Family photos of Carol Katz Beyer and her children, Bryan and Alex. In the beach photo, Bryan is on the left. The photo on the lower right is of Carol and Alex.
“He’s gone! Bryan’s gone!” Carol Katz Beyer’s ex-husband screamed into the phone.
Carol, on the receiving end of the call, shook sleep from her eyes as she glanced at the clock. It was just after sunrise.
“He’ll be okay,” she assured him even as panic rose in her throat.
“No, he’s gone,” Wayne sobbed. “He overdosed. He’s gone.”
Dread settled over Carol. It just didn’t seem possible. Since he was a boy, Bryan, her eldest son, had possessed a drive and unquenchable optimism that made death seem untenable even during the most chaotic periods of his struggle with drug addiction.
“I’m fine, mom. Everything is going to be fine,” Bryan used to tell Carol as he chatted about his latest plans and achievements. Despite his struggles with addiction, he had gone through school, fulfilled his dream of working as a chef, married, and made plans to buy a house.
“I just thought if anyone could pull through it, Bryan could,” his mother tells me as we sit huddled under a staircase at a hotel in New Orleans. We are attending a conference here on harm reduction, but we have found a quiet place so that Carol can recount her family’s fight to keep Bryan alive.
Now a resident of New Jersey, Carol grew up in New York. She spent most of her career working in health care, but says her greatest joy was being a mother. With a wistful smile she describes the ball games, the parties, the music concerts, the happy moments nurturing little ones. But when she starts to talk about Bryan, her face clouds.
The story she has to tell is not uncommon. It is one that made her an expert in the struggles of addiction—and in the industry that has grown up around it. For more than a decade, before drugs claimed his life, Bryan was in and out of treatment centers. Most were private, for-profit facilities, all of which came out of the deal better off than he did.
Over the last several years, as drug overdose deaths have tripled and panicked parents search for a cure, the drug treatment industry has flourished. From 1999 to 2008 alone, opioid-related patient admissions to treatment facilities surged 600 percent, spurring a rise in the number of for-profit treatment centers. Meanwhile, in the past ten years, the number of nonprofit, state, and federally run drug treatment centers has declined.
This gold rush of treatment investors has been fueled in part by increasing demand, but also by an unlikely catalyst—the Affordable Care Act (ACA). President Obama’s signature achievement, which included substance use treatment in its list of essential services covered by health insurance, greatly increased the number of people with insurance plans and allowed young adults to stay on their parents’ health care until the age of twenty-six.
This law, coupled with the Mental Health Parity Act of 2008, which required insurers to cover mental health care as they do other health care, brought substance use treatment within reach to millions of families. As a result, annual spending by private insurers on opioid treatment alone skyrocketed by more than 1,000 percent in the five years following the passage of the ACA. Investors have taken note. By 2014, drug treatment and rehabilitation had become a $35 billion industry.
In Palm Beach County, Florida, alone, for-profit drug treatment providers rake in $1 billion a year. Treatment centers and detox facilities have flourished under Florida’s lax licensing requirements. While most treatment programs consist of twenty-eight days of inpatient care, Florida pioneered the idea of “sober homes” or houses where patients live and pay rent as they attend an off-site treatment center. Since sober homes are cheaper than residential facilities, insurance companies are often more willing to pay for them.
The trouble is that there is no incentive for sober homes to actually help people. Business is more lucrative if patients continue to use drugs and to rack up insurance expenses for treatment. As a result, there are documented cases in which patients in sober homes have actually been encouraged to continue using drugs.
“This is an entire industry that’s been corrupted by easy money,” Palm Beach County’s top prosecutor, State Attorney Dave Aronberg, told NBC News last year. “Unscrupulous actors have taken advantage of well-intended federal law, and a lack of any good law at the state level, to profit off people at the lowest stages of their lives.”
With so much money to be had from insurance companies and very little oversight, entire swaths of Florida, California, Arizona, and other rehab hotspots have evolved into giant pyramid schemes. Out-of-state patients who enter these rehab facilities are left homeless and jobless once their insurance runs out.
Many also have criminal records that make it more difficult to find employment. So the treatment centers hire former patients to recruit people seeking treatment from across the country in a practice known as “patient brokering.” There is no incentive for the centers to help people get well, because every relapse means a new harvest from insurance companies.
Investigations into the treatment industry have uncovered cases where employees divided urine samples or mixed them in order to charge insurance companies for more tests than were actually conducted.
Investigations into the treatment industry have uncovered cases where employees divided urine samples or mixed them in order to charge insurance companies for more tests than were actually conducted. Another popular form of fraud involves online marketers using advertisements on Google to hijack the names of legitimate treatment centers and reroute their numbers to call centers, which connect patients to predatory facilities.
