Introduction
This article is not trying to send you anywhere. There is a large industry built around this decision, some of it excellent and some of it predatory, and one of the most useful things anyone can give you is the ability to tell the difference.
What follows is a map of what exists, how to evaluate it, and what to walk away from.
Rehab Is Not One Thing
The word conjures a single image — residential, twenty-eight days — which is one level of care among several. Treatment is conventionally arranged along a continuum, roughly from most to least intensive:
Medically managed detox. Short-term, clinical, for withdrawal that carries medical risk. Necessary for alcohol and benzodiazepines in heavy sustained use. This is stabilization, not treatment.
Residential / inpatient. You live there. Structure, groups, individual therapy, medical staff. Typically weeks.
Partial hospitalization (PHP). Most of the day, most days, but you sleep at home.
Intensive outpatient (IOP). Several sessions a week, often evenings, designed around a job.
Standard outpatient. Weekly or fortnightly therapy.
Medication. For opioid use disorder, buprenorphine or methadone — the interventions with the strongest evidence base. For alcohol, naltrexone, acamprosate, disulfiram. Medication is not a lesser form of recovery and it can be delivered at any level above.
Mutual aid and peer support. Free. Not treatment, and for many people the thing that sustains the rest.
The Right Level Is a Clinical Question
The single most important sentence in this article: you should not choose your level of care from a website.
Get an assessment. Severity, withdrawal risk, co-occurring psychiatric conditions, home environment, and prior treatment history determine what's indicated. A great many people are placed in residential treatment who did not need it, and some who badly needed it were sent home.
An assessment is also the document your insurer will respond to.
The Industry Has a Problem
This has to be said plainly, because it is the part the brochures omit.
Patient brokering — also called body brokering — is the practice of paying third parties a fee for delivering patients to a facility. Reported figures run to several hundred or a thousand dollars per head, and brokers have been documented recruiting from support meetings, homeless encampments, and drug courts, prioritizing people with good insurance.
It has been prohibited under federal law since 2018 and is criminalized in many states.1 Enforcement has been uneven.
Related practices include billing insurers for services never provided, excessive and unnecessary urine testing — one case reported by NPR involved a charge of $9,500 for five tests — and cycling people between facilities and sober homes to maximize billing, a pattern that acquired the name "the Florida Shuffle."
The Red Flags
Any of these should stop you.
They offer to pay for your travel, or to fly you to another state. Legitimate facilities and insurers do not do this.
They offer you money, gifts, free rent, or free treatment to enrol or to switch facilities.
They offer to enrol you in a new insurance plan, particularly using an address that isn't yours. This is fraud, and you may be a party to it.
You're being pressured to decide immediately. Urgency is the salesman's tool. Real clinicians want you to ask questions.
The website is generic, lists many locations, and has one phone number for all of them. Some directories are elaborate brokering operations. Contact facilities directly.
Anyone guarantees success, quotes an implausible success rate, or promises a cure.
They are vague about services, staff credentials, or costs. Reputable programs answer these immediately.
Someone at a support meeting offers to get you into a place and asks about your insurance. This is a documented recruitment pattern.
What to Check, Concretely
Licensure. Verify with the state agency that licenses treatment facilities. This is a phone call.
Accreditation. The Joint Commission and CARF are the main accrediting bodies in the US. Accreditation is voluntary and not required by law — which is why so many facilities lack it. It certifies that minimum standards were met, which is a floor rather than a ceiling. Verify claims of accreditation directly with the accreditor, because facilities have lied about it.
Staff. Who are the clinicians? What are their credentials? Is there medical oversight, or only counsellors?
Do they offer medication for opioid and alcohol use disorder? A facility that refuses to provide the most evidence-based treatment available, on ideological grounds, is telling you what it prioritizes.
Do they treat co-occurring conditions? If not, and you have one, they will treat half of you.
Ask your referrer if they benefit. "Do you receive anything for sending me there?" It is a fair question and the answer is informative.
Questions Worth Asking Directly
What does a day look like? What therapies do you use, and what evidence supports them? What is the staff-to-patient ratio? What happens after discharge — what does aftercare consist of, specifically? What are the total costs, including anything not covered? What do you do if I relapse?
If the answers are enthusiastic rather than specific, keep looking.
What Actually Predicts the Outcome
Not the amenities. Not the beach.
Length of engagement with treatment, whether medication is used where indicated, whether co-occurring conditions are addressed, and what happens in the year after discharge. Luxury facilities are not better at these things by virtue of being expensive.
The Bottom Line
There is a continuum of care and residential rehab is one point on it — get a clinical assessment before assuming. Then treat the search as a due diligence exercise, because patient brokering, insurance fraud, and unnecessary testing are documented features of this industry. Nobody legitimate pays for your flight, guarantees results, or pressures you to decide today. Verify licensure and accreditation independently. And ask what happens after you leave, because that is what determines whether any of it worked.
Sources
- Patient brokering prohibited federally since 2018 (18 U.S.C. 220) — Eliminating Kickbacks in Recovery Act of 2018 (EKRA), codified at 18 U.S.C. Sec 220; enacted 24 October 2018 as part of the SUPPORT for Patients and Communities Act. View source ↗