127: Addiction Treatment is a Cesspool; Here’s How I Would Navigate It with Heidi Voet

Where can you turn when a loved one is in the throes of addiction and needs help? How do you know what professionals to trust and if a treatment center is reputable? So many questions surround the topic of addiction treatment, and it’s a murky industry. We are discussing the seedy underbelly of the addiction industry with my guest. Heidi Voet, LPC, is a longtime mental health professional and the owner of Chapter House Counseling and Sober Living. Heidi and I take on this important topic and explain why, despite the problems, we would still send a loved one into treatment. Join us to learn more!

Show Highlights:

  • Heidi’s take on the ugliness of the treatment industry

  • Understanding the medical model of treatment vs. the community model

  • 12-step programs, legalism, insurance corruption, and integrity

  • The truth: Exploitation has bled into addiction treatment.

  • The real dilemma for family members

  • The struggle for political correctness while trying to intervene for an addict

  • Heidi’s advice to families who want to intervene:

  • Don’t intervene too fast. 

  • Find the lowest level of appropriate care (think of a ladder of options).

  • Be wise and ask questions of the consultant, case manager, or interventionist. (“Are you on the payroll of a treatment center?”)

  • Speak to current clients, alumni, and families of the center.

  • Red flags in your interaction with a treatment center and helpful questions to ask

  • The need to consider gender-specific treatment

  • Why KC would never recommend a wilderness treatment center

  • Assessing a center’s approach to trauma, medications, and religious philosophies/affiliations

Resources and Links:

Connect with Heidi Voet and Chapter House Counseling: Website

Connect with KC: Website, TikTok, Instagram, and Facebook

Get KC’s book, How to Keep House While Drowning

We love the sponsors that make this show possible! You can always find all the special deals and codes for all our current sponsors on our website: www.strugglecare.com/promo-codes.

  • KC Davis 0:05

    Hello, you sentient balls of stardust. Welcome to struggle care. I am your host, KC Davis, and today I have Heidi boett here in the studio with me. Heidi is the owner of chapter house counseling and sober living, and we're going to talk today about the seedy underbelly of the addiction industry and why we would still probably send someone that we love to treatment. Hi, Heidi. Hello. Thanks for having me. So you know, I feel like you and I, like, get on the phone sometimes and have like, gab sessions about, like, how much we hate the treatment industry, despite the fact that, like, I worked in it for a long time, and you still work in it and and so I wish we could, like, talk about some of these things, but I find it ironic that, like, when I talk about the treatment industry, and people are like, so then, like, what would you do if your child had an addiction, or, like, your partner needed rehab, and I'd be like, I mean, I'd send them to rehab. Like, I would still send them

    Heidi Smith 1:00

    to me, like, unfortunately, there's a need, you know, I mean, and I find myself, too, being really conflicted on my opinions, like you said. I mean, obviously I work in this industry, and there's times that, like, even in my head, I'll go back and forth to, you know, thinking, you know, how trashy this industry can be, you know, and how it's crazy. It can almost be kind of political, too. It's like all addiction treatment should be free. This is crazy that people are having to pay money and that people can't access good treatment if they don't have money, you know, all that stuff. But then, on the other hand, as a mental health professional who's worked really hard to educate myself and build a career, I also feel like mental health professionals deserve to be paid well, you know. So there's this, like, it's like, this double edged sword of, like, addiction treatment camp. I mean, how do you give good care for something and have the professionals that are doing it not be getting paid, you know? And so it's kind of a spiral down, you know, of the systems in place, especially in the United States, around healthcare and, you know, reimbursement rates and all of that, which I know is for another day, but it's all plays into, I think, why? Sometimes this industry can be really ugly,

    KC Davis 2:08

    yeah, and I think in my head there's like, you know, when I was coming up in the industry, a lot of the treatment centers really utilize, like, the medical model of addiction, where it's like, all we need to do is get you sober and give you some tips and tricks and then send you on your way. This is all we need to do. And there were other places that were doing more of like a community model, where they were really looking at, like bio, psycho social, like holistic healing. And I was like, see, that's what we need to be doing. We need to be doing community model. We need to move away from the medical model, and like theoretically, I still believe that. But the problem was, was that what seemed to be happening is that in the community model, it was like they were turning into little cults like you often the staff were themselves in recovery, and they were like, really married to their own kind of version of recovery. And a lot of the staff that were actually administering the treatment were just like 24 year olds with two years of sobriety that were being underpaid, and they're passionate, but underpaid. You

    Heidi Smith 3:22

    know, that's the other thing. Unique thing about this industry is that, you know, it's staffed almost exclusively by people in recovery themselves, and so, you know, and I mean, I know we're not talking necessarily about the troubled teen industry, but obviously there's an overlap. And I have that same and I know you've spoken to it a lot on Tiktok, but, I mean, I have the same conflicts around I mean, when I've watched some of those exposes on Netflix and whatnot, I sit there and I think, oh my gosh, this is so awful. But there's another part of me that, as a professional in this industry who's worked at facilities and been passionate about, you know, holding clients feet to the fire and, you know, and having a passionate philosophy of how to run a program and what was really best for the clients, and finding myself oddly feeling, you know, compassion for the programs that are being exposed, and thinking to myself, like, gosh, I think they were trying to help, like, I think they believed in what they were doing. It's like, it just, it can fall off a cliff real fast. So it's a lot of complexities

    KC Davis 4:23

    well, and I think to that, and it's not like, I mean, part of the irony of like dealing with an industry where so many of the professionals are themselves in recovery, is that, like a lot of people in my life, are in recovery from drugs and alcohol, and I feel like there's very few just like average, like people of average integrity. Like, if you just took like a section of the population, you would find some people that have, like, great integrity and are on, like a, you know, a spiritual path of growth, and, you know, being a better person. And then you. Have people who are just like malignant narcissists, who are bad, you know, people who are bad people, people who are here to like, you know, be deceitful and just get all for themselves, and they're sick and toxic. But I feel like the majority of the population are just like, you know, in the middle, like we're all selfish sometimes, but we all have good in us sometimes, and yada and maybe I'm biased, but I feel like all of the people I know in recovery, there's like, a very small portion that are of that, like, average integrity. It's like they're either super committed to integrity, or they're kind of pieces of shit, crap,