“The addiction treatment industry has become very predatory as a whole,” Michael Schatman, director of research and network development at Boston Pain Care, told WebMD. “The consumer seeking help is in a bad position, and he or she is not going to know where to go.”
Carol and Wayne certainly did not. Their ordeal with drugs and drug treatment began when Bryan was around sixteen. Then divorced, they began getting phone calls from his school, letting them know that he was skipping classes.
Carol thought that Bryan was just testing his limits, as many teenagers do, and as she herself had done as a young person. But the school disagreed. When Bryan tested positive for cocaine and marijuana, the administration insisted that he enroll in an intensive outpatient drug program as a condition of staying in school. After that, soccer games and band practice were replaced by twelve-step group therapy sessions.
Carol remembers pulling up to the therapy center to pick up Bryan, and all of the kids in the program would be standing outside, smoking cigarettes. She later learned that Bryan had started using more drugs, such as prescription pills, that he obtained from other kids in the program.
Parents were required to attend the treatment program as well. Carol and Wayne learned how to drug-test Bryan, how to search his room, and how to call law enforcement if they found evidence of drug use.
“Now instead of being a mom I was monitoring all the time,” Carol recalls. “Are you using drugs? Are you thinking about drugs? Life became all about drugs.”
For two years, Bryan’s drug use waxed and waned, but he did manage to graduate from high school and enroll in Johnson & Wales University in Providence, Rhode Island, to pursue a degree in hospitality. At that time, it appeared that he had stopped using drugs. Carol’s face glows as she recounts the days spent helping Bryan settle into his new home and the relief of feeling that he had finally outgrown the rebellious teenage years.
Things seemed fine, for a while. Bryan would call home to let his parents know how school was going. But when they came to campus for a visit a few months into his freshman year, they found the beautiful apartment they had helped set up in a shambles. Glassy-eyed kids drifted in and out. It was clear an intervention was needed.
Carol and Wayne sought advice from addiction specialists and the school counselor. Everyone advised them to send Bryan to a twenty-eight-day rehab program where he could detox from the drugs. And everyone said that the mecca for treatment and recovery programs was Palm Beach County, Florida.
Bryan’s first trip to Florida ushered in a period of chaos, fear, and uncertainty. For ten years he went in and out of dozens of detox, rehab, and treatment centers, rarely anywhere for longer than twenty-eight days—the maximum length of time that most health insurance companies will cover treatment costs.
For his mother, tethered to the phone and nearly paralyzed with worry, that decade was a living nightmare. “Once the insurance benefits were exhausted,” she says, the treatment centers “would literally give the kids garbage bags with their clothes and tell them to get out.”
Carol describes an endless cycle of replacing licenses, wallets, clothes, shoes, and belongings that were left in one rehab facility or another. At times, Bryan seemed to be doing well and Carol would allow herself to hope. Then he would stop returning her calls and she would know that the ordeal had begun anew.
“[He wasn’t] better after a year, from ten rehabs, twenty rehabs, thirty detoxes,” she says. “It was terrifying . . . it kept coming back.”
All those rehabs didn’t come cheap. Carol and Wayne were fortunate, as Wayne’s second wife had a good insurance plan that paid for most of Bryan’s treatment, which could run in the tens of thousands of dollars per month. When I try to press Carol for an estimate of how much Bryan’s treatment cost over the ten-year period, she looks baffled and shakes her head.
“The money was just unfathomable,” she says. “It was just this whole feeling as a family of being emotionally and financially bankrupt.”
Thirty-five-year-old Justin Kunzelman spent seven years in South Florida working for different treatment centers beginning in 2009. Over the phone, he describes to me a network of cronyism where detox centers and rehabs refer patients to each other and shuffle them around to maximize insurance benefits.
During his twenties, Kunzelman had himself lived in a sober home in Palm Beach, where he was also born and raised. After only sixty days in the home, he was promoted to house manager. Later, he worked at various treatment centers on a team of “marketers,” whose job was to keep the facilities well stocked with paying customers. He says most treatment facilities paid a bonus of $200 or $500 per new recruit.
But we know that Bryan and Alex are only two casualties in a war against drugs that continues to chew up and spit out families across the country.
In 2016, Kunzelman followed his conscience and left the industry to found Rebel Recovery, a harm reduction organization in West Palm Beach that offers sterile syringe services, overdose prevention medication, and other life-saving interventions to people who use drugs. Kunzelman says that even though Florida has passed new laws to crack down on patient brokering and other fraud, the industry hasn’t changed much.
Indeed, the prevalence of fraud is driving up the cost of health insurance for many consumers, but for families with a loved one caught in the fray, the ordeal costs much more than money. Carol Katz Beyer says bankruptcy is common among families with a loved one in treatment, as is divorce, and the specter of death looms large.
“Every family I was talking to was on this quest to save their kid’s life,” she says. “Some were successful and some were not successful. But for every family it was chaos.”
Bryan was at home in his wife’s arms when he died of a fentanyl overdose on October 20, 2016. He was twenty-eight.
But Carol’s story does not end with Bryan. She has a second son, Alex.
As a young boy, Alex often mimicked Bryan, who was two years older. He followed Bryan into sports, music, and later, drugs. As Bryan was going through the cycle of drugs, rehab, recovery, relapse, and rehab again in Florida, Alex was going through it too.
But after Bryan died, Carol says that her younger son found new motivation to escape the cycle. He didn’t want his brother to have died in vain.
In 2017, Alex left Florida and enrolled in a long-term treatment center on a quiet mountaintop in Pennsylvania. There, far from the predatory chaos of South Florida, he found peace. The center had a music center and restorative programs. It was quiet, serene, reflective. Alex even called his mother to report that he was doing yoga, a practice he had previously disdained. He was finally getting better.
Alex spent two months in Pennsylvania, and Carol describes his homecoming as the joyful return of the prodigal son. She and Wayne had both remarried when Alex and Bryan were boys, and the two families, united by a decade of trauma, were finding solace in one another.
“[When Alex came home] it was like a weight had been lifted off us,” says Carol, as her eyes fill with tears. “[We said] Bryan, you are watching over Alex. You did this for your brother.”
The family felt they had finally learned how to navigate the complex world of addiction and their conversations about drug use had become more open. Bryan’s life had been a terrible price to pay, but all that mattered now was that Alex was home.
At twenty-seven, Alex settled in with his parents and began taking steps toward a music career. But in October 2017, one year after Bryan’s death, Alex overdosed on fentanyl in the bathroom of his father’s home. He had followed his brother’s lead for the last time.
Carol’s story does not end with Alex either. She has a third son, Devin, from her second marriage.
This year, on his graduation day from Fairleigh Dickinson University in New Jersey, Devin went to visit his brothers’ graves. He and his family stood quietly by the gravesites, remembering the joys, pain, smiles, and suffering of the past few years.
Today Devin teaches at a preschool academy in New Jersey. Carol dedicates her time to a nonprofit, Families for Sensible Drug Policy, which she co-founded in 2015 to help stir honest conversation among families who are struggling with loved ones who are using drugs. She hopes that, one day, substance use will be treated the same as any other medical condition.
Grief and the desire to make a better world for Devin fuel her passion for the work. That young people are forced into treatment programs and labeled as addicts “is the most fucked up thing I can think of doing to a young person,” she tells me, eyes blazing.
We have been talking for almost three hours under the hotel stairwell in New Orleans. We are both exhausted from crying.
But we know that Bryan and Alex are only two casualties in a war against drugs that continues to chew up and spit out families across the country. The problem will not be solved by tightening regulations and rooting out fraud. The entire way we see and respond to drug use needs to change.
In the United States, instead of treating chaotic drug use as a medical condition, we treat it as a crime. This approach has birthed a patchwork industry where church-basement prayer meetings, court-mandated group therapy, and not-so-sober homes are lumped into the same category of “treatment” as certified addiction professionals.
There are no federal regulations for drug treatment centers in the United States save for opioid maintenance programs, and state regulations vary dramatically. In fact, many state-run and religious treatment programs are exempt from regulation entirely. Of the nearly one million active physicians in the United States, fewer than 600 specialize in addiction, according to a 2012 report by the Center on Addiction.
In fact, the majority of treatment programs in the United States operate completely outside the medical field. Most are based on the twelve-step program of Alcoholics Anonymous, despite little evidence of this model’s effectiveness beyond anecdotal success stories.
Though drug addiction is a medical condition, its treatment is often left in the hands of prosecutors and police instead of doctors. In 2009, according to the 2012 report, 44.3 percent of referrals to publicly funded treatment programs came from the criminal justice system, while only 5.7 percent came from a health care provider.
The report cited a study that found that 95.6 cents of every dollar that the government spends on substance use goes to pay for its consequences (i.e. emergency room visits and criminal justice costs), compared to just 1.9 cents spent on prevention or treatment.
No wonder families like Carol’s are subjected to years of chaos and torment trying to navigate a system whose flaws are built into its foundation. No wonder the death toll is climbing unchecked. No wonder addiction is spreading like forest fire. We are using squirt guns and kerosene to put it out.