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Rehab: An American Scandal
Pulitzer finalist Shoshana Walter exposes the country’s failed response to the opioid crisis, and the malfeasance, corruption, and snake oil which blight the drug rehabilitation industry.
Our country’s leaders all seem to People who suffer from addiction need treatment. Today, more people have access to treatment than ever before. So why isn’t it working? The answer is that in America—where anyone can get addicted—only certain people get a real chance to recover. Despite record numbers of overdose deaths, our default response is still to punish, while rehabs across the United States fail to incorporate scientifically proven strategies and exploit patients. We’ve heard a great deal about the opioid crisis foisted on America by Big Pharma, but we’ve heard too little about the other half of this epidemic—the reason why so many remain mired in addiction. Until now.
In this book, you’ll find the stories of four people who represent the failures of the rehab-industrial complex, and the ways our treatment system often prevents recovery. April is a black mom in Philadelphia, who witnessed firsthand how the government’s punitive response to the crack epidemic impeded her own mother’s recovery—and then her own. Chris, a young middle-class white man from Louisiana, received more opportunities in his addiction than April, including the chance to go to treatment instead of prison. Yet the only program the judge permitted was one that forced him to perform unpaid back-breaking labor at for-profit companies. Wendy is a mother from a wealthy suburb of Los Angeles, whose son died in a sober living home. She began investigating for-profit treatment programs—yet law enforcement and regulators routinely ignored her warnings, allowing rehab patients to die, again and again. Larry is a surgeon who himself struggled with addiction, who would eventually become one of the first Suboxone prescribers in the nation, drawing the scrutiny of the Drug Enforcement Administration. Together, these four stories illustrate the pitfalls of a system that not only fails to meet the needs of people with addiction, but actively benefits from maintaining their lower status. They also offer insight into how we might fix that system and save lives.
Our country’s leaders all seem to People who suffer from addiction need treatment. Today, more people have access to treatment than ever before. So why isn’t it working? The answer is that in America—where anyone can get addicted—only certain people get a real chance to recover. Despite record numbers of overdose deaths, our default response is still to punish, while rehabs across the United States fail to incorporate scientifically proven strategies and exploit patients. We’ve heard a great deal about the opioid crisis foisted on America by Big Pharma, but we’ve heard too little about the other half of this epidemic—the reason why so many remain mired in addiction. Until now.
In this book, you’ll find the stories of four people who represent the failures of the rehab-industrial complex, and the ways our treatment system often prevents recovery. April is a black mom in Philadelphia, who witnessed firsthand how the government’s punitive response to the crack epidemic impeded her own mother’s recovery—and then her own. Chris, a young middle-class white man from Louisiana, received more opportunities in his addiction than April, including the chance to go to treatment instead of prison. Yet the only program the judge permitted was one that forced him to perform unpaid back-breaking labor at for-profit companies. Wendy is a mother from a wealthy suburb of Los Angeles, whose son died in a sober living home. She began investigating for-profit treatment programs—yet law enforcement and regulators routinely ignored her warnings, allowing rehab patients to die, again and again. Larry is a surgeon who himself struggled with addiction, who would eventually become one of the first Suboxone prescribers in the nation, drawing the scrutiny of the Drug Enforcement Administration. Together, these four stories illustrate the pitfalls of a system that not only fails to meet the needs of people with addiction, but actively benefits from maintaining their lower status. They also offer insight into how we might fix that system and save lives.
320 pages, Hardcover
First published August 12, 2025
119 people are currently reading
1756 people want to read
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Displaying 1 - 30 of 66 reviews
August 8, 2025
This book was fine. It did what it set out to do. I didn't find the storytelling to be particularly deep (I knew most of the info). Some of the writing (end of chapters) were irksome, the author was really holding our hands in a way that felt almost corny. It is a good overview book into the opioid treatment industry. Given the title I thought the book might go more into AA as well, but it is mostly about drug addiction. I liked the book fine but it isn't one I think will stick with me long term.
August 8, 2025
DNF @ p149
I grabbed this book because I hate every aspect of USian for-profit medical system, but especially as it impacts poor and disabled patients and those who are persons of color.
Walter's research is extremely thorough. And I thought she organized the book well, except I found it repetitive. Each case she shares is distinctive, but I don't think she highlights the distinctions, but the similarities, as that's kind of her point. But for me, in finding the material triggering (institutionalization and stigmatization of mental illness, like addiction), this kind of intentionally repetitive structure was difficult to read. I would have liked a diversion in the text, a subplot, a discussion, something besides more and more evidence of abuse and negligent murder of disabled people.
I still maintain that this is an excellent and necessary text for anyone wanting to know more about what goes on behind the curtain at residential mental health facilities.
I grabbed this book because I hate every aspect of USian for-profit medical system, but especially as it impacts poor and disabled patients and those who are persons of color.
Walter's research is extremely thorough. And I thought she organized the book well, except I found it repetitive. Each case she shares is distinctive, but I don't think she highlights the distinctions, but the similarities, as that's kind of her point. But for me, in finding the material triggering (institutionalization and stigmatization of mental illness, like addiction), this kind of intentionally repetitive structure was difficult to read. I would have liked a diversion in the text, a subplot, a discussion, something besides more and more evidence of abuse and negligent murder of disabled people.
I still maintain that this is an excellent and necessary text for anyone wanting to know more about what goes on behind the curtain at residential mental health facilities.
July 4, 2025
Book Review: Rehab: An American Scandal by Shoshana Walter - A Public Health Practitioner's Perspective
Rating: 5/5
Reactions & Emotional Impact
Walter’s Rehab: An American Scandal is a searing, meticulously researched exposé that left me oscillating between outrage and heartbreak. As someone familiar with the opioid crisis’s broad strokes, I was unprepared for the depth of systemic rot Walter uncovers. Her narrative—woven through four protagonists’ lives—transforms statistics into visceral human suffering. April’s story of intergenerational punishment under the crack and opioid regimes shattered me; Chris’s exploitation in forced labor “rehab” programs ignited fury. Walter’s prose is clinical yet compassionate, balancing investigative rigor with emotional resonance. The chapter detailing Wendy’s fight for accountability after her son’s death in a sober living home was particularly gut-wrenching, exposing how profit motives eclipse patient safety. By the end, I felt both haunted by the failures she documents and galvanized by her call for reform.
Strengths
-Narrative Power: Walter’s choice to anchor systemic critique in individual stories (April, Chris, Wendy, Larry) humanizes the crisis without sensationalizing it. Their intersecting struggles reveal how race, class, and policy failures compound addiction’s toll.
-Investigative Depth: The book dismantles rehab industry myths with forensic precision—from fraudulent billing practices to the suppression of evidence-based treatments like Suboxone. Walter’s Pulitzer-finalist chops shine in her sourcing (whistleblowers, court records, insider accounts).
-Structural Clarity: She maps the rehab-industrial complex with stunning clarity, showing how insurers, courts, and regulators collude to prioritize profit over recovery. The DEA’s persecution of Suboxone prescribers (like Larry) is a masterclass in institutional hypocrisy.
-Solutions-Oriented: While unflinching in critique, Walter highlights grassroots alternatives (e.g., harm reduction models) that offer tangible hope.
Constructive Criticism
-Policy Prescriptions: Though the epilogue gestures toward reform, readers may crave a fuller blueprint for dismantling the systems Walter critiques (e.g., specific legislative fixes).
-Global Context: A brief comparative analysis of rehab systems in other nations could underscore the uniquely American failures she exposes.
-Data Visualization: Given the complexity of financial flows in the rehab industry, infographics could enhance accessibility for general readers.
Final Thoughts
This book is a Molotov cocktail tossed at the rehab industry’s façade—a work of moral urgency that belongs alongside Dopesick and Empire of Pain. Walter doesn’t just diagnose a crisis; she indicts the machinery perpetuating it, demanding we confront addiction treatment as a civil rights issue. This is an element, as a public health practitioner myself, I can really appreciate.
Gratitude:
Thank you to Simon & Schuster and Edelweiss for the gifted copy—this is the kind of journalism that can (and must) spark change.
Why 5/5?
A flawless synthesis of narrative force and investigative brilliance, Rehab: An American Scandal is a landmark work that redefines addiction discourse. Essential reading for policymakers, healthcare professionals, and anyone who believes recovery should not be a privilege - Sincerely, A Public Health Executive Practitioner.
Rating: 5/5
Reactions & Emotional Impact
Walter’s Rehab: An American Scandal is a searing, meticulously researched exposé that left me oscillating between outrage and heartbreak. As someone familiar with the opioid crisis’s broad strokes, I was unprepared for the depth of systemic rot Walter uncovers. Her narrative—woven through four protagonists’ lives—transforms statistics into visceral human suffering. April’s story of intergenerational punishment under the crack and opioid regimes shattered me; Chris’s exploitation in forced labor “rehab” programs ignited fury. Walter’s prose is clinical yet compassionate, balancing investigative rigor with emotional resonance. The chapter detailing Wendy’s fight for accountability after her son’s death in a sober living home was particularly gut-wrenching, exposing how profit motives eclipse patient safety. By the end, I felt both haunted by the failures she documents and galvanized by her call for reform.
