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The Hidden Crisis of Addiction Treatment

In Rehab, Shoshana Walter investigates the corruption and abuse rife in the business of drug rehabilitation.

A billboard in St. Paul, Minnesota, 2025.

Shoshana Walter’s Rehab: An American Scandal opens with the search for a body. But there are no homicide detectives on the scene. In the spring of 2014, family members, local volunteers, and a retired crime-scene investigator set out to find the remains of 21-year-old Donovan Doyle, a former patient at the Above It All Treatment Center in Skyforest, California. Doyle had disappeared eight months earlier and was presumed dead. When he initially went missing, the police did not try to find him. One law-enforcement official told a local newspaper that he was considered a “voluntary missing adult” and thus “did not meet the criteria to send our search and rescue and put them in danger.” No foul play was suspected, and the police closed the case. 

Rehab: An American Crisis

The night before Doyle disappeared, he had threatened to kill himself. Upon hearing this news, the rehab’s supervisor, Kory Avarell—a Mormon businessman with no training in addiction treatment—ordered a concerned employee not to call 911; he said Doyle was merely courting attention. This went against Above It All’s policy—employees were supposed to contact authorities if a patient might be in danger. When Doyle refused to go to a counseling session the next morning, Avarell immediately kicked him out of the program, which meant that he had to leave the facility. Avarell did not notify Doyle’s family or arrange a way for him to reach the nearest bus station (it had begun to snow heavily). Doyle left the facility angry—he threw his belongings into a trash bag and attempted to punch his counselor on the way out. He then walked off into the San Bernardino National Forest. That’s where a search-party member found his wallet, his tattered sweats, and then his skull. 

Doyle’s death at Above It All is one of several preventable deaths that Walter investigates in Rehab. In opening her book with Doyle’s story, Walter, a staff writer for the Marshall Project, signals to readers that the stakes go beyond arguments over what constitutes effective addiction treatment in America. Rehab is fundamentally concerned with life and death, revealing how the places we might send our loved ones for help when they are at their most in need are not just ineffective, but rife with exploitation, fraud, abuse, and mortal danger. 

Walter characterizes the rehab industry as “America’s other drug crisis,” one in which residential treatment—which abruptly ends after 30, 90, or 365 days—often leaves patients worse off than they were before. Walter holds rehabs to account in the way that Patrick Raden Keefe exposes the malfeasance of the Sackler family and Purdue Pharma in Empire of Pain. But Walter is also more exacting: She calls Purdue Pharma an “easy villain to blame for the opioid epidemic,” implying that the pharmaceutical dynasty’s outsize profile conveniently obscures other forces that have contributed to the public-health crisis.

Unlike the Sacklers, rehabs are faceless; these extra-medical facilities hide behind names that signal moral uplift: Above It All, Future Promises, Harmony Place. We use rehab as shorthand for addiction treatment, but this implies a degree of standardization. One rehab may offer medications for addiction, counseling, and access to licensed health professionals; another might put you to work for no pay, overmedicate you, or discharge you for using your cell phone. As Walter writes, “unlike other forms of medical treatment, there [are] no real standards or even a proven addiction cure.” And what’s worse, these centers are intertwined with the legal system. Legal entities known as drug courts often send people arrested for drug-related crimes and who want to avoid prison sentences to punitive rehabs for months. (The judges presiding over these courts, who have no training or experience in addiction medicine, are allowed to dictate treatment plans without any input from medical professionals.)

So what happens when the treatment itself is rotten—when it exploits the most vulnerable for profit and manages to evade accountability? And how have these facilities continued to operate for decades without oversight? In unearthing the stories of the people who have suffered inside addiction treatment centers, Walter shines a harsh light on an epidemic of apathy toward people who use drugs. 

Rehab revolves around four characters, each of whom introduces readers to a disturbing, little-known facet of addiction treatment in America. Chris Koon was at Cenikor, a nonprofit rehab with locations across Texas and Louisiana that forced its participants to perform labor for no pay. Rehabs like Cenikor say that the act of work—specifically physical labor—can help cure addiction. Cenikor patients were ordered to work at industrial laundromats, Exxon, Shell, and Walmart, among other for-profit companies. Laying steel in more than 100-degree heat and moving boxes in a warehouse were considered core tenets of therapy. (Robert F. Kennedy Jr., the current secretary of the Department of Health and Human Services, is a fan of work camps for addiction treatment, which he calls “healing farms.”)........

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