REHAB: An American Scandal, by Shoshana Walter
By now, the opioid crisis has yielded a substantial body of journalism, with a particular emphasis on the role of the pharmaceutical business in stoking the flames. At this point, it is widely understood that the deadly epidemic was created not by cartels and street dealers alone but also by a legal and regulated industry, consisting of name-brand drugmakers, distributors and chain pharmacies. Such corporations have agreed to pay around $50 billion in settlements to state and local governments to fight the crisis.
Much of that money will go toward drug treatment and rehab, as a consensus has formed around the idea that addiction should be addressed more as a medical matter than a criminal one. But will this approach work, and who will benefit? Treatment is an industry too, one whose troubling place in the epidemic has garnered much less attention than pharma’s. Shoshana Walter’s “Rehab: An American Scandal” brings some needed scrutiny to bear.
Walter, a reporter for The Marshall Project who covers criminal justice, paints a picture of a broken treatment system that is more shadowy than the prescription-drug industry, with more obscure players, but just as capable of taking advantage of patients while purporting to help them. In braided chapters, she tells the stories of four Americans enmeshed in the rehab apparatus.
Two of her subjects are patients, of different races and social stations, who wanted help but found themselves in recovery programs that ranged from inadequate to outright inhumane and corrupt. A third is a mother who was driven “just insane from grief,” as a lawyer close to her said, after her son died of an overdose at a sober-living home, and who became an aggressive gadfly agitating for crackdowns on dodgy, profit-hungry rehab centers. The last is a surgeon who was arrested in 2014 in connection with liberally prescribing Suboxone — even though the drug, despite a history of controversy, is now considered the gold standard for medication-assisted treatment of opioid addiction.
Notwithstanding some poignant passages, the prose in “Rehab” doesn’t dazzle; it’s marred by some limp language, strained transitions and a weak epilogue. When Walter widens her lens to discuss the flaws of the treatment system at large, she suggests that a real solution would require an overhaul of the social safety net and the elimination of racial inequity. This may be true, but it is not an especially fresh or practicable prescription, and at times she seems to fault policymakers in the rehab arena for failing to clear that very high bar.
Walter is at her best when she zeros in on her four subjects and elucidates the specific ways in which the treatment system fails or abuses them. Especially revelatory is her reporting about the major rehab provider Cenikor and one participant’s experience with it. In Walter’s account, the program — founded by a convict who, once out of prison, used Cenikor’s funds to finance an outrageous lifestyle — operated with cultlike discipline, putting patients to work in brutal, sometimes dangerous jobs at outside employers, then retaining their pay. (Thanks in part to reporting by Walter and a colleague, state regulators in Texas and Louisiana began investigations of Cenikor. Earlier this year, the provider settled a class-action lawsuit regarding its labor practices; it says it discontinued its work program in 2021.)
In a remarkable journalistic feat, “Rehab” manages to delve deeply into the personal lives of the kind of people who are typically leery of speaking to reporters at all, and through their stories, the book shines vital light into dark places.
REHAB: An American Scandal | By Shoshana Walter | Simon & Schuster | 299 pp. | $29.99
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