Strengths
-Narrative Power: Walter’s choice to anchor systemic critique in individual stories (April, Chris, Wendy, Larry) humanizes the crisis without sensationalizing it. Their intersecting struggles reveal how race, class, and policy failures compound addiction’s toll.
-Investigative Depth: The book dismantles rehab industry myths with forensic precision—from fraudulent billing practices to the suppression of evidence-based treatments like Suboxone. Walter’s Pulitzer-finalist chops shine in her sourcing (whistleblowers, court records, insider accounts).
-Structural Clarity: She maps the rehab-industrial complex with stunning clarity, showing how insurers, courts, and regulators collude to prioritize profit over recovery. The DEA’s persecution of Suboxone prescribers (like Larry) is a masterclass in institutional hypocrisy.
-Solutions-Oriented: While unflinching in critique, Walter highlights grassroots alternatives (e.g., harm reduction models) that offer tangible hope.
Constructive Criticism
-Policy Prescriptions: Though the epilogue gestures toward reform, readers may crave a fuller blueprint for dismantling the systems Walter critiques (e.g., specific legislative fixes).
-Global Context: A brief comparative analysis of rehab systems in other nations could underscore the uniquely American failures she exposes.
-Data Visualization: Given the complexity of financial flows in the rehab industry, infographics could enhance accessibility for general readers.
Final Thoughts
This book is a Molotov cocktail tossed at the rehab industry’s façade—a work of moral urgency that belongs alongside Dopesick and Empire of Pain. Walter doesn’t just diagnose a crisis; she indicts the machinery perpetuating it, demanding we confront addiction treatment as a civil rights issue. This is an element, as a public health practitioner myself, I can really appreciate.
Gratitude:
Thank you to Simon & Schuster and Edelweiss for the gifted copy—this is the kind of journalism that can (and must) spark change.
Why 5/5?
A flawless synthesis of narrative force and investigative brilliance, Rehab: An American Scandal is a landmark work that redefines addiction discourse. Essential reading for policymakers, healthcare professionals, and anyone who believes recovery should not be a privilege - Sincerely, A Public Health Executive Practitioner.
September 16, 2025
Yet another book about how the profit motive ruins EVERYTHING!!!!!! In Rehab: An American Scandal, Shoshana Walter explains how rehab has become big business, and thus a big problem for the many people in dire need of quality addiction treatment. I know this topic is close to many of our hearts as readers, and I perhaps imagine the same is true of the author given her years-long relationships with the subjects of her book. I will now talk a bit about each of their stories, one by one!
Chris Coon from Louisiana
Chris is a fellow Virgo, so first I want to say that I hope that wherever he is, he had a great birthday season!!! His treatment journey is heartbreaking because you see how so much of this starts because none of the alternatives are appealing to people. He’s dealt with lingering pain ever since a childhood injury, and then has countless new injuries piled ON TOP thanks to his hellish rehab program. That would make anyone seek out pain pills! In his earlier years, Chris also didn’t see many other options for his life besides working too hard at jobs that pay too little, like his parents had done all his life. Furthermore, when he was trying to stay clean with Suboxone, this was made nearly impossible by the price gouging of its manufacturers.
What’s worse, Chris was put squarely into the middle of Louisiana’s incredibly carceral responses to any and every human problem known to mankind. I think most people understand that Angola Prison used to be and still really is a plantation, but I didn’t know just how much the same could be said for Cenikor, the nightmarish “rehab” program that Louisiana courts ordered many people to in lieu of prison time. Chris’ options were to spend 2 years at Cenikor or 5 years in prison, which again were just NO GOOD OPTIONS AT ALL. It’s very similar to onerous probation requirements, where Cenikor’s rules were so impossible that many people had to end up serving time anyhow. 😭 Anyway, I don’t want to spoil the whole book, but let’s just say Chris’ treatment there was abysmal, and often included LITERAL SLAVE LABOR. It made me realize how the terrible history of asylums as neo-plantations that Antonia Hylton covered in Madness is still alive and well in “rehab” programs. If anything, it’s gotten worse because our government is even MORE hell-bent “self-sufficiency” and “work requirements” instead of just providing the things that people need to survive. Basically with every element of society, we just REFUSEEEEEE to support people we deem as able bodied when they need and truly DESERVE mental help or even just a safe place to land. My final note on all this is that there’s a Citations Needed episode about how our policy is still shaped by the terrible history of labor houses and asylums. Making a note to myself to listen to this!!
Angel from Philly
They had my girl at the Blue Moon Hotel!!! My God, today!!!! 😭 Angel had such a tough experience with intergenerational trauma, cycles of addiction, and the church’s role in making recovery harder. Angel TOO started using because she had untreated back pain, and couldn’t get any other form of help. However, she also started using pain pills because her childhood experiences had left her with a lot of moral hang-ups about “street drugs” and addiction being a moral failure, like one because people didn’t have enough “self-discipline.” Throughout her story, it was just so clear how the Puritan work ethic and logics of pre-determination are RUINING our people and keeping us hating ourselves for needing rest or support, and believing ourselves to be permanently and irrevocably evil.
Angel’s story was also infuriating because we see how the treatment that is available often wasn’t culturally competent for Black patients, didn’t offer childcare needed for parents in recovery, and carried a HUGE risk of entanglement with another carceral system: child protective services or what many people like Dorothy Roberts call the family policing system. (Sidenote: if you want more book recommendations and organizations to support around this topic, I added those to my review of Torn Apart: How the Child Welfare System Destroys Black Families—and How Abolition Can Build a Safer World.) Just like with Chris, I hope Angel is now somewhere really good for her. I hope she is no longer in pain, that she’s reunited with all her kids, and receiving all of the support and love she needs—she truly deserves!!! 💚
Dr. Larry from Indiana
Okay so this isn’t about Dr. Larry specifically, but I had a hard time with the narrator for his chapters of the audiobook (each “subject” had a different voice actor.) I think this made me not connect as much with his story, though I can say that once again, the DEA made everything worse. In this case, they were going after the people who were actually trying to help patients get better, and blocking the proactive harm reduction measures taken in many other countries, like allowing all doctors to prescribe Suboxone, or enabling safe needle exchange sites. Another issue was the same as what Chris found—Suboxone was reserved for a small group of patients, mostly those with some form of recovery capital to navigate medical systems and keep up on the expensive payments for the drug. Meanwhile, Dr. Larry saw so many other people who he couldn’t help, and they had to have carceral and punitive methods of care! It was really infuriating because in many ways, Dr. Larry was punished for being “too early” at trying to help people, and he was criminalized for things that would later be promoted as best practices. RIP to a complicated man who truly did intend to make many peoples’ lives better! 🕊️
My recommendations here are that if anyone wants a more in-depth look at how Suboxone and Methadone manufacturers were able to price gouge through patent fraud and lobbying exercises, I’d highly recommend Patrick Radden Keefe’s talked about my own connections to this industry in Empire of Pain: The Secret History of the Sackler Dynasty. If you want to understand the private equity of it all, Megan Greenwell’s newest book is a good place to start. (My review of Bad Company: Private Equity and the Death of the American Dream has recommendations for other places to keep learning about PE, as I don’t think that book is exhaustive nor as well-written as PRK’s work.)
Wendy from Los Angeles
Okay last but not least, we have Wendy from California! She was so devoted to her family, and I felt SO sad about how many curveballs life threw her. Wendy’s chapters are interesting because she is a parent impacted by addiction, not a person in recovery themselves. Overall, her chapters allowed us to see the astounding costs for quality treatment, even for those who could afford it, and how the failures in our societal safety net impacts even the most fortunate families. Wendy focused a lot on how the rehab industry exploits desperate families, and how sober living facilities particularly avoid licensing and regulation requirements. I think for personal reasons, I understood some of her vengeance—like people really can turn into righteously indignant Karens when their loved ones are being manipulated at the most vulnerable points of their lives. Like Wendy was going to MAKE SURE that someone had to pay for being the specific site of unraveling in her family, even though that unraveling had many other roots (both familial and societal ones.) Let’s just say I have a hard time with this stance at points, but I definitely respect her fight. Because of this moral quandary (like the ultimate ends of mothers’ vengeance), Wendy’s story sort of reminded me of Haley Cohen Gilliland’s book on the Abuelas de Plaza de Mayo, A Flower Traveled in My Blood: The Incredible True Story of the Grandmothers Who Fought to Find a Stolen Generation of Children.
The nuanced take I’ve been looking for
Okay now that I’ve discussed these incredible people, I want to talk about the incredible things the author did. The stakes of addiction are so dire that people will often pay ANYTHING to feel like there is a chance of getting “better”. This desperation, particularly with parents of teens/young adults, creates soooo many opportunities for exploitation in the rehab industry. Walter spends about half of her book focusing on cases like the one I’ve described, where people have access to “recovery capital”, which I learned describes the various forms of financial, medical, and social support available to help someone deal with their addiction. Walter strikes a good balance in the other half of Rehab, focusing on people who have less recovery capital, and more interaction with the carceral sides of rehabilitation. By the end, it felt like her general point was that while some people fall on the more privileged side of treatment, and some fall on the more punitive side, BOTH sides are supremely fucked due to their exploitative origins.
This nuance is just really helpful and a great improvement over the last nonfiction book on drug use that I read, the middling When Crack Was King: A People's History of a Misunderstood Era. In that book and so many other places, many people describe the disparities in opioid and crack epidemic responses as if treatment actually is working perfectly now just because the “face” of this current drug crisis is whiter and wealthier. The reality is much worse—our country is so fucked that NO ONE, even the most fortunate people, can reliably get the treatment they deserve. Our country’s “treatment-focused” response to the opioid epidemic has still failed, because of the persistence of carceral logics and apparatuses, the ableist moral logics deeming addicted people as “sinners” who need to be forced to atone and take whatever scraps they’re offered, and the lack of regulation of treatment centers—again, BECAUSE all this makes people money. Walter achieves the great feat of making this point without ignoring disparities in her Black and White subjects, or her wealthy and working-class ones. I just WISH more of her fellow writers were able to bring this level of nuance to their work!!!
Conclusion
Walter concludes by affirming that we must create BETTER ALTERNATIVES to drug use, not just better treatment systems. We need more resources to support recovery (recovery capital for all, not just my fellow children of suburbia), and truly strong Plan Bs for addiction: quality housing and employment options, free medical and mental health care, CUSTOMIZED PHYSICAL THERAPY WITH LOW WAIT TIMES AND NO REFERRAL NEEDS, and so much more. For people to go on and lead a more fulfilling life, they need actual PATHWAYS to a better life, not just more of the same struggle (Chris and Angel dealt with this a lot in their chapters.) What’s more, the “consequences” for addiction (becoming incarcerated or placed on probation, losing your housing, being barred from certain jobs, having to pay way too much money for Suboxone, etc.) often become barriers to recovery that keep people trapped without support. So basically, we must do SO MUCH BETTER at creating a world that cares for people!!!!
I will close by saying that I don't think everyone will love this book--a lot of it felt important to me because of things outside the book, both in my family life and professional work in affordable housing. I do think everyone can learn something from it, but it varies how impactful it might feel to you specifically. However, if you're even a bit interested, I'd recommend giving it a chance!!
Chris Coon from Louisiana
Chris is a fellow Virgo, so first I want to say that I hope that wherever he is, he had a great birthday season!!! His treatment journey is heartbreaking because you see how so much of this starts because none of the alternatives are appealing to people. He’s dealt with lingering pain ever since a childhood injury, and then has countless new injuries piled ON TOP thanks to his hellish rehab program. That would make anyone seek out pain pills! In his earlier years, Chris also didn’t see many other options for his life besides working too hard at jobs that pay too little, like his parents had done all his life. Furthermore, when he was trying to stay clean with Suboxone, this was made nearly impossible by the price gouging of its manufacturers.
What’s worse, Chris was put squarely into the middle of Louisiana’s incredibly carceral responses to any and every human problem known to mankind. I think most people understand that Angola Prison used to be and still really is a plantation, but I didn’t know just how much the same could be said for Cenikor, the nightmarish “rehab” program that Louisiana courts ordered many people to in lieu of prison time. Chris’ options were to spend 2 years at Cenikor or 5 years in prison, which again were just NO GOOD OPTIONS AT ALL. It’s very similar to onerous probation requirements, where Cenikor’s rules were so impossible that many people had to end up serving time anyhow. 😭 Anyway, I don’t want to spoil the whole book, but let’s just say Chris’ treatment there was abysmal, and often included LITERAL SLAVE LABOR. It made me realize how the terrible history of asylums as neo-plantations that Antonia Hylton covered in Madness is still alive and well in “rehab” programs. If anything, it’s gotten worse because our government is even MORE hell-bent “self-sufficiency” and “work requirements” instead of just providing the things that people need to survive. Basically with every element of society, we just REFUSEEEEEE to support people we deem as able bodied when they need and truly DESERVE mental help or even just a safe place to land. My final note on all this is that there’s a Citations Needed episode about how our policy is still shaped by the terrible history of labor houses and asylums. Making a note to myself to listen to this!!
Angel from Philly
They had my girl at the Blue Moon Hotel!!! My God, today!!!! 😭 Angel had such a tough experience with intergenerational trauma, cycles of addiction, and the church’s role in making recovery harder. Angel TOO started using because she had untreated back pain, and couldn’t get any other form of help. However, she also started using pain pills because her childhood experiences had left her with a lot of moral hang-ups about “street drugs” and addiction being a moral failure, like one because people didn’t have enough “self-discipline.” Throughout her story, it was just so clear how the Puritan work ethic and logics of pre-determination are RUINING our people and keeping us hating ourselves for needing rest or support, and believing ourselves to be permanently and irrevocably evil.
Angel’s story was also infuriating because we see how the treatment that is available often wasn’t culturally competent for Black patients, didn’t offer childcare needed for parents in recovery, and carried a HUGE risk of entanglement with another carceral system: child protective services or what many people like Dorothy Roberts call the family policing system. (Sidenote: if you want more book recommendations and organizations to support around this topic, I added those to my review of Torn Apart: How the Child Welfare System Destroys Black Families—and How Abolition Can Build a Safer World.) Just like with Chris, I hope Angel is now somewhere really good for her. I hope she is no longer in pain, that she’s reunited with all her kids, and receiving all of the support and love she needs—she truly deserves!!! 💚
Dr. Larry from Indiana
Okay so this isn’t about Dr. Larry specifically, but I had a hard time with the narrator for his chapters of the audiobook (each “subject” had a different voice actor.) I think this made me not connect as much with his story, though I can say that once again, the DEA made everything worse. In this case, they were going after the people who were actually trying to help patients get better, and blocking the proactive harm reduction measures taken in many other countries, like allowing all doctors to prescribe Suboxone, or enabling safe needle exchange sites. Another issue was the same as what Chris found—Suboxone was reserved for a small group of patients, mostly those with some form of recovery capital to navigate medical systems and keep up on the expensive payments for the drug. Meanwhile, Dr. Larry saw so many other people who he couldn’t help, and they had to have carceral and punitive methods of care! It was really infuriating because in many ways, Dr. Larry was punished for being “too early” at trying to help people, and he was criminalized for things that would later be promoted as best practices. RIP to a complicated man who truly did intend to make many peoples’ lives better! 🕊️
My recommendations here are that if anyone wants a more in-depth look at how Suboxone and Methadone manufacturers were able to price gouge through patent fraud and lobbying exercises, I’d highly recommend Patrick Radden Keefe’s talked about my own connections to this industry in Empire of Pain: The Secret History of the Sackler Dynasty. If you want to understand the private equity of it all, Megan Greenwell’s newest book is a good place to start. (My review of Bad Company: Private Equity and the Death of the American Dream has recommendations for other places to keep learning about PE, as I don’t think that book is exhaustive nor as well-written as PRK’s work.)
Wendy from Los Angeles
Okay last but not least, we have Wendy from California! She was so devoted to her family, and I felt SO sad about how many curveballs life threw her. Wendy’s chapters are interesting because she is a parent impacted by addiction, not a person in recovery themselves. Overall, her chapters allowed us to see the astounding costs for quality treatment, even for those who could afford it, and how the failures in our societal safety net impacts even the most fortunate families. Wendy focused a lot on how the rehab industry exploits desperate families, and how sober living facilities particularly avoid licensing and regulation requirements. I think for personal reasons, I understood some of her vengeance—like people really can turn into righteously indignant Karens when their loved ones are being manipulated at the most vulnerable points of their lives. Like Wendy was going to MAKE SURE that someone had to pay for being the specific site of unraveling in her family, even though that unraveling had many other roots (both familial and societal ones.) Let’s just say I have a hard time with this stance at points, but I definitely respect her fight. Because of this moral quandary (like the ultimate ends of mothers’ vengeance), Wendy’s story sort of reminded me of Haley Cohen Gilliland’s book on the Abuelas de Plaza de Mayo, A Flower Traveled in My Blood: The Incredible True Story of the Grandmothers Who Fought to Find a Stolen Generation of Children.
The nuanced take I’ve been looking for
Okay now that I’ve discussed these incredible people, I want to talk about the incredible things the author did. The stakes of addiction are so dire that people will often pay ANYTHING to feel like there is a chance of getting “better”. This desperation, particularly with parents of teens/young adults, creates soooo many opportunities for exploitation in the rehab industry. Walter spends about half of her book focusing on cases like the one I’ve described, where people have access to “recovery capital”, which I learned describes the various forms of financial, medical, and social support available to help someone deal with their addiction. Walter strikes a good balance in the other half of Rehab, focusing on people who have less recovery capital, and more interaction with the carceral sides of rehabilitation. By the end, it felt like her general point was that while some people fall on the more privileged side of treatment, and some fall on the more punitive side, BOTH sides are supremely fucked due to their exploitative origins.
This nuance is just really helpful and a great improvement over the last nonfiction book on drug use that I read, the middling When Crack Was King: A People's History of a Misunderstood Era. In that book and so many other places, many people describe the disparities in opioid and crack epidemic responses as if treatment actually is working perfectly now just because the “face” of this current drug crisis is whiter and wealthier. The reality is much worse—our country is so fucked that NO ONE, even the most fortunate people, can reliably get the treatment they deserve. Our country’s “treatment-focused” response to the opioid epidemic has still failed, because of the persistence of carceral logics and apparatuses, the ableist moral logics deeming addicted people as “sinners” who need to be forced to atone and take whatever scraps they’re offered, and the lack of regulation of treatment centers—again, BECAUSE all this makes people money. Walter achieves the great feat of making this point without ignoring disparities in her Black and White subjects, or her wealthy and working-class ones. I just WISH more of her fellow writers were able to bring this level of nuance to their work!!!
Conclusion
Walter concludes by affirming that we must create BETTER ALTERNATIVES to drug use, not just better treatment systems. We need more resources to support recovery (recovery capital for all, not just my fellow children of suburbia), and truly strong Plan Bs for addiction: quality housing and employment options, free medical and mental health care, CUSTOMIZED PHYSICAL THERAPY WITH LOW WAIT TIMES AND NO REFERRAL NEEDS, and so much more. For people to go on and lead a more fulfilling life, they need actual PATHWAYS to a better life, not just more of the same struggle (Chris and Angel dealt with this a lot in their chapters.) What’s more, the “consequences” for addiction (becoming incarcerated or placed on probation, losing your housing, being barred from certain jobs, having to pay way too much money for Suboxone, etc.) often become barriers to recovery that keep people trapped without support. So basically, we must do SO MUCH BETTER at creating a world that cares for people!!!!
I will close by saying that I don't think everyone will love this book--a lot of it felt important to me because of things outside the book, both in my family life and professional work in affordable housing. I do think everyone can learn something from it, but it varies how impactful it might feel to you specifically. However, if you're even a bit interested, I'd recommend giving it a chance!!
September 30, 2025
2.5 stars
In Shashana Walter’s book, “Rehab” - Routes to treatment are still largely funneled through the criminal justice system and through a profit driven healthcare system that prioritizes profits over individualized patient care. Walter’s finds the pursuit of profit has overridden the duty to provide humane and effective care in too many cases.
Drugs are compelling. Drugs offer benefits for the people who use them. They quiet physical and mental pain. They offer route to community, especially in a culture that encourages the restless pursuit of pleasure but demonizes those who appear to lose control or take it too far.
Walter weaves the stories of four Americans from different corners of the nation into a single narrative of a rehab system gone very wrong: a young white man in Louisiana; a low-income Black mother in Philadelphia; a crusader against rehab abuse in California; and a physician with his own addiction who dedicated his professional life to treating others similarly afflicted. The often-chaotic lives of these substance abusers are presented with sensitivity and tact but never sentimentalized.
Most of the stories are about opiate addiction. Opiate withdrawal is horrendous. It’s like the worse flu you ever had ten times. Every muscle in your body aches. You have profuse vomiting, severe diarrhea. On top of that opiate withdrawal causes profound insomnia. So, you can’t even rest or sleep the pain away.
Walter offers more immediate prescriptions for the addiction epidemic, including the wider availability of the treatment drug Suboxone (which blunts the craving for heroin and other opioids) and rehabilitation services that not only avoid abuse but focus on the needs and goals of each individual. Walters sounded like she advocated for suboxone but was not clear on how accessible it is to everybody.
Research shows us that stop using drugs needs to be reinforced and rewarded with hope and better, more positive alternatives. As long as using drugs remains more compelling than not using drugs people will continue to use drugs.
“If there’s anything I’ve learned about our treatment system, it’s that it is essentially run by these twin principles of punishment and profit,” Walter’s says. “People are punished for having addictions, and then these rehab programs proliferated with the intent of making a ton of profit off them. And that’s how a lot of our systems in this country operate. Walters writes about this like it’s some big revelation.
The exploitation of patients for profit is one of the book’s common themes. Rehab programs sometimes bill thousands of dollars for unnecessary tests and services, and trap patients in a cycle of relapse and treatment, Walter writes.
I couldn’t agree more with Walters. I used to be an Addictions Counselor 15 years ago. My problem with her book is that everything she is talking about I experienced 15 years ago. So, what is new here?
Walter writes, “In reality, recovery requires continued support, which means access to food, housing, jobs and medication. Lacking any one of these can impede recovery.” The one thing she is leaving out is the person with the addiction must be motivated to be clean themselves. If they are doing it for someone else, sobriety is not realistic. The individual must want it themselves.
I think as long if we live in a for profit healthcare system, in a lot of cases addicts are going to be taken advantage of. In my experience if someone wants to be clean, they need to have outside support like a committed AA sponsor, or a therapist, sober friends and family. They need to know what triggers them to use and have action plans if a trigger comes up. They also need to have activities, because boredom is a common trigger for relapses.
Walter’s did not shed light on anything new. The four stories of the patients she wrote about lacked depth and were not that interesting to me. I agree that people who have or come from money might have more going for them in recovery vs. someone who is broke with no job. Just because someone has money does not guarantee sobriety. In my experience, less educated people are more open-minded and have no problem that there is a higher power as they talk about in AA. Many educated, secular people have a problem believing in a higher power. So, if AA/NA does not work for them, where are they going for support?
Treatment programs are especially effective when they are accessible and easy to enter, and providers listen to a person’s needs, support them in finding motivation to get better, and continue that support in the long term. Ultimately the individual has got to want it. They say in AA to accept the good and forget the rest. I think that it might be the same mentality to have when going to rehab and moving forward with ones life.
In Shashana Walter’s book, “Rehab” - Routes to treatment are still largely funneled through the criminal justice system and through a profit driven healthcare system that prioritizes profits over individualized patient care. Walter’s finds the pursuit of profit has overridden the duty to provide humane and effective care in too many cases.
Drugs are compelling. Drugs offer benefits for the people who use them. They quiet physical and mental pain. They offer route to community, especially in a culture that encourages the restless pursuit of pleasure but demonizes those who appear to lose control or take it too far.
Walter weaves the stories of four Americans from different corners of the nation into a single narrative of a rehab system gone very wrong: a young white man in Louisiana; a low-income Black mother in Philadelphia; a crusader against rehab abuse in California; and a physician with his own addiction who dedicated his professional life to treating others similarly afflicted. The often-chaotic lives of these substance abusers are presented with sensitivity and tact but never sentimentalized.
Most of the stories are about opiate addiction. Opiate withdrawal is horrendous. It’s like the worse flu you ever had ten times. Every muscle in your body aches. You have profuse vomiting, severe diarrhea. On top of that opiate withdrawal causes profound insomnia. So, you can’t even rest or sleep the pain away.
Walter offers more immediate prescriptions for the addiction epidemic, including the wider availability of the treatment drug Suboxone (which blunts the craving for heroin and other opioids) and rehabilitation services that not only avoid abuse but focus on the needs and goals of each individual. Walters sounded like she advocated for suboxone but was not clear on how accessible it is to everybody.
Research shows us that stop using drugs needs to be reinforced and rewarded with hope and better, more positive alternatives. As long as using drugs remains more compelling than not using drugs people will continue to use drugs.
“If there’s anything I’ve learned about our treatment system, it’s that it is essentially run by these twin principles of punishment and profit,” Walter’s says. “People are punished for having addictions, and then these rehab programs proliferated with the intent of making a ton of profit off them. And that’s how a lot of our systems in this country operate. Walters writes about this like it’s some big revelation.
The exploitation of patients for profit is one of the book’s common themes. Rehab programs sometimes bill thousands of dollars for unnecessary tests and services, and trap patients in a cycle of relapse and treatment, Walter writes.
I couldn’t agree more with Walters. I used to be an Addictions Counselor 15 years ago. My problem with her book is that everything she is talking about I experienced 15 years ago. So, what is new here?
Walter writes, “In reality, recovery requires continued support, which means access to food, housing, jobs and medication. Lacking any one of these can impede recovery.” The one thing she is leaving out is the person with the addiction must be motivated to be clean themselves. If they are doing it for someone else, sobriety is not realistic. The individual must want it themselves.
I think as long if we live in a for profit healthcare system, in a lot of cases addicts are going to be taken advantage of. In my experience if someone wants to be clean, they need to have outside support like a committed AA sponsor, or a therapist, sober friends and family. They need to know what triggers them to use and have action plans if a trigger comes up. They also need to have activities, because boredom is a common trigger for relapses.
Walter’s did not shed light on anything new. The four stories of the patients she wrote about lacked depth and were not that interesting to me. I agree that people who have or come from money might have more going for them in recovery vs. someone who is broke with no job. Just because someone has money does not guarantee sobriety. In my experience, less educated people are more open-minded and have no problem that there is a higher power as they talk about in AA. Many educated, secular people have a problem believing in a higher power. So, if AA/NA does not work for them, where are they going for support?
Treatment programs are especially effective when they are accessible and easy to enter, and providers listen to a person’s needs, support them in finding motivation to get better, and continue that support in the long term. Ultimately the individual has got to want it. They say in AA to accept the good and forget the rest. I think that it might be the same mentality to have when going to rehab and moving forward with ones life.
September 14, 2025
4.5 stars, rounded up
I thought this was really solid! For some reason I also expected this to be a little more AA focused (Is it the cover? Do we really all associate AA with those chairs?) and while I would be interested in a critical look at the 12 step program, this book was actually about drug rehab, largely in the context of the opioid crisis and the insurance money that has flooded the rehab industry in its wake.
I thought the four person approach kept the story momentum really well balanced and I’m glad that we got to see how different people get rattled around by different parts of the system. A lot of the accounts we hear are really devastating, but the overall emotional flavor of this book is more rage than sorrow, which I appreciated. It’s a look at systemic factors that are reflected by the same injustices in our wider society and also how specific bad actors are exploiting loopholes to take advantage at some of the most vulnerable people in our communities. The constant repetition of fraud and lack of care and exploitation was infuriating.
The only thing I could have asked a little more from the book would be more specific policy recommendations. There is a slight air of defeatism at the end worrying about how another Trump presidency is exacerbating the issues, but I honestly found that pretty relatable. But some more specific recommendations for how to channel the righteous anger would have been appreciated. Still, a very solid read.
I thought this was really solid! For some reason I also expected this to be a little more AA focused (Is it the cover? Do we really all associate AA with those chairs?) and while I would be interested in a critical look at the 12 step program, this book was actually about drug rehab, largely in the context of the opioid crisis and the insurance money that has flooded the rehab industry in its wake.
I thought the four person approach kept the story momentum really well balanced and I’m glad that we got to see how different people get rattled around by different parts of the system. A lot of the accounts we hear are really devastating, but the overall emotional flavor of this book is more rage than sorrow, which I appreciated. It’s a look at systemic factors that are reflected by the same injustices in our wider society and also how specific bad actors are exploiting loopholes to take advantage at some of the most vulnerable people in our communities. The constant repetition of fraud and lack of care and exploitation was infuriating.
The only thing I could have asked a little more from the book would be more specific policy recommendations. There is a slight air of defeatism at the end worrying about how another Trump presidency is exacerbating the issues, but I honestly found that pretty relatable. But some more specific recommendations for how to channel the righteous anger would have been appreciated. Still, a very solid read.
September 11, 2025
Best work I’ve read on the state of addiction treatment in the US. Riveting, informative, revealing, shocking, moving, and deeply insightful. Everyone should read!
October 19, 2025
Rehab by Shoshana Walter has all the elements of the worst perfect storm: a vulnerable population with very few allies, an unregulated industry which allows virtually anyone to open a rehab center with no medical background or training, an insurance industry that cares for nothing much beyond the least amount of payoff possible, and a government which provides inept guardrails against incredible corruption. The research to pull all these different threads towards a coherent narrative seems overwhelming, but this is a miracle author; it’s as compelling a story as you will read this year.
Addiction is such a challenging problem, but when you add a pharmaceutical industry that lies and coverups how addictive their newest painkillers were, and you have one of the deadliest crisis ever.
If you believe that government is the problem and business is the solution, read this and see if your needle didn’t move a bit.
This is such an important book about a very uncomfortable subject. Remember this: at the end of the day, ignoring a problem will only compound the consequences.
Addiction is such a challenging problem, but when you add a pharmaceutical industry that lies and coverups how addictive their newest painkillers were, and you have one of the deadliest crisis ever.
If you believe that government is the problem and business is the solution, read this and see if your needle didn’t move a bit.
This is such an important book about a very uncomfortable subject. Remember this: at the end of the day, ignoring a problem will only compound the consequences.
October 8, 2025
This was fantastic, but absolutely enraging. Walter examines rehab from multiple angles, principally through 4 personal stories, to explain why rehab is failing in the US. The problem is multifaceted. We often like to simplify problems in healthcare to "for profit sucks" or "insurance sucks," and it's so complicated. First (the book doesn't get into this as much) our knowledge of addiction medicine isn't as good as it should be, and is often overly reliant on morality and 12-step. Second, we started funding rehab (thanks in part to the ACA) but what we did was turn on a money faucet without paying enough attention to quality.
Profit was certainly a motive, but there are nonprofit facilities that aren't providing good care. And what's more, states and the feds are falling down on the job. A for profit rehab chain was allowed to let MULTIPLE people die, because regulators just did not act despite efforts to draw their attention. Another rehab was using its patients as unpaid forced labor and the state was diverting people there. Meanwhile the DEA dragged its feet on Suboxone. Until the opioid crisis erupted and the DEA started going after pill mills, doctors could prescribe unlimited amounts of opioids but only take 30 patients who needed Suboxone. There's also stigma associated with prescribing Suboxone, so doctors are unwilling to do it. (Regulations are also partly why methadone is stigmatized and cash only.)
And even when patients can get rehab paid for, insurance and Medicaid can impose arbitrary limits, turning treatment into a revolving door. There's little to no social and welfare support, so patients have no way of supporting themselves if they need outpatient treatment. Too much is dumped on "sober living" homes.
The stories are interesting and morally complex. For example, Larry Ley absolutely started his clinic to make money, but he also probably provided better care than most other rehabs. Wendy McEntyre absolutely was right about the clinics she crusaded against, but her techniques were questionable.
Profit was certainly a motive, but there are nonprofit facilities that aren't providing good care. And what's more, states and the feds are falling down on the job. A for profit rehab chain was allowed to let MULTIPLE people die, because regulators just did not act despite efforts to draw their attention. Another rehab was using its patients as unpaid forced labor and the state was diverting people there. Meanwhile the DEA dragged its feet on Suboxone. Until the opioid crisis erupted and the DEA started going after pill mills, doctors could prescribe unlimited amounts of opioids but only take 30 patients who needed Suboxone. There's also stigma associated with prescribing Suboxone, so doctors are unwilling to do it. (Regulations are also partly why methadone is stigmatized and cash only.)
And even when patients can get rehab paid for, insurance and Medicaid can impose arbitrary limits, turning treatment into a revolving door. There's little to no social and welfare support, so patients have no way of supporting themselves if they need outpatient treatment. Too much is dumped on "sober living" homes.
The stories are interesting and morally complex. For example, Larry Ley absolutely started his clinic to make money, but he also probably provided better care than most other rehabs. Wendy McEntyre absolutely was right about the clinics she crusaded against, but her techniques were questionable.
August 19, 2025
4.5 stars. The author used 4 characters to structure the book, each of which is located in a different part of the US. Each character represents a unique view of the opioid issue, as well. She really got deep enough into each person’s situation to give interest and depth to the conversation without bogging it down with too much detail. I thought she struck a perfect balance in that regard. I was invested in each character and appreciated the epilogue to learn their updated statuses.
The commercial and political aspects of rehab were well-considered and -researched. I feel like i have a better understanding of what rehab is and does - and its limitations and dangers. Anyone who has been touched in any way by addiction will find something to appreciate here. Highly recommend. (The half star under 5 reflects my personal lack of clarity on the physician’s story. Not really sure if the role he filled was overall positive or negative for the addicted community)
The commercial and political aspects of rehab were well-considered and -researched. I feel like i have a better understanding of what rehab is and does - and its limitations and dangers. Anyone who has been touched in any way by addiction will find something to appreciate here. Highly recommend. (The half star under 5 reflects my personal lack of clarity on the physician’s story. Not really sure if the role he filled was overall positive or negative for the addicted community)
August 20, 2025
4.5 rating. This was a tough read. The business of rehab is highlighted in this investigative book following four people and their journeys. Chris and April are addicts that go through different stages of recovery with various results. You can tell which one gets more of the benefit of the doubt and second, third, fourth, etc. chances vs. someone from a minority group who is not given those opportunities. Larry is a former surgeon that lost his profession due to addiction but has reinvented himself as a provider for those in need of the tools in order not to relapse. Wendy lost a son to an overdose and now goes after those responsible for his death and in general the for-profit rehab industry.
August 17, 2025
A marvelous page turner!
A brilliant book that reads like a mystery novel. It is so interesting and informative, poignant yet uplifting. Don't be surprised if this ends up on the Pulitzer Prize shortlist!
A brilliant book that reads like a mystery novel. It is so interesting and informative, poignant yet uplifting. Don't be surprised if this ends up on the Pulitzer Prize shortlist!
August 16, 2025
Eye-opening piece of non-fiction. The stories of four people navigating different aspects of the addiction treatment industry are compelling and shocking. A must read for anyone whose life, or the lives of loved ones, has been affected by addition.
October 7, 2025
I knew that the medical system in the USA is profit driven and reading this book just reiterated this fact. A fascinating read about putting profit ahead of actually helping people kick their addictions.
August 28, 2025
This book is about some of the problems in the modern world of helping people with drug addictions. The author picked four different people and alternated their stories. Each person's story showed a different facet of issues in rehab: too short of stays allowed by insurance, too many regulations on the drug suboxone, not enough regulations on quality of care, and exploitative and dishonest programming, and weak state oversight that never lead to any changes.
