1249: Rehab and Recovery | Skeptical Sunday

24:52Right. I'm going to quit drinking for a month and see how it goes. And the month was seven years ago. Yep. And I'm never like, oh, man, I'd love to get a drink. It's more just like I've had a toast at a wedding. I think that's it. I don't miss it. And if anybody was going to fit this, like, you're not calling, you need help. You know, it's like I never lost a job. I never did this. I never did that. That's true of my father. He went to AA. He hasn't drank in years and years, but like, I don't have any, like the worst thing I ever did when I was drinking was act a fool. You're listening to the Jordan Harbinger show.

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27:52But when companies see that people are responding to the ad, that sponsor is more likely to continue their partnership with us. So if you decide to sign up for something, please use our code. It's Jordan a lot of the time, but not always. Definitely check the deals page. It is a double win. You get a great deal. You help keep the show thriving. And thank you for the support. All right. Back to Skeptical Sunday. None of this, by the way, is to dissuade people from getting help. We're just illustrating that not everyone who drinks a bunch is an alcoholic that needs medical intervention, right? That's the point of this.

28:22If you think you need help, you should ask somebody for it. This is an academic discussion about rehab recovery and the money behind it. If you're listening to this and you're like, oh man, I thought I needed help, but like, I don't. Just go get help. I agree with that. That's a good disclaimer. I absolutely do not want to discourage anybody from getting help. What are the metrics that we do have? How successful are rehab centers? Yeah, studies are all over the place. There's no consistency because so much of it relies upon self-reporting. So it's very hard to verify sobriety other than trust me, