If you caught John Oliver’s Last Week Tonight this past Sunday, you saw a lengthy segment detailing the atrocities of the rehabilitation industry. As Oliver pointed out, it’s largely an unregulated, unstandardized market rife with bad actors, scams, and bunkum that offers little help to patients desperate to recover from deadly addictions. With some charging tens of thousands of dollars for a month of treatment, rehab facilities often rely on therapies with little evidence of efficacy—such as horse petting—and report largely made-up percentages for their success rates.

Even experts in the field find themselves at a loss for how to identify effective, quality facilities. The result is that many patients pay large sums only to go on to struggle with or die from their condition. And these devastating consequences are only heightened by the country’s current epidemic of opioid addiction.

While Oliver gave a skillful overview of some of the rampant problems, an ongoing investigation by Reveal from The Center for Investigative Reporting picked out a particularly egregious case this week—Recovery Connections Community, a rehabilitation program outside of Asheville, North Carolina.

There, director Jennifer Warren spent years recruiting poor and desperate patients suffering from drug addiction into her rehabilitation program, offering free treatment in exchange for unpaid labor. With the promise of counseling and a path to recovery, patients cleaned her house, babysat her children, cared for her large collection of exotic pets, and worked 16-hour days at adult care homes—with little to no state-required training.

“It’s like slavery,” Denise Cool told Reveal. Cool was addicted to crack cocaine when a judge ordered her to Warren’s program in 2011. It was “like we were on the plantation,” she added.

While Warren collected wages from the adult care homes, many rehab patients worked as janitors, cooks, or personal aids. Being an aid meant dispensing prescription drugs—even ones the rehab patients were addicted to—as well as bathing disabled and/or elderly residents and changing their diapers. Many rehab participants succumbed to temptation and relapsed, stealing residents’ prescriptions. For those that did dispense drugs, they sometimes gave residents the wrong medications. Others were accused of sexual misconduct or assaults while caring for the residents.

History of abuse

Despite those stories, some still say that the therapy Warren promised rehab patients was the worst part of the program. In the little time when rehab patients weren’t working, patients recounted traumatic therapy sessions involving patients hurling insults and screaming at each other to break people down. The tactic has its roots in the controversial Synanon organization, which has been called a cult.

Meanwhile, Warren benefited from her patients. She reportedly took lengthy vacations at the beach and places such as Paris and Greece. She had rehab participants solicit donations for the program—which she set up as a nonprofit—but kept those donations for herself, including concert tickets and free appointments at beauty salons (meant as empowering opportunities for low-income rehab patients.)

In 2015, Warren pled guilty to illegally collecting thousands of dollars’ worth of food stamps. Rehab participants told Reveal that Warren continued to take their food stamps to stock her own kitchen despite the legal trouble.

Warren declined to answer questions but said in an email to Reveal, “I have no reason to believe that you will report anything positive about our program or are interested in the people’s success stories, of which there are many.”

The many complaints and concerns about Warren and her program have largely gone ignored or neglected by state agencies, Reveal reported. In 2012, Warren was stripped of her counseling license. After Reveal began asking questions, the state health department banned the program from sending participants to work as caregivers in adult care homes. But that was just last week. Otherwise, agencies have mostly let her continue, citing incomplete paperwork on complaints and loopholes in regulations. Because Warren claims to the state that she operates a “12-step, self-help” program instead of a treatment program, she mostly skirts government oversight. State hospitals, psychiatric facilities, and social workers continue to send patients to the program.