A snap decision by Google has begun to reshape the drug treatment industry, tilting the playing field toward large conglomerates — the precise opposite outcome Google had hoped to achieve. The fateful decision was made September 14. Google faced pressure from an exposé in The Verge released a week earlier, documenting how shady lead generators game its AdWords system. High-cost ads based on rehab keywords referred users to phone hotlines that gave the impression of being independent information services, but were actually owned by treatment center conglomerates. Representatives, who reap large fees based on how many patients they sign up, employ high-pressure sales tactics to push people into their favored facilities, whether or not that facility is the right one for the patient. This deceptive marketing can lead to substandard treatment and massive overbilling. It also made lots of money for Google, which was shown in the story actively courting addiction treatment advertisers. And so Google made a quick call: It effectively stopped running ads from treatment facilities. At first blush, that may look like a happy alignment of the public good and a company’s need for good public relations, with Google taking a hit to make the world a better place in the midst of an epidemic. But the problem of economic concentration is so deep in the United States today that peeling back one layer merely reveals another. Without ads, addicts or their parents are left only with the organic search results. Guess who wins those? It’s not Ben Camp. He’s the CEO of RehabPath, which bills itself as a resource for addiction recovery, connecting patients with quality treatment information. Camp has been a longtime critic of the fraud rampant in the treatment industry and felt that Google was operating from the right impulse, but got it wrong — to the detriment of smaller facilities. “I think Google made a mistake,” Camp told The Intercept. “They’re putting rehab centers out of business that are doing good work. And if they come back in a month and say, ‘We figured this out,’ the centers will say, ‘Thanks, but we’re out of business now.’” Addiction recovery during the worst drug epidemic in American history is expected to generate $42 billion in business by 2020. Insurers are required to cover substance abuse treatment under the Affordable Care Act, and some stays can cost up to $60,000 a month, making every patient extremely lucrative. And the majority of addicts or their parents — 61 percent, according to Google’s internal statistics — use the internet to find help. The first click on that path is usually to Google, giving the search engine tremendous influence over how America responds to a public health emergency. Google ads gave preferential treatment to whomever paid the most, regardless of the standard of care. Kenneth Miller, who worked at community treatment centers in Florida for a decade (and, full disclosure, is my cousin), said his facility “spent an insane amount of money on advertising, specifically through Google. They used to give us flash drives with the Google logo on them.” Some facilities were spending $1 million a month on this type of advertising. Many of those ads steered addicts to woefully substandard facilities that were little more than vehicles for insurance and Medicaid fraud. That’s been widely known and was even the subject of the industry’s 2016 conference. But The Verge article touched a nerve, and Google responded by stopping all AdWords marketing for addiction treatment, a blanket policy that froze out every treatment center — good and bad. “We found a number of misleading experiences among rehabilitation treatment centers that led to our decision, in consultation with experts, to restrict ads in this category,” said Google spokesperson Elisa Greene in a public statement at the time of the announcement.





Today, that restriction mostly remains in place. You can definitely find paid ads if you use certain obscure combinations of words in searches; Google has described the change as a gradual process. But a Google search for “ drug rehab near me ” yields no links with that ubiquitous green “Ad” box in front. It just shows organic search results, listing treatment centers in your area, as well as third-party referrers and locators. The problem is that organic search is often dominated by the same sketchy treatment chains that were buying up the ads, because when it comes to search results, scale almost always trumps quality — and now the conglomerates no longer face competition from decent centers that were losing on search but at least could buy ads. “Almost any result you find with a neutral query has some sort of tie-in,” Camp said. He gave the example of Rehabs.com, the top listing under Google Maps in the generic search The Intercept tested. (Test it yourself: Type in any combination of addiction-related keywords you can think of into Google, and Rehabs.com won’t be far from the top.) The website runs what appears to the consumer to be an unbiased, comprehensive directory of treatment facilities, with ratings, reviews, and helpful articles. Because the site has been featured on The Huffington Post, Business Insider, and other top sites, it maintains a high Google rank. But Rehabs.com was purchased in 2015 by American Addiction Centers, a 1,200-bed conglomerate that owns 20 facilities, in a $60 million deal. In fact, AAC owns several websites with neutral-sounding names, like Recovery.org, MentalHelp.net, and Dependency.net, all through a subsidiary, making it hard to figure out what’s going on. This drives more users to its dedicated call centers, especially with AdWords out of the way and organic search as the only option for inquiring addicts. “It’s like Consumer Reports being owned by Toyota,” Camp said. Other companies have parroted this technique. Addiction Campuses, which owns four large facilities, also owns DrugRehab.org, another online aggregator. “Some of the people who were most aggressive with AdWords are the most scaled-out as an organization,” said Marcello La Rocca, director of Sandstone Care, which runs two substance use facilities in Colorado. “They put money into organic ratings.” Facilities could buy their way onto the aggregator sites, but that’s a far more costly option, and one without quality controls. Meanwhile, taking out an ad and hoping for a click is a relatively simple process for the tiny IT and marketing staffs of smaller facilities, compared to battling large players for the top of the Google rankings. “It’s hard to get patients in South Florida regardless, we have a reputation as a sewer. This will make it worse,” said Miller, who now works with a small 10-bed facility, referring to South Florida’s well-earned reputation for being a haven of fraudulent rehabs. Google’s approach to the business of drug treatment is being crafted in consultation with the nonprofit group Facing Addiction, Google spokesperson Elisa Greene said, referring The Intercept to the heads of the organization. Jim Hood, the co-founder and CEO of Facing Addiction, confirmed to The Intercept he’s been in regular contact with Google and applauded its interest in solving the problem. The ban on ads, he said, was a good first step, though he thinks there is more work to be done. “They’re trying to work with people who have no axe to grind,” said Hood, referring to his organization’s nonprofit status. “It’s problematical if Google turns to any player within the treatment industry. It’s a cesspool.” Facing Addiction launched in the fall of 2015 with a celebrity concert on the National Mall and has drawn criticism for aligning itself with what’s known as an abstinence-only approach to drug treatment and recovery. The American treatment industry in general has been deeply resistant to opening itself up to an evidence-based approach, even as the medical establishment and federal regulators insist on the efficacy of medication-assisted treatment. The medication buprenorphine has been shown in repeated studies to be a far more effective approach when it comes to length of recovery and reduction of overdose deaths, but many treatment centers remain committed to in-patient, 30-day abstinence programs developed around Alcoholics Anonymous, despite challenges in adapting the program for opioid use disorders. Hood said his organization is still developing a consumer guide to treatment centers and that if future evidence shows the medication to be effective, he may include a section on it. But as of now, his group treats all approaches equally. Camp decided to put Addiction Campuses to the test. He performed an organic Google search for “alcohol rehab center in Wisconsin,” purportedly looking for help for his father. The first link went to a list on DrugRehab.org of the 10 top rehab centers in the state. All of them directed users to the same phone number. So Camp dialed the number and recorded the call.

For 20 minutes, the helpline operator “Jamie” persistently tried to steer him away from the Wisconsin facility he chose, claiming she could find him something better out of state. “Most of the time when you go to rehab, close to home is not the best idea,” Jamie said. “It’s more of a commitment when you get on an airplane.” Jamie instead recommended an Addiction Campuses site in Massachusetts called Swift River — “It’s basically a resort” with a five-star chef, fitness center, and rock wall, she said. Stays at Swift River can cost $25,000 for 30 days. The facility recently went from 48 to 112 beds. The Intercept called the facility intake and asked if Suboxone, the leading medication for addiction that contains buprenorphine and naloxone, was allowed. “We prefer you get off that stuff,” the operator said, medical advice offered without knowing the situation. When Camp pushed back on Swift River’s treatment plan, Jamie suggested another high-end Addiction Campuses site in Dallas, the Treehouse. Even when Camp said that his father didn’t want to travel and asked if there were any good facilities in Wisconsin, Jamie said no, they catered to heroin abuse, not alcohol. Camp asked about Illinois, a neighboring state, and Jamie said she couldn’t find any open beds. “This is going to save his life,” she said, pivoting again to Addiction Campuses sites. “He needs the best possible place for him. The best might not necessarily be the closest.”



Drug addicts in recovery listen to a counselor at a substance abuse treatment center on March 22, 2016 in Westborough, Mass. Photo: John Moore/Getty Images