    Heidi Smith 5:36

    absolutely, absolutely because, yeah, because, I mean, if you kind of buy into the principles of the 12 steps in recovery. There's this legalism that comes with that, you know, the idea that, like, you really have to hold yourself to this very high standard if you want to not die, you know? And so, so, yeah, there is this kind of upper echelon of of high moral standards and high integrity. Or it's just, it's like, a bunch of guys with anti social personality disorder running treatment

    KC Davis 6:06

    centers, yeah. And so, like, you know, going into the industry, I was so, like, bright eyed and Bucha tailed, and, you know, I was like, This is gonna be great, because, like, we know what it's like to go through addiction. Like, we know what people really need, and and I'm gonna get educated, and we're gonna come together and we're gonna have and, like, it appeared to be that way, like people, you know, even staff, would talk about, you know, being accountable and having integrity, and, but then, like, the longer I stayed in the industry, I started to see just how, like, the dark side of, like, people who were in recovery, but like, weren't actually doing any personal growth work. And I'm not just talking about, like, relapse. I'm just talking about people who, like, they got sober, but like, they continued to be, like, morally bankrupt.

    Heidi Smith 6:59

    It's so unfortunate, because it ends up really, really affecting the lives of the people that are there to get help. Like, I will never forget,

    KC Davis 7:07

    like, being in, like, working in a treatment center and having, like, someone on the leadership come to me and be like, listen, there's this, like, client who is ready to discharge. But I think I like, I want you to figure out a way to keep her longer, because her insurance is paying us so much money for her drug test. And this was at the time where this was, like a big part of the addiction industry, where we, you know, you mentioned low reimbursement rates, like, it is truly a crime, how low insurance pays for treatment, and so what a lot of facilities figured out? And I truly believe, again, it was like, split like, I think some people figured it out of a

    Heidi Smith 7:55

    almost like a benevolent workaround. It was like, I'm passionate figure out how we can get more money to help more people. You know, yes,

    KC Davis 8:02

    like, I want to keep the doors open. I want it to be affordable. Let's figure out how to get these crooked insurance to pay. Like, here's a loophole. And the loophole they found was that, although there were tons of like, checks and balances and regulations around how much insurance would pay for, like, a therapy session or, like an intensive outpatient, some policies were paying like, hundreds or 1000s of dollars for a drug test, like you could bill them for every drug test at these insane rates. And then, of course, you had like, the dark side of it, where people were just like, I can get rich.

    Heidi Smith 8:36

    Oh yeah. I mean, it became an absolute phenomenon, you know. And what happened is that, you know, there was, it was all these very specific lab tests that everybody figured out, you know, kind of the medical end of your insurance, you know, people's insurance would pay astronomical rates, and you could do them, you know, five days a week. So, I mean, somebody could be in treatment for 45 days, and you could bill, you know, five days a week, insane amount of money. And you'd be people were making millions of dollars, sometimes off of clients lab tests. So then what treatment owners would do is they would start their own lab. So they realized, like, we could have our own lab. And so then there became a lot of ethical gray area, you know, around this whole drug test scheme, the federal government got involved, and I mean a lot, most of it's been shut down at this point. So

    KC Davis 9:32

    it was straight up fraud in a lot of ways. Because, like, it wasn't just the kind of test you would like send away to a lab. It was like, literally, the $3 cup from Walgreens, and you could bill insurance, you know, $3,000 for you dip in that. Like you could pay a 20 year old with two years of sobriety, like, $12 an hour to, like, dip P sticks into the $3 cups, and then bill insurance $4,000 and again. Yeah. There is this, you know, when it was people who were like, and then we take that money and we scholarship clients, or we pay therapists, yeah,

    Heidi Smith 10:08

    or we keep the people for longer we're able to extend their stay. Or, you know, yeah,

    KC Davis 10:12

    there was kind of this sentiment amongst the industry, which was like, I mean, fuck the insurance. Who cares? It's kind of like, when you see people be like, Rob from Walmart,

    Heidi Smith 10:22

    yeah, absolutely. And they're not, we're not making a sustainable income source, you know, from just the regular billing. So let's figure out some sideline stuff,

    KC Davis 10:31

    yeah? But then one of the things that started to also happen was that you'd get these guys who would open up sober livings

    Heidi Smith 10:40

    and and then they'd start a lab,

    KC Davis 10:43

    and then they'd start a lab. And so it's like, there's no clinical services. They're just literally people living in a house, calling it sober living. Maybe there's like a house manager that lives there, and they're drug testing 20 guys, you know, five days a week, and making 1000s of dollars and not putting that money, like, back into the program at all, just getting rich, just getting rich. Anyways, that was a bizarre

    Heidi Smith 11:10

    and at that point, if you if they relapsed, it would actually be better, because then you could just keep, you know, bring them back in and, you know, so that's where that kind of human trafficking, body brokering thing, you know, it's like, if somebody had good insurance, you know, you could almost sell them, you know, metaphorically, you know, to programs like, Hey, I got this guy, he's been shooting heroin, and he's got, but he's got great insurance, you know. And then it's like, hey, go pick him up on the side of the street and put him in your program. No one even cares if he's getting sober. You just care if he's his insurance is active, and you can bang his insurance for, you know, 12 drug tests a week. So it got really ugly,

    KC Davis 11:49

    yeah, like, body brokering was the term that we always use. But it like, it is straight up human trafficking. Like, Absolutely, it got so bad that people sober Livingston treatment centers would pay their like, I say this in quotes, but like marketers to go to 12 step meetings and, like, find the ones that were relapsing. And there were even, I mean, there were some rumors of, like, really corrupt places down in Florida that were, like, purposefully relapsing their clients.

    Heidi Smith 12:21

    I mean, it was absolutely insane. I guess the good news is, is that a lot of that has stopped, you know, and there have been a lot of protections that have come on the scene, you know, through the federal government and various, you know, credentialing that's required and things like that. But, I mean, it's a double edged sword, too, because, you know, it used to be with treatment. You either went to a treatment center, like you either had money to pay for treatment, or you had to go to kind of like a homeless shelter, indigent program. There was really not much in between. But once Obamacare came in and all the parity laws came in, insurance is now required to cover behavioral health and addiction treatment. So now that opened up this whole other Middle World where treatment centers can bill insurance. And so what's happened is, over the last 10 years, 10 to 15 years, the amount of treatment centers that have popped up in every city, I mean, it is exponentially larger than it was 15 years ago. So I mean, there's a treatment center on every corner, almost because insurance is required to cover it at the same they do for medical issues. So which is great. I mean, that was needed, that was needed, you know. But now back to the kind of the point of the podcast. I think it, it's like, how do you know which ones are good? And how do you know, what do you do when you need to send your loved one somewhere. And how do you figure out, you know, everyone says they're great online, but what does that really mean? And what do you look for? And it can leave it really confusing for the consumer. Yeah,

    KC Davis 13:49

    and I think, like, you know, there's even like, This is so weird, but I mean, men just suck sometimes, a lot of times, most of the time, and I'm so sorry if you're a man listening to this. Like, I have a lot of man in my life that I love, but men in general, like all of the like, systemic problems that we see men participate in politics and education. Like it's no different in the addiction industry, like it was commonplace for there to be some kind of big wig, and you would just find out, and you would just know on the down low, like, this guy is screwing clients. Like this guy is, like, I knew of like a CEO type one time who flew in a client from a different state under the guise of, like, she went to a program that, you know, I ran out there, and now she's relapsed, and I just want to bring her here a scholarship her. And then, like, you know, fast forward a few years, and it's like, oh, we realized that he was, like, sexually assaulting her. Yeah.

    Heidi Smith 14:59

    Yeah, yeah. It's like, unfortunately, it's like, the oldest story in the book, right? It's like, it's such a easy way. I mean, women and men that are, you know, in this compromised position of being sick with addiction, you know, a lot of times really lacking in resources. And you know, some ways it's like a breeding ground for people to come in and exploit them. And so it's a really unfortunate part of, I think, just the world in general, but it definitely bleeds into addiction treatment. I mean, yeah, like you said. I mean, there's a million stories. If you've worked in this industry, you know that you hear left and right so of sexual misconduct and

    KC Davis 15:36

    a lot of the stuff that came out about the troubled teen industry, where there was, like, these rehabs that were wilderness camps, where they would take teenagers to, like, hike through the wilderness, and come to find out there was a lot of physical abuse and neglect and clinical abuse, but I mean, even the facility, like the facility that I went to, wasn't a wilderness facility, but there was still some, like, pretty questionable interventions. Like, we weren't, like, starved or neglected, like, I think everyone that worked in my facility really wanted to help us, but again, the staff were, they were kind of going off book, like, just really intense interventions, lot of isolation, a lot of things that cause trauma. And I think what's really confusing for parents and loved ones is that they hear about like these horrors, and they think like, Well, how could anyone ever send their child to one of these places? And I think there's also like this comparison to like conversion therapy, where it's like, you know, it is horrible and traumatic and wrong to, like, send someone to conversion therapy, but where the metaphor breaks down is like, there's nothing damaging about being gay. Like gay doesn't need to be treated. Like addiction does actually need to be treated. Oh, yeah.

    Heidi Smith 17:01

    Well, I, I mean, I can't tell you how many phone calls I get from parents who, like, nobody wants to send their child to treatment, but, but they're crying on the phone and saying, but he can't stay here anymore. Like we have other children in the house. We have younger siblings. Like, he can't be here. He's out of control. So, like, I mean, you end up in a position where it's like, the lesser of the evils. He has to go somewhere, he has to get help. He's not well. It's not safe. It's not safe for my other children. And so, yeah, I mean, given choices of like, obviously, you know, your child doing great, and not having to send them anywhere, and then sending us. I mean, of course, nobody wants to do that, right? I mean, every kind of fork in the road like this is is in a really unfortunate situation where there's no good choices. But you know, I mean, there is still absolute need, you know, to be able to get a child or young adult or anybody you know, removed from their current living situation in their current environment to go get help. Like, I think that's always, there's always going to be a need for that. That's that's not going away. And so all the exposes in the world like, aren't going to remove the need,

    KC Davis 18:12

    yeah, and I think it's difficult when they're like, the theoretical conversations about, like, this should never happen, and no one should ever do this. And it's like, but then when you're actually a family member looking at your very real choices of like, okay, they can't stay here. I guess I could just kick them out, or go hide from them and have them on the street, but like, the reality is, it's like, if you have someone who needs help, you're forced to interface with the addiction treatment and all of its glorious potential and downside and dark side and upside. And the truth is, is that, like people do, go to rehab and get sober and get helped, and sometimes it at places that are kind of shitty, they get better. And sometimes people go to the best places in the most ethical places in the world, and don't get sober

    Heidi Smith 19:04

    well, and sometimes the path to getting freedom from addiction is traumatic, you know, I mean, I even think about your story. I mean, it's like, and I know you've shared some of it, you know, publicly, but it's like, I know there's a lot of it that was very traumatic. And is like, you look but it's like, I mean, here you are. That

    KC Davis 19:22

    was, what was there? Like, yeah, that. I mean, there is kind of this, like, you gotta break a bone to set it idea. And when people ask me, like, how are you not angry at your parents, I'm always like, I mean, what else should they have done? Like, they put me in therapy and I still used, and then they put me in outpatient and I still used, and then they put me in partial hospitalization, and I still used like I was gonna die, and like they had to choose between, like the trauma of me living in active addiction and dying, or like the trauma of me going to a place that, like I might still die, but there's a chance that maybe. I would get better, or that I would at least be like, held long enough to come to my senses or whatever. And it's a weird thing to make sense of, because on the one hand, like, I could say yes, it was traumatic and I deserved better, but like, look at me now. I'm sober and I'm happy and healthy, but at the same time, like, there are many girls that I went through with that are not that back in relapse, possibly with even more trauma, ones that killed themselves, ones that just, you know what I mean, and it's kind of like, it's almost like, when you're trying to diagnose someone, like on paper, you can talk all day long about the difference between autism and ADHD, or, like, what's bipolar and what's just, like, you know, a different thing, what is a narcissistic personality disorder, versus like, what's just a shitty human being? But like, those theoretical differences, like, it's that's a really different than looking at a human being that likely has, like, multiple overlapping factors in their life. So it's not as easy to pull apart, like it was bad and it shouldn't have happened, and therefore, I'm mad it happened, versus like it should have been better, but it's all there was. And I'm glad something worked, but it didn't work for every it's kind of like there's a bazillion things happening and there's not like a straight correlation.

    Heidi Smith 21:15

    Well, yeah, that, and that's what I think that that's why it's such a hard topic, because we can't pretend when you're trying to change somebody who's out of control, right? Like, let's go with the parent, somebody who's behaviorally out of control and then out of control with using substances. Like, that's not the same as treating somebody with a broken leg. Like, you know what I mean? Like you're dealing with somebody who actively has essentially a thought disorder. Like they they cannot, they're clearly not making correct decisions in their life, like they're and so it's like, ultimately, like, you know, even like the program you went to, it's like, the design kind of is to break your spirit. I mean, a little bit, it's like, and, I mean, no matter how much I feel like, you know, we've studied, you know, the process of change and human behavior, like that's not a perfect process, and so it's impossible to walk the line perfectly of balancing like unconditional positive regard for a person's autonomy and choices while they're suffering from a disease that's affecting their ability to make choices and their ability to think properly and to make proper choices for their own well being. And as much as I think, you know, we struggle with like, I think the political correctness of that, you know, of like, of how much are we allowed to intervene, you know, on someone's behalf, you know, it's just, it's a very hard industry, and I think we don't talk about that enough. Well,

    KC Davis 22:38

    what's ironic is that you'll see, like on social media, you know, an out of control teenager or, you know, like, I'll see a mom post, and you know that kid will swing on her, and the general feedback is like people criticizing the parent, and they say things like, you can't let him do that. You can't tolerate that. You can't stand for that. And what's always been interesting to me is like, the very thing they keep saying, like the parent needs to do, is very similar to what people often criticize facilities for doing, which is like, what do you all think that looks like to quote, unquote, not tolerate,

    Heidi Smith 23:17

    right? Like when you run a facility and like, one of the 16 year olds, like, spits in the face of the group facilitator. What are you supposed to do with

    KC Davis 23:25

    that? And it's that's not to say that we don't need like, we get it. We're a therapist. We understand the like, you know, all behaviors, communication, like, I know that you still have to manage the population, you still have to hold people accountable. You still have to, you know, address the straight up, like anti social behavior that happens. And I mean, I feel confident saying that as someone who exhibited a lot of that behavior, you know what I mean? But it's messy. And so that's a good way to put it. It is messy. And so here's the question that always gets posed to me when I talk about my experience in a teen industry is, what would you do? What will you do if one of your children needs treatment? And I just think that that's probably the most helpful question, because the reality is, like, there is no perfect solution out there, and even if there was, there wouldn't be a guarantee that it would work. So I just wanted to kind of talk, because, like, we're both parents, and we both have people in our life that we love, that are in recovery, and kind of, you know what, from our sort of, like, unique perspective of knowing how bad it can be, like, how we would navigate that system, absolutely, maybe an easy way to ask is like, start at The let's start at the beginning. Like, let's talk intervention, like that kind of realm, and tell me things that you like would and wouldn't do. So

    Heidi Smith 24:48

    I mean, the first thing, and again, this isn't going to apply to everybody, but I do think one mistake that I see is, I think there is a trend where families intervene. In too hard, too fast. So, I mean, that's one thing. I mean, I like, I've talked to, you know, my son's father, we've talked about this a lot, you know, like, we're only going to send, you know, hopefully we don't end there. But it's like, we're not going to do this whole sending him to treatment 10 times, you know what? I mean, like, if we're going to ever send him to treatment, we want to make sure he's willing and ready for it, you know? And it's like kind of hit a place of willingness and doneness. And so what I think happens is that there is a certain sect of parents that panic, you know, when their kids dabbling in drugs and they just immediately rip them out of school and throw them in treatment. I mean, that's one thing. And obviously there's a lot of nuances we'd have to, you know, you'd have to dive in as a professional to the whole story and everything. So, I mean, this is obviously, like, a very, very and

    KC Davis 25:45

    whether there's other, like, mental health issues with standing but yeah, the first time you catch Jared smoking weed at a Friday night football game, like, is not the time to, like, jump to an intervention, absolutely.

    Heidi Smith 25:56

    So I mean, that's honestly, like, where I would start kind of with your question is, like, making sure that, like, we appropriately intervene from the beginning with, like, the lowest and most appropriate level of care, if that makes sense. So I mean, I think one mistake that a lot of families make is is jumping the gun. And again, that would be very individual and specific for me to be able to kind of know who how that's happening, but I do see that, you know, so and it almost kind of blows your wad too soon, you know? I mean, it's like, you know, it kind of ruins the opportunity. So if you throw them and treat them when they're 16, then it's like, you kind of, I mean, then when they're 25 and they're really ready, it's like, well, now they have so much prejudice against treatment and so much hatred and trauma about treatment, it's like, and you kind of the money's

    KC Davis 26:45

    out. They know the game, yeah. So I'm curious if you think that there's like, because I think parents can make the opposite like, I totally agree with you. And I think some parents make the opposite mistake of, like, not intervening when they actually have like, the legal power to do so, yes, and you know, because sometimes you'll see parents, and it's like, they're coming to you, and the kids 19, and it's like, okay, this kid's been smoking crack since they were 15,

    Heidi Smith 27:12

    right? Like, geez, this would have been nice too.

    KC Davis 27:15

    Yeah, you like, you can't make this kid get mental health care anymore. And I do think that a lot of it to me, at least if I were to, and I know that's like, not helpful to be like, son, not too late, not too early. Don't get it wrong, or they'll fucking die. Get the timing right. Yeah. No, I think that there are some, like, tangible flags we could, like, lay down. Which one is like, I think the existence of mental health, especially if there are mental health issues that have predated substances Absolutely. Like, if you've had depression, anxiety, thought disorders, behavior disorders that predate the substances, like that would be a situation where I wouldn't wait, like, maybe they'll grow out of it, right?

    Heidi Smith 27:54

    Yeah? Like, that's a downward spiral that's probably not going to end well, you know, if we've already been struggling for years with other stuff. You know, that's gonna the escalation is gonna be significant. So, yeah, no, I couldn't agree more. And I also think

    KC Davis 28:09

    in if I had a daughter that I believed was at risk of being trafficked, which happened a lot, like if she's hanging out with 25 year olds, things like that. Like, I might actually pull the trigger on that, but I might some do some things first. Like, I might just move my family first. Like, that's another thing is, like, sometimes a kid does just need to be, like, put in a different situation, yeah? Like, taking a new Yeah, yeah. Like, I think there were some things even that I asked my like, I asked my parents to take me out of the private school that I was because I hated it I hated it. I wanted to go to the performing arts school. I wanted to and they really resisted a lot of those things. And I think obviously Hindsight is 2020 but like, I think there were ways that if I had been my parent, I think I would have listened a little more, like, who knows what could have been different if I could have gotten situated in a different peer group, in a different place, where I could have explored some passions, which I'm not saying, like, go super controlling about who they can and can't hang out with, because that always backfires. But like, I think, like before I sent my kid away to a like, long term residential treatment, or any treatment. I think the first thing I would do is move my family to a different state, like that would kind of be like, let's see if this, like, exhaust

    Heidi Smith 29:28

    all your options. I mean, there would be like, I mean, you definitely want to, you know, kind of like, climb the ladder of the options. I mean, to me, sending away is at the very top of the ladder, you know. So it's like, you know, like you said, I mean, yeah, do we need to move schools? Do we need to move, you know, cities? Do we need to move state? Do we need to, you know, remove ourselves from our current situation? Do we need to, you know, try this therapist. We need to try medication. Do we need, I mean, like, there's a million things you can do from home. And the nice thing is, is that these days is a lot more, I think. Because of this whole trouble teen industry, the idea of having case managers and kind of like in home social workers, has become much more accessible, like there's that's become its own industry of its own, where you can really hire a mentor, a case manager, who will get involved with your loved one while they're still living at home. You know, income and consultant, mentor and all of that. And so there's a lot of options now that are way outside, you know, above and beyond, having to remove them from the home. And so, I mean, I think that's and most of the professionals I work with are going to exhaust all those efforts, you know, especially someone who's under 18 before they send them out of

    KC Davis 30:39

    the home. And I think for any age, when you talk about, like, having an intervention and hiring an interventionist, I think that's fine. Like, I think it's fine to, like, want a third party that can, like, inform you about the industry and like, tell you about because the whole point is, like, some, like, every treatment center is going to tell you that they're the best treatment center, like they are sales people, literally, right? So like, be aware that when you're talking to a treatment center, and yes, they are going to make sure they meet criteria, and they will, you know, some places will say, like, Ah, they're not a good fit for us, but like, at the end of the day, they are sales people. And so like, I totally get and understand and think it's valid to go. I want someone to make a referral. I want someone to help us navigate this, but the thing that I would do is that if I was working with like a family manager or an interventionist or a case manager, I would ask specifically if that person gets any type of payment or like remuneration for referrals, meaning there are people. And this is really unethical, but it happens, who a treatment center will come to an interventionist and be like, Listen, you know, we'll pay you 1000 bucks for every person you refer to us. Yeah? And so, like, I would ask that outright. I mean, I know some people will lie, but I'd ask it.

    Heidi Smith 31:57

    Oh, yeah, no, absolutely. I think that's a baseline question for any kind of consultant, case manager, interventionist, it's like, are you on payroll of treatment centers, you know, are you getting kind of pay for play, you know, do you get, you know, and really asking them their process of how they do treatment placement, and, you know, have they, I mean, another one is, you know, a lot of, there's a whole kind of industry called education consultants, And so, you know, a lot of and therapeutic consultants, and so a lot of them will not refer to a program that they haven't visited in person. And so, I mean, I think there's a lot of criteria you can ask, like, if you know, how do you decide how you refer, you know, and what are your ethical boundaries around, you know, being paid for referrals and things like that. And I just, I don't think anything can beat. I mean, I guess this kind of just jump in the gun, even to placement of treatment, nothing can beat, you know, like individual conversations of people who have worked with that person or been to that treatment center, like there's Google reviews are all paid for. And, you know, that's all. I don't trust anything on Google, you know, I mean, and so the first thing I would do if I was going to work with an interventionist or a consultant, or work with or want to send my son to treatment, the first thing I would say is, can I speak to some current clients, some alumni? Can I speak to some families? You know, of current clients, moms and dads or families of alumni. I mean, that is one of my favorite things, is when I'm talking to a family and they ask for referrals, I think it's like, just the most raw, beautiful thing to ask, like, you know, what can I talk to another mom whose son is there? Absolutely, it's like, the smartest question you could ask me. You know, because

    KC Davis 33:41

    the thing about like, the online reviews is that if they're good, you'll never know if they're just paid for, and if they're bad, you never know if that's just a disgruntled client, like, who has, like, severe issues and like, the amount of clients that like because I held them accountable, or because I, like, refuse to allow them to, like, enact violence on someone, or because I wouldn't put up with their bullshit. Like, who will then turn around and be like, she is abusive, she's an incompetent counselor. I mean, like, obviously, that's how that goes. And so you don't really know how much of the criticism is just, sort of just gruntled ex clients, how much of it, or how much of it is real, and I almost trust,

    Heidi Smith 34:23

    I mean, when a treatment center has some bad reviews, I mean ones that just have 5005 star reviews, like, that's sketchy, you know. I mean, that's almost I'd rather have an authentic, you know, platform where it seems like people are, you know, are authentically leaving reviews. But, yeah, no, absolutely. And that's the hard thing is, you've got a lot of clients that are, you know, in the grips of addiction, you know, maybe they were kicked out, they were sent back to jail, you know, they lost relationships or whatever, and they're pissed.

    KC Davis 34:51

    I want a three star review, like, I want someone who can be like,

    Heidi Smith 34:55

    yeah, that was good. You know, there could have been some were better, but they were kind or, you know. So, yeah, absolutely.