1. Chris went to Cenikor, and from his story I learned: don't go to Cenikor. Their program forced patients to work all day every day as rehabilitation (the direction RFK wants to take things). Cenikor had all its patients work for different agencies or businesses doing hard and dangerous work, and the company got to keep their paychecks (the patients got paid in cigarettes). Their insurance was billed for therapy they never got because they were too busy working. Chris was injured on the job and Cenikor refused to let him seek medical care. The author points out it was his white privilege that got him into this program, but it sounds like a really shitty program, so I'm not sure this was the biggest takedown for white privilege.
2. April's story was heartbreaking. She is a black woman who's a third generation of addicts who had kids super young. She had so many problems created by systemic issues. She was finally able to access rehab in the form of "sober-living homes." These places don't have to provide therapy or detox, and they can have religious values as part of their programming, but you do have to pay for them. The one April went to had three women to a bedroom in tiny bedrooms. She kept relapsing and going back to being homeless, then returning to sober-living homes. They don't have a great success rate but April was eventually able to stay sober and get her kids back. She was a compassionate woman who looked out for homeless addicts after she got sober, doing things like bringing warm hot dogs to the tent city addicts. She was a very resilient and good-hearted person, which stayed with me more strongly than the points about sober living homes.
3. Wendy's story really did not land for me! Sorry, Wendy! Wendy's son died in a sober-living home when he was 20. It was badly run and they falsely advertised a bunch of programs at the home that weren't actually in place. It was run by a Mormon who knew nothing about addiction. Wendy's son had texted her saying he was unhappy/suicidal, but the owner convinced Wendy he was fine and shouldn't leave. Then her son ran away and months later they found his body. That part was sad. The part I didn't sympathize with was Wendy's reaction. She got a bunch of employees to spill the beans on how poorly the place was run and about some of her son's suicide attempts there. So Wendy spent all her time after that emailing everyone in the state these crazy, all caps emails, multiple times a day. She kept saying, "I'm not crazy," but it was because her behavior actually was crazy. She printed out all her emails and would bring them to trials, and the judge would be like "you can't just print out a bunch of emails and submit them as evidence in the middle of a trial." The author was trying to frame her as this warrior mom, but I have been on the other end of people's emails like this, and they're just impossible to deal with. Maybe the point of this story is that grief from bad rehab can make loved ones insane?
4. Larry was a former surgeon and recovering (?) alcoholic who who was prescribing Suboxone, a drug that reduces cravings for opiates and makes them harder to take (kind of like Chantix does for cigarettes). The author says the problem with Suboxone is that the FDA has put so many limits on who can get it that it's not having nearly the impact it could if it were less stigmatized/heavily regulated by the government. Larry was allowed to only have 30 patients for Suboxone. But he decided to write prescriptions for it as off-label use for "pain." Then his practice turned into a pill mill. He would spend hardly any time with patients and write hundreds of suboxone prescriptions a day for patients lining up all day. Believe it or not, this got him arrested. The author made it seem like this was somewhat of a travesty, but after the Sacklers this guy should really know what pill mill behavior looks like. His story was the worst one.
SO overall, I liked some of the individual stories, but I think the author pretty one-sided in her views. I didn't think her analysis always held up, or that the stories always illustrated the points she was trying to make. But I did learn some new things about shady rehab practices and the latest battles in the drug war, so that was nice! Plus it was a quick read.
1. Chris went to Cenikor, and from his story I learned: don't go to Cenikor. Their program forced patients to work all day every day as rehabilitation (the direction RFK wants to take things). Cenikor had all its patients work for different agencies or businesses doing hard and dangerous work, and the company got to keep their paychecks (the patients got paid in cigarettes). Their insurance was billed for therapy they never got because they were too busy working. Chris was injured on the job and Cenikor refused to let him seek medical care. The author points out it was his white privilege that got him into this program, but it sounds like a really shitty program, so I'm not sure this was the biggest takedown for white privilege.
2. April's story was heartbreaking. She is a black woman who's a third generation of addicts who had kids super young. She had so many problems created by systemic issues. She was finally able to access rehab in the form of "sober-living homes." These places don't have to provide therapy or detox, and they can have religious values as part of their programming, but you do have to pay for them. The one April went to had three women to a bedroom in tiny bedrooms. She kept relapsing and going back to being homeless, then returning to sober-living homes. They don't have a great success rate but April was eventually able to stay sober and get her kids back. She was a compassionate woman who looked out for homeless addicts after she got sober, doing things like bringing warm hot dogs to the tent city addicts. She was a very resilient and good-hearted person, which stayed with me more strongly than the points about sober living homes.
3. Wendy's story really did not land for me! Sorry, Wendy! Wendy's son died in a sober-living home when he was 20. It was badly run and they falsely advertised a bunch of programs at the home that weren't actually in place. It was run by a Mormon who knew nothing about addiction. Wendy's son had texted her saying he was unhappy/suicidal, but the owner convinced Wendy he was fine and shouldn't leave. Then her son ran away and months later they found his body. That part was sad. The part I didn't sympathize with was Wendy's reaction. She got a bunch of employees to spill the beans on how poorly the place was run and about some of her son's suicide attempts there. So Wendy spent all her time after that emailing everyone in the state these crazy, all caps emails, multiple times a day. She kept saying, "I'm not crazy," but it was because her behavior actually was crazy. She printed out all her emails and would bring them to trials, and the judge would be like "you can't just print out a bunch of emails and submit them as evidence in the middle of a trial." The author was trying to frame her as this warrior mom, but I have been on the other end of people's emails like this, and they're just impossible to deal with. Maybe the point of this story is that grief from bad rehab can make loved ones insane?
4. Larry was a former surgeon and recovering (?) alcoholic who who was prescribing Suboxone, a drug that reduces cravings for opiates and makes them harder to take (kind of like Chantix does for cigarettes). The author says the problem with Suboxone is that the FDA has put so many limits on who can get it that it's not having nearly the impact it could if it were less stigmatized/heavily regulated by the government. Larry was allowed to only have 30 patients for Suboxone. But he decided to write prescriptions for it as off-label use for "pain." Then his practice turned into a pill mill. He would spend hardly any time with patients and write hundreds of suboxone prescriptions a day for patients lining up all day. Believe it or not, this got him arrested. The author made it seem like this was somewhat of a travesty, but after the Sacklers this guy should really know what pill mill behavior looks like. His story was the worst one.
SO overall, I liked some of the individual stories, but I think the author pretty one-sided in her views. I didn't think her analysis always held up, or that the stories always illustrated the points she was trying to make. But I did learn some new things about shady rehab practices and the latest battles in the drug war, so that was nice! Plus it was a quick read.
This entire review has been hidden because of spoilers.
December 1, 2025
I wish this one had gone a bit deeper into the issues plaguing for profit rehab centers. This is a good primer, but I was hoping for more. Walter follows 4 people - a second-generation addict struggling to get her kids back, a middle class man who ends up in a cult-ish rehab instead of prison, a mom whose son died in a sober living home, and an early suboxone provider who is wrongly arrested by the DEA because they didn't understand how addiction treatment works.
The stories are good at showing the humanity behind what is often a maligned part of society. For those wanting more, Empire of Pain: The Secret History of the Sackler Dynasty is a great next read.
* Biden was a long-time supporter of finding a medical cure for addiction and worked with Congress to create a special division of the National Institute on Drug Abuse (NIDA) which worked with pharma companies to develop new medications. NIDA eventually developed and manufactured suboxone.
* The drug rehab industry is a crude spin off of alcohol rehab and often based on a 30-day (ish) stay. But without wraparound support, the same problems and triggers are still there after rehab; almost 60% of people entering drug treatment have had at least one prior stint in similar treatment. More than 1 in every 10 people have been to rehab 6+ times.
* For opioid addictions, the period following rehab or incarceration is often the deadliest. Programs that last fewer than 90 days have higher rates of relapse. One study found that graduates of 28-day rehab programs were far more likely to die of an overdose in the year after treatment than those who failed to finish it. These programs are effective at temporarily stopping drug use, but lowered a user's tolerance level, increasing the chance of overdose when relapse inevitably occurred.
* While much addiction research tries to find a cure - a way to block dopamine activity in the brain to stop compulsive cravings - newer research is showing that economics might be an answer. Experiments with addicts of crack and meth showed that almost every drug user in an experiment passed up a dose of their drug of choice when they were offered $20 instead. "When they were given an alternative to crack, they made rational economic decisions." I want to read more about this, as this is fascinating to me and almost seems too good to be true. 60% of addicts, though, overcome their addiction without any treatment at all. Scores of research shows that contingency management - a type of treatment in which patients receive consequences and rewards for behavior - is highly effective at treating addiction. Recovery capital, resources to support recovery often via support networks, money, education, etc. are more successful at maintaining their recovery.
The stories are good at showing the humanity behind what is often a maligned part of society. For those wanting more, Empire of Pain: The Secret History of the Sackler Dynasty is a great next read.
