatch that typically heralds the popping of an asset bubble followed by financial pain. It's the capacity boom that's new, making competition at the high end of the market increasingly a viscious, cutthroat, beggar-thy-neighbor type game that makes client acquisition evermore a problem.

Investment bankers who are increasingly focused on addiction treatement in recent years say they are aware of this mismatch. "Buyers of treatment centers are now more than ever aware of the risk that marketing costs pose and in some cases are discounting the prices they offer for centers based on that, especially out-of-network payment reliant centers,"

Ted Jackson


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