    KC Davis 35:01

    So tell me what your like red flags would be if you were, like, interacting with a treatment center. So

    Heidi Smith 35:09

    I mean, one of my, and this may not be popular, one of my things that I would inform somebody about the treatment industry these days is that there are treatment centers that are owned by huge corporations. Like, you know, they're managed by, like, these big hedge fund conglomerates. I don't know all the right words, but you know, like, you know, money people, you know, our banks own them, basically, you know, and and then there's treatment centers that are still owned by individuals who are passionate about helping people. And so I can tell you hands down, if I had to send my son to treatment, I would send him to a program that was individually owned, you know, by a person, a couple, a family, you know, who was passionate about working and helping people, as opposed to a program that was owned by like a huge, a big conglomerate or corporation, and that may be controversial, and I'm not saying that those programs can't provide good treatment. I You're asking me what I would look at for my son, you know, I would go to more of kind of a private, individually owned, smaller program. So I don't know what your thoughts are on that Casey, but so

    KC Davis 36:23

    yeah, I think I mostly agree with you. I might even try to, like, ferret out like a third option of, like, a non profit owned, yeah, or, like a foundation owned, which there are fewer of those, only because, in my mind, like the downside to the ones that are owned by the hedge funds it's like, usually what happens is, they come along, they either start it up or they buy it from somebody else, and they gut it and they streamline it. And everything is about efficiency. Everything is about the bottom line, and they lose a lot of like, good treatment that way. So, like, that would be my hesitation of why I wouldn't want to do that. For that reason. I think it is better to get an individually owned or family owned place, but I think that I would still have my own personal like, I want to know, like, what's their deal? What's your philosophy? What's their deal? What's your philosophy, you know, and if you're the owner, it's like, what's your involvement? Like, I want to know that the people who are mostly making clinical decisions are, like, licensed clinical practitioners. They're therapists, their social workers, things like that, like,

    Heidi Smith 37:25

    are you state licensed? Are you accreditation body? I mean, there's, yeah. I mean, there's definitely questions you can ask. I want that to make there's accountability, you know, there's, you know, people don't even know to ask that kind of stuff. So, yeah, what are the licenses of your counselors, organizations do you belong to? What accrediting bodies or provide oversight? What, what city, county and state, you know, licenses do you have? You know, what kind of inspections does your facility have? All of that, you know. So I think I mean, and it's a lot, but, yeah, absolutely, because you don't want it to be too much of a mom and pop program too, you know, like a legit program that's that's well run. So I think that finding that balance is important. I

    KC Davis 38:12

    think what is helpful to do in those cases of when you're talking to someone is, I always think asking to see their policy or asking what their policy is. So it's like, what's your policy when you know there's a relapse? What's your policy if there's like, because I don't want someone who's like, oh yeah, what we do is like, I want someone who can be like, well, here is like, on paper. Show you like, what happens, or, you know, what happens if there's a fire in the building? Like, what do you do with the clients? What happens if they run what happens if you know whatever, like, I would want to know those things. I also if it was a child, like, one of the things that happened when I was in treatment was that there was about six months where they wouldn't allow me to talk to my family. Oh, God. And they convinced my family that that's what was best for me. And here's the thing, this one's hard because, like, I have occasionally gotten clients where the family was so toxic, you genuinely felt as though, like this person is going to be better without the influence of their family. But as a parent, I would never allow a facility to block access to me from my child or vice versa,

    Heidi Smith 39:17

    and as much as like and the truth, I've kind of gone full circle with that. I mean, I've been in this industry for over 20 years and I mean, again, like, there's actually, I mean, therapeutically, I think that's beneficial a lot of times, to have separation and communication. I think a lot of times the client's toxic for the family, and the client is, you know, bullying the family and screaming at them and being really emotionally and verbally abusive and terrorizing them. And there's all kinds of like, legitimate reasons why I think not communicating would be like a great therapeutic intervention, but in this day and age, I just don't think it's an approach. It's an appropriate thing to do for longer than a couple weeks. I mean, like, there's no way that I would send my son to a treatment center that didn't let me regularly. At least once a week, right? Like, have just, are you okay? Are you being fed? Are you, I mean, are you safe? Do you feel okay? Do you need anything? I understand that, like, you've got to submit to kind of the treatment program and all of that. But, yeah, having that level of isolation, I just, I've come full circle with that, and I'm just not on board with it. I just don't think you can do that.

    KC Davis 40:22

    Yeah, speaking of isolation, I think one thing that I would ask is that I would ask the clinical like, what are your interventions, in terms of, like, do you use behavior contracts? Like, do you use isolation? Do you use like, I'm trying to think of the best way to put this, like, I don't want there to be a situation where someone's deciding, like, the therapeutic move here is that, like, we're not going to allow anyone to talk to you, right?

    Heidi Smith 40:52

    Like we're going to alienate you and make you sit at a table by yourself for a week and no one can talk to you. Or, yeah,

    KC Davis 40:58

    I'm not into that. I'm not into that. Like, I want it to be clinical and professional, and I'm fine with people being very, you know, they don't, they don't need to, like, talk all fancy, like, if you need to tell my, you know, kid, they're full of shit, great. But like, I'm not down with any of that weird or,

    Heidi Smith 41:17

    like, some psychotherapeutic and psycho dynamic and psycho dramatic interventions, right? Like, I think, think there's a place for doing some really, like, interesting therapeutic work that involves, like, hey, let's have a funeral for your, like, ego. Or, you know, like, I mean, death can be great, but, like, when it crosses over into alienation and isolation, yeah, I mean, and, I mean, most states, I'll have clear guidelines about that too. I mean, that's, you know, like, you know, when you have a state license. I mean, there's very clear cut guidelines about that stuff, but, but it is, I mean, and that's where, like, I get it, like, kind of, as a clinician who likes psychodynamic therapeutic interventions, like, I see both sides of it, I get that kind of 70s Gestalt, you know, kind of, like, I don't know, like, kind of being able to create experiences for somebody, you know, that carry

    KC Davis 42:09

    this rock around and you're not allowed to put it down. And then we'll talk about how you won't let go of things like,

    Heidi Smith 42:14

    like, put the bricks in your backpack and don't talk, you know, all that. I mean, I can get with it, you know. But like, there's just a certain point at which there's, there's lines you just can't cross. There just are, I mean, there's just lines you can't cross. And sometimes it kind of sucks as a therapist to be like, Man, that would be really powerful if we could do that. And the rest of the team's just like, Yeah, but we can't. Like, we can't,

    KC Davis 42:35

    yeah, my thing about those, like, kind of creative things. And another example would be, like, there's a facility out in Montana that has, like, a ropes course that they make you do blind, and it's all about, like, letting go of control, like, I'm talking about, like, kind of, like, weird, creative stuff like that, right? I think some other examples were, like, carrying the rock around, putting the brick in your backpack, you know, having to write everything down in a notebook before you say it out loud, like, all that kind of stuff. I think for me, it really comes down to two things, and like, one is time limit and the other is consent. Yes, absolutely. Like, I think if you want to do something like hippy dippy, like that, as a clinician, I'm okay with 48 hours of that, and I'm okay if my child says, Yes, I will do this. I'm willing to do this to see what it looks like. And I think if