* Biden was a long-time supporter of finding a medical cure for addiction and worked with Congress to create a special division of the National Institute on Drug Abuse (NIDA) which worked with pharma companies to develop new medications. NIDA eventually developed and manufactured suboxone.
* The drug rehab industry is a crude spin off of alcohol rehab and often based on a 30-day (ish) stay. But without wraparound support, the same problems and triggers are still there after rehab; almost 60% of people entering drug treatment have had at least one prior stint in similar treatment. More than 1 in every 10 people have been to rehab 6+ times.
* For opioid addictions, the period following rehab or incarceration is often the deadliest. Programs that last fewer than 90 days have higher rates of relapse. One study found that graduates of 28-day rehab programs were far more likely to die of an overdose in the year after treatment than those who failed to finish it. These programs are effective at temporarily stopping drug use, but lowered a user's tolerance level, increasing the chance of overdose when relapse inevitably occurred.
* While much addiction research tries to find a cure - a way to block dopamine activity in the brain to stop compulsive cravings - newer research is showing that economics might be an answer. Experiments with addicts of crack and meth showed that almost every drug user in an experiment passed up a dose of their drug of choice when they were offered $20 instead. "When they were given an alternative to crack, they made rational economic decisions." I want to read more about this, as this is fascinating to me and almost seems too good to be true. 60% of addicts, though, overcome their addiction without any treatment at all. Scores of research shows that contingency management - a type of treatment in which patients receive consequences and rewards for behavior - is highly effective at treating addiction. Recovery capital, resources to support recovery often via support networks, money, education, etc. are more successful at maintaining their recovery.
October 11, 2025
Every few years, there's a new book highlighting yet another systemic problem that has allowed the current epidemic of drug use (particularly opioids) to grow larger than it needed to be and delayed a much needed resolution. The author of "Rehab" chose to draw our attention to the rise of predatory, rehab and sober living facilities. Much of the story is not surprising for an American: individuals and corporations took advantage of governmental efforts to address and resolve the opioid epidemic, and quickly prioritized profits, cut safety, imposed rules of conduct which were not backed by science while emphasizing a need to believe in a specific religion (or become part of a mini-cult). Starting with personal stories of recovering addicts and surviving family members, Shoshana Walter offers us a broad view of how greed and stubbornness are causing harm and trapping people into long, sometimes inescapable, cycles of drug use. The DEA's reputation comes out, once again, rather tarnished: by the description of DEA's obsession with rejecting suboxone/bupernorphine treatment as a valuable tool to end addiction, emphasizing their obsession with putting people in jail, and by showcasing how the leadership overwhelmed much needed diversion investigators. A brief contrast with the way European countries dealt differently with their methadone treatments, needle exchange, and emphasized safety and reform for addicts was very useful. But I did have trouble believing that the narrative was objective at times. For e.g., I have some suspicion that parts of Dr. Larry's story were left out in order for the reader to see him as a victim of the evil DEA. There was also a quick claim in the epilogue about using psychoactive substances as treatment for addiction, even though recent studies have suggested that those early success stories may have been significantly blown out of proportion by yet another market hoping to grow and become legitimate. While to my knowledge the research is solid, I would pair it with more works of investigative journalism to get a clearer picture.
October 26, 2025
Wow. Four stars for a thoroughly researched, genuinely disturbing look at the for-profit rehab industry in America today.
This book profiles four people ensnared in the shadow industry that is drug rehabilitation (and, as I learned, the completely unregulated cottage industries that spring up within it - like sober living homes). Chris is a middle class white guy who falls into addiction and finds himself in a jail-like rehab facility for nearly two years. April is a Black mom struggling to break the multigenerational cycle of addiction. Dr. Larry Ley struggled with alcoholism and now battles the DEA in his attempt to provide lifesaving medications for addicted people trying to quit. And Wendy McEntyre loses her son to drugs, only to work through her grief by exposing the rehab industry for what it really is.
I always struggle with books like this when the four perspectives are interwoven. I opted to read one perspective all the way through, then go back and read the second one and so forth. This helped me keep track of each narrative arc and feel more invested in each story. I skimmed through a bit of the exposition/context - but if you’re looking for that, the author certainly does it well.
Four stars for a harrowing look at an industry operating in the worst corners of capitalism. I felt so deeply for everyone trapped within this system - including the low-wage workers with no medical qualifications who are just as trapped as the people they’re ostensibly helping.
Regardless of whether or not your family has been touched by addiction, please read this. You won’t regret it.
This book profiles four people ensnared in the shadow industry that is drug rehabilitation (and, as I learned, the completely unregulated cottage industries that spring up within it - like sober living homes). Chris is a middle class white guy who falls into addiction and finds himself in a jail-like rehab facility for nearly two years. April is a Black mom struggling to break the multigenerational cycle of addiction. Dr. Larry Ley struggled with alcoholism and now battles the DEA in his attempt to provide lifesaving medications for addicted people trying to quit. And Wendy McEntyre loses her son to drugs, only to work through her grief by exposing the rehab industry for what it really is.
I always struggle with books like this when the four perspectives are interwoven. I opted to read one perspective all the way through, then go back and read the second one and so forth. This helped me keep track of each narrative arc and feel more invested in each story. I skimmed through a bit of the exposition/context - but if you’re looking for that, the author certainly does it well.
Four stars for a harrowing look at an industry operating in the worst corners of capitalism. I felt so deeply for everyone trapped within this system - including the low-wage workers with no medical qualifications who are just as trapped as the people they’re ostensibly helping.
Regardless of whether or not your family has been touched by addiction, please read this. You won’t regret it.
September 11, 2025
Like most Americans, I was familiar with the ravages of the opioid crisis and the evils of Big Pharma, but I didn't know much about the rehab industry. I suppose I trusted that any recovery centers that are operating would be licensed and have the patients' welfare in mind as they came up with treatment plans for those who are addicted to drugs. But as this investigative report into the industry shows, that often isn't the case, and even if someone is able to "recover" in 30 days, the chances of relapse are high since there's often little support when they leave the facility. This book tells the story of this industry and our country's failure through the eyes of four very different individuals--a Black mother living in Philadelphia, a white middle-class man living in Louisiana, a doctor in Indiana who prescribes bup to his patients, and an activist in California who makes bringing to light the corruption in the industry after the death of her son. Readers will feel as though they know these individuals as they follow them through various ups and downs, and while their experiences are representative of many others, readers will feel as though they know these individuals and their families, surely rooting for them to stay on the path to recovery. After finishing this important book, it's easy to question the whole recovery and treatment industry and the huge moneymaker it is and while embracing some of the author's suggestions for reform. Sadly, it's clear that once again, it's the most vulnerable who are being exploited. This cannot go on.
August 10, 2025
Thanks to NetGalley and Simon and Schuster for providing an eARC of Shoshana Walter's latest.
"Profit and punishment have ruled our treatment system, but it is these same concepts that seem to rule the United States. It is an addiction, since the founding of this country, that we just can't seem to quit".
Wow, this is an incredibly tough but essential read for everyone in the United States right now. Addiction has affected almost everyone's life at this point. Whether it’s someone's own addiction or those of friends or family, the damage is the same. People want to blame others, point fingers, and can't understand why some people "can't just stop using." They don’t see why nobody is helping, where to turn for help, or why people even start using drugs in the first place.
This non-fiction masterpiece is divided into three parts and follows four individuals' journeys from start to (sometimes quite literally) the end. It exposes the dark, ugly side of addiction treatment in the US. Covering sober living, scams, court-ordered treatment, private options, insurance costs, and more. The story is raw and gripping, yet handled with great care. It's clear why Shoshana Walter is a Pulitzer finalist.
I recommend this book to everyone. This should be required reading for those working in counseling, social work, etc.
Available August 12
"Profit and punishment have ruled our treatment system, but it is these same concepts that seem to rule the United States. It is an addiction, since the founding of this country, that we just can't seem to quit".
Wow, this is an incredibly tough but essential read for everyone in the United States right now. Addiction has affected almost everyone's life at this point. Whether it’s someone's own addiction or those of friends or family, the damage is the same. People want to blame others, point fingers, and can't understand why some people "can't just stop using." They don’t see why nobody is helping, where to turn for help, or why people even start using drugs in the first place.
This non-fiction masterpiece is divided into three parts and follows four individuals' journeys from start to (sometimes quite literally) the end. It exposes the dark, ugly side of addiction treatment in the US. Covering sober living, scams, court-ordered treatment, private options, insurance costs, and more. The story is raw and gripping, yet handled with great care. It's clear why Shoshana Walter is a Pulitzer finalist.
I recommend this book to everyone. This should be required reading for those working in counseling, social work, etc.
Available August 12
January 17, 2026
I thought this book was well-researched, and at one point as she began describing a particular rehab practice, I knew immediately she was describing the methods of the Synanon the scam/cult movement. I was floored that its methods were still being used by rehabilitation services, I thought those had been debunked as abusive back in the 1970s.
It's clear almost immediately that as soon as capitalism is unleashed on a vulnerable population, humanity goes right out the window. If people can make a profit off something they will lobby for it, pay off the politicians and do everything they can to keep the money rolling in even if people die.
Slavery never really ended in this country, it's just repackaged and forced on people who have no other choice. I was sickened but not surprised that a rehab in Louisiana was using their alternative-to-prison program enrollees as forced unpaid labor, interrupting their sleep with petty punishments, inflicting hundreds of pointless rules, not providing them any therapy, or medical care, and taking all their pay. That's textbook cult behavior.
I think I became aware of the rehab-for-profit problem when I saw the movie Body Brokers, which featured Michael K. Williams, who eventually died of an overdose himself -- a death the hit me hard. I've read other books on the opioid epidemic.
This country still has a long way to go.
It's clear almost immediately that as soon as capitalism is unleashed on a vulnerable population, humanity goes right out the window. If people can make a profit off something they will lobby for it, pay off the politicians and do everything they can to keep the money rolling in even if people die.
Slavery never really ended in this country, it's just repackaged and forced on people who have no other choice. I was sickened but not surprised that a rehab in Louisiana was using their alternative-to-prison program enrollees as forced unpaid labor, interrupting their sleep with petty punishments, inflicting hundreds of pointless rules, not providing them any therapy, or medical care, and taking all their pay. That's textbook cult behavior.
I think I became aware of the rehab-for-profit problem when I saw the movie Body Brokers, which featured Michael K. Williams, who eventually died of an overdose himself -- a death the hit me hard. I've read other books on the opioid epidemic.
This country still has a long way to go.
September 23, 2025
(Ordered from Amazon) "In America's uniquely profit-driven healthcare system, unethical business practices thrive," writes investigative journalist Shosahna Walter in her piercing new book Rehab: An American Scandal. The opioid crisis was depicted in two TV mini-series and Walter covers the aftermath. As a result of the tidal wave of addiction, rehabilitation entrepreneurs cashed in, but their facilities had very little, if any, regulation. As a result, too many clients relapsed or even died due to inappropriate treatment or lack of supervision. Walter focuses on four individuals caught in the web of the rehab industry. Chris is trapped in a rehab which farms out its patients as essentially slave labor for profit. April is caught in an endless cycle of drugs, prostitution and homelessness (This section hit me hard because April finds herself in the Kensington neighborhood of Philadelphia where my dad grew up in the 1930s, but which is now the most notorious drug and crime-infested section of the City of Brotherly Love.) Wendy has lost a son in one of the rehab centers and crusades to bring the owners to justice, even to the point of getting herself arrested. Dr. Larry, a recovering alcoholic, runs a rehab facility and runs afoul of federal agencies. It's a compelling and heartbreaking study.
September 19, 2025
This book really opened my eyes to how broken the U.S. rehab system is. Walter shows how so many programs are profit-driven, exploit people at their lowest. She also explains “recovery capital” — the idea that things like housing, money, and support networks make a huge difference in recovery, and how those resources aren’t equal across race and class.
The book really comes alive through the people she follows: a Black mother who lost custody of her children and turned to prostitution to fund her drug use; a white man sent to a cult-like, manipulative rehab program who left without true recovery; a wealthy suburban mother whose son died in a sober living home and who spent years exposing the dangers of for-profit rehabs, only to struggle to get authorities to listen; and a doctor who prescribed Suboxone — a medication proven to help with opioid recovery, but stigmatized and tightly regulated — and ended up treated like a criminal.
I’d recommend it to fans of investigative journalism, especially those who enjoyed Empire of Pain.
The book really comes alive through the people she follows: a Black mother who lost custody of her children and turned to prostitution to fund her drug use; a white man sent to a cult-like, manipulative rehab program who left without true recovery; a wealthy suburban mother whose son died in a sober living home and who spent years exposing the dangers of for-profit rehabs, only to struggle to get authorities to listen; and a doctor who prescribed Suboxone — a medication proven to help with opioid recovery, but stigmatized and tightly regulated — and ended up treated like a criminal.
I’d recommend it to fans of investigative journalism, especially those who enjoyed Empire of Pain.
August 22, 2025
A sad quasi-sequel to Dopesick: Dealers, Doctors, and the Drug Company that Addicted America, showing how greed, victim-blaming, racism, lack of oversight, and more greed made a mockery of the drug addiction "treatment" process. Here's a prime example of the shitshow: when opioid pushers Purdue Pharma went under, their aggressive salespeople were eagerly snapped up by the company that manufactured Suboxone (an opioid disorder treatment medication), and offered the same incentives to enroll as many physicians as possible. The job titles might have evolved from "sales rep" to "clinical liaison," and the medication was genuinely effective, but the profit motive remained the same. And low-income patients were still screwed.
August 27, 2025
Thank you to NetGalley and Simon & Schuster for the ARC on this very timely and important book. These are true stories of people across all ethnicities and economic backgrounds who are addicts and want to get clean. As someone who has had experience with this personally in my life with friends and family, we know that this Rehab industry is filled with scammers and schemers praising their almighty dollars. The families left behind when they lose one of their own to this disease while in a treatment center is terrifying. But the fact that the bureaucracy allows it and refuses to give consequences to those in charge is absolutely enraging. It took me longer than usual to finish this book because I was so upset and felt so helpless while reading he’s in passion please of mothers and fathers. This is a terribly important book and should be read by all this book was so well researched and so well written and explains everything in layman‘s terms. Highly Recommended!
September 6, 2025
An eye opening account taken from several stories of real people either part of the problem or enduring through a system designed to profit from drug addiction rehab without the true rehabilitation needed to sustain sobriety. It was hard to read, sickening beyond measure and complicit in bringing awareness into for-profit organizations supposedly helping addicts through sober living communities, rehab centers and even medical fields who only enabled and even worsened the addict's condition. Shameful, ridiculous and a down right outrage learning about the state government's lack of recourse or ability to make needed changes and not enforcing necessary punitive measures to hold these despicable people accountable for known deaths under their watch.
A must read for those unaware of the nefarious intentions of these so called rehabs that are just as bad as the street drug dealers and pharmaceutical companies.
A must read for those unaware of the nefarious intentions of these so called rehabs that are just as bad as the street drug dealers and pharmaceutical companies.
September 27, 2025
Shoshana Walter deftly reports on the exploitive methods of some rehab facilities and how the U.S. health insurance system and a lack of government regulation enable those abuses, all to the detriment of the people who are trying to get well. Walter brings her considerable investigative reporting skills to this effort, revealing the interconnected layers of the "profit and punishment" system. But what makes the book immersive are the characters Walter focuses on. She chooses four people whose stories exemplify the system's failures. You don't need her to spell it out in the epilogue but can tell in the pages that she spent a lot of time getting to know them. She handled their stories with great care and made me care about them, too. This book shows how luck and money too often determine who gets well.
November 3, 2025
I thought this was an excellent book about the dark side of addiction medicine. This book made me so angry about the way we treat addiction, like people have a problem with their personality rather than a biological problem. It feels like the system has barely changed, and then on top of it the way crimes intermingle with drugs and how it destroys people, and the system simply doesn’t care to help. Instead, we the taxpayers fund prisons that do not rehab, and healthcare overcharges for fraudulent rehab programs that do more harm while bankrupting people.
I think this book could have expanded on any recent changes or insights we have seen to the industry and how we should move forward. Would have liked a bigger call to action.
Thanks Net Galley and Simon and Schuster for a copy of this Arc.
I think this book could have expanded on any recent changes or insights we have seen to the industry and how we should move forward. Would have liked a bigger call to action.
Thanks Net Galley and Simon and Schuster for a copy of this Arc.
September 7, 2025
This was part collective biography, part exposé of the rehab industry, especially the for-profit facilities. I've worked in addiction treatment and based on this book, I should be grateful the facilities where I worked were NOT like what she described. Then again, they eventually went out of business for lack of funding. The author describes the funding difficulties for addiction treatment, especially non-profit agencies. She also thoroughly covers the lack of oversight where it's needed, and the excessive restrictions where there should be more flexibility. While she doesn't cover all the problems plaguing the US mental health system, she covers quite a few and how these programs affect clients, physicians and treatment professionals, and families.
January 7, 2026
Having read almost all the books available on the Opioid crisis (which now you could characterise as an illicit drug crisis ) in the United States, I was intrigued when I saw this book on my recent book search.
The book is extremely well written and tells the story of four different people navigating their way through addiction recovery and the blatant lack of resources that surrounds the rehabilitation network in the US.
Having had my own personal battle with opioid use I am so grateful that I didn’t need to go to rehab for my recovery. I thankfully had my own team of Legends to get me through. All these poor souls want to do is get better but there is SO much standing between them & recovery. Especially money.
The book is extremely well written and tells the story of four different people navigating their way through addiction recovery and the blatant lack of resources that surrounds the rehabilitation network in the US.
Having had my own personal battle with opioid use I am so grateful that I didn’t need to go to rehab for my recovery. I thankfully had my own team of Legends to get me through. All these poor souls want to do is get better but there is SO much standing between them & recovery. Especially money.
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