    Heidi Smith 43:21

    it's a minor, obviously the parents have to be on board too. And I would add to it is their humiliation involved. You know, that's like that old school, right? Like, where you even, I think, on some movies about treatment, where the person's having to wear like, a sign around their neck that says, like, Don't speak to me, or, you know, like, you know, that kind of stuff. Like, when it involves humiliation, I think that's where you start walking that fine line. And again, I completely agree. It's like, that's where there's consent involved. There's it's just that stuff has to be handled very, very, very carefully,

    KC Davis 43:51

    basically, like anything outside of just talking, yeah,

    Heidi Smith 43:55

    and I love that stuff. I mean, that's like, the thing, and that's that part of me that's like, ah, you know, like, when I watch these exposes and stuff like, and they're talking about things they did as the other part of me is like, I think I know what the team was trying to do. You know what I mean? And I get that when they're describing it, it sounds so abusive. But like, from my perspective, I'm like, I think they were trying to, like, do this therapeutic intervention, and it just fell flat, and again, ended up being really abused or but like, there's part of me that really can see both sides. So

    KC Davis 44:26

    I mean, listen when I talk about how in treatment, I was made to write down on newspaper, like, all the things I wouldn't let go of, like friends and drugs and art, like images and whatever, like things about, like, a drug subculture, and put it in a big trash bag, and I had to carry it around with me. And then they put, like bricks and balls in it, so it was heavy and big, and I wasn't allowed to put it down. And the whole shtick was like, you know, it's gonna be hard for you to, like, move throughout the day, but this is, like, a representation of, like, all. This stuff you're carrying around with you that you won't let go of, that's really hindering you. And, like, I don't necessarily, like, have an issue with that. Conceptually, the problem was I was not given a choice. Yeah, I was given that as a punishment for having been caught cheating on schoolwork. I was not given a choice, and they made me carry it for six months, oh gosh. Like, oh my gosh, even on like, family visitor day, where I was, like, humiliated because I was like, the girl with the trash bag, yeah, never could I put it down during meals, when I slept, it was in the bed with me. Like, I think that is what made that traumatic and humiliating and not a creative, interesting experience that really could have stretched and grown or whatever. I just think you can't force that stuff on people as much as you want to. Absolutely,

    Heidi Smith 45:47

    it's such a good way to put it. I mean, six months is crazy, yeah. I mean, the other thing you know that I would say is really considering you know whether you need gender specific treatment. If I had a daughter, I think, you know, if I had a 22 year old daughter that I needed to send a treatment like I'd probably want to send her to a women's only program. And maybe I have some personal bias or whatever, you know, to unpack there. But I mean, that's just for just kind of and just I don't know. I just know too much. I just know. I know what happens at co ed programs a lot of times, if they're not run, I mean, extremely well. I mean, I think you can pull off good co Ed treatment if you have, I mean, if you're, you know, that's the other thing I would ask. It's like, if it's a co Ed facility, like, how are we, you know, protecting, you know, from frat organization, because otherwise that will become the entire purpose of the client's existence is just to figure out how to date and treatment, and it's just kind of a waste. So

    KC Davis 46:53

    I also think, like a big thing for me, would be asking about how trauma informed the approaches, and I would want a really specific answer to that, like, I wouldn't want, like, a vague answer. I would want to know how they identify trauma, how they assess for trauma, how they treat trauma. Because, like, there just isn't, there just isn't going to be hardly anyone seeking out, like, addiction treatment that doesn't also have trauma, and I think that part of the things that I've seen turn like unethical or abusive. Sometimes they do so because someone is just genuinely trying to be abusive because they're a bad person, but oftentimes it is more a result of like, either a clinician or a non clinical staff, like kind of going off the rails and not being trauma informed, not having an appreciation for what trauma is, or understanding trauma. I also, and I know people are going to call me snobby for this, but I want to know what level of licensure the clinical staff has, because I know it takes an associate's degree and some studying to have, like, a chemical dependency licensure in a lot of states, and I just wouldn't send and I'm not saying that there aren't people out there that have that that are kick ass clinicians. I'm just saying, if I don't know you, I want someone that has a graduate degree. I want someone with a master's level clinical degree? Yeah,

    Heidi Smith 48:23

    absolutely. I mean, we used to joke, there's some, you know, licensures out there, that it's like, it all it takes to get is two proofs of purchase and a letter from your mom, you know. And it's, you know, like, it's like, you'd like to know that the person has some education, some experience and but, you know, I can't be missed, even when you just said, some people might call you snobby, like just I think it's important even this whole conversation. It's not lost on me that this whole conversation is assuming their privilege. You know what? I mean, that like that we have the people we're speaking to have choices about the treatment center that they send their child to, you know, and that they're going to be able to be real picky, and that they're going to be able to be able to call and interview and ask all these questions and like, you know, it's sad that mean a lot of people just they're going to have to go to the program that's a network with their insurance, or they have to go to the program that's free and covered by the state. And so I just want to acknowledge that I don't have even have a solution to it, but I just want to acknowledge that the idea that somebody can be so picky and have all these questions and all these interview questions and all these criteria is assuming some level of privilege, you know, that you're going to have really kind of the pick of the litter, you know, and choices where you send your child and, you know, maybe you can send them out of state, and maybe you can afford to private pay and like, you can do all these things where a lot of people don't have those choices. Yeah,

    KC Davis 49:42

    and I think that's it's important to acknowledge, and it's important to acknowledge that, like, there are very few nevers like, Honestly, the only never on my list is that I would never, ever, ever send a client to a wilderness treatment center that's like, one of my never. Like. If I had to choose between wilderness or nothing, I would choose nothing. And that's saying something, because I don't think if you asked me, like, should you send your kid to the place that's like, you know, I don't know, Bill in their P tests, if that's truly the only option, I'd be like, Yeah, send them right? Like, I would send someone to a shitty place, if the option was a shitty place or nothing, because at least there's going to be some exposure to some recovery language, recovery concepts, recovery world, so that you know, they would know kind of how or when to reach out to those types of people. And I even know that people talk about, like, oh, we sent my sister away. She came back worse. Or, like, I went to treatment and learned about how to do harder drugs. I don't necessarily, I mean, again, like you said at the beginning, like, if you've jumped the gun way too early, and you just, like, have a kid that's smoking pot. Like, yeah, that could happen. But I know for me, like, I mean, I was hanging out with people that were, like, smoking crystal meth, like I wasn't, like, learning about hard drugs in rehab. Like, wasn't really, it's not like I wasn't learning about them anyways, like I was going to learn about them. I was hanging out with people doing those drugs,

    Heidi Smith 51:16

    I would say nine times out of 10 when it's a manipulation that, you know, a kid calls their mom and dad on their Sunday phone call and whispers in the phone and says, there's all these big bad guys here that are teaching me more about drugs than I ever knew. Usually, like, that's a that's attempt to get Mom and Dad scared, you know, and get them to pull you out of treatment. But I mean that again, that's, there's some bias there, but, but, yeah, like you said, I mean, you don't land yourself there, you know, because you're like, innocent snowflake, you know. And so that's usually a technique that I see. You know, guys in my program, and programs I've worked in use to scare mom and dad into bringing them home,

    KC Davis 51:56

    yeah. And I do think that's why, like, I want to have my kid assessed by a therapist or someone before I ask someone who is related to a treatment center, do you think they need treatment?

    Heidi Smith 52:10

    Yeah, yeah, absolutely. And, I mean, unfortunately, it's like, yeah, as we're talking about this. I mean, I keep being reminded of like that. I mean, if you have resources. I mean, in a lot of ways, you do get what you pay for, you know, like, when I think hiring an education consultant or a therapeutic consultant, like, can be very valuable, you know, to help like that out and get, like, really good testing, you know, like, and get really good assessments, and, you know, and really, like, find the right fit. And, you know, based on their trauma and based on this, do they need gender specific? Do they need, you know? And there's amazing resources out there for that. It's just not something everybody can access. So, but yeah, I'm trying to think what else would be a big part of what I would ask, yeah, I'd be real curious, too, about medication management. We get a lot of guys that come, what I would call, like, out of shitty treatment centers that it's astounding, like the mismanagement of medication, like they show up and they're put on like, seven different psychiatric medications that don't even make sense, you know, they're like, a 30 day treatment, and they leave with, Like, you know, seven prescriptions for just an outrageous combination of medications. So I would say that would be another huge thing that I would kind of be on the lookout for, is, you know what their philosophy is around that,

    KC Davis 53:32

    I think also on the topic of medication, one of my like, that's one of my big ones, is like, if they're over medicating, which I know is kind of hard to ask, but just asking about medication in general. But another flag for me is if they have medications that they and I'm not talking about like a sober living or a place where, like, that client's gonna, like, have their medication on them, but like a place where they're handling medications, if they have, like, an automatic No, like, medications that a person is on, that's honestly a red flag for me, and I know that that's hard, because a lot of places have it, but like, a lot of the places that I worked, it was like, Yeah, we don't allow Adderall. You can't take your Adderall here. And as someone who has, like, a late diagnosis ADHD that just wouldn't fly. Like, you're not taking my child off the medication that they need. Oh, yeah, because you're afraid that they're, you know, it's gonna get whatever or like, if when you have chronic pain patients, when you have ADHD medication, like, I also, personally would want a place that is open to medication managed recovery if somebody's on opiates, like, I don't want a place that's religious in their abstinence. Like, I don't want them like zealous about, like, Oh, we're abstinence only, meaning, you know, no medications or only certain types of. Occasions, or you can't be on Suboxone or methadone, or any of that kind of stuff.

    Heidi Smith 55:04

    Yeah, it's like, it's the idea that, like, we have a box that all the clients have to fit into, versus, like, Hey, we're going to be individualized enough to kind of build a box around each specific client to what makes sense to them. And I think that's a lot of you know, and I think at the same time, like, I think, you know, owners of treatment centers like, have the autonomy to have their philosophy, and they get to have, you know, their way of doing treatment, you know, obviously, if it's ethical. But I also think that, like you said, I mean, I think making sure that you ask those questions, and if somebody that that's like, there's your sign, you know what? I mean, if they're like, Oh, well, you can't take Adderall here, it's like, well, clearly this isn't the right place for my child or, you know, but I do, I think that's also, I mean, I do think it's a red flag of like, of really being able to realize, especially when you're working with adolescents and people with dual diagnosis, you know, it people are really close minded to like their one philosophy, you know, and that you have to fit inside this very specific box, and that's just information that it may not be the best place for you or your child.

    KC Davis 56:06

    And I also think that it would behoove people to ask about like, whether they use 12 step, whether there is like, spirituality or religion, not because I think that there's like one right answer, but because I think if you feel strongly about those things, I don't think you want to accidentally discover that, like they're talking about God,

    Heidi Smith 56:25

    yeah, absolutely. And, I mean, I think that's why, like, it's very important for families like to take their value system and find the program that fits for them, you know. I mean, I know my parents, you know, were conservative Christians, and you know, if they had looked at a treatment center for me or my sister, like it would have been very important for them to find a program that was not it minimum wasn't working against their Christian value system, you know, like, I just know them, I know they wouldn't have wanted to send us to some kind of, like spiritual Why can't I think of it, you Know, Like witch doctor place in like Santa Fe I'm not maybe, you know, like, where there's like, shamans, and you know, that wouldn't have worked for my parents. My parents would have been petrified and terrified that, you know, whereas another family, you know, that might be exactly what they want. And so it's like, yeah, it's just knowing, like, based on your value systems, like, what questions do you need to ask?

    KC Davis 57:19

    So Well, I think that is, I could have, like, a more comprehensive or easier checklist, but I think that that's a pretty good summary. The Heidi, thank you so much for the time. And do you want to plug yourself and your place? If anybody is looking for somewhere? Oh, sure.

    Heidi Smith 57:35

    I mean, you know, we're in Dallas, and our program is called chapter house. Our website is chapter house recovery.com. We work with young adult men, and you know, even if that's not what you need, I'm always happy to be a resource. You know, for anyone, especially in Texas, that's looking for treatment or has questions about sending their children to treatment, you can always email me. My email is on our website. You

Christy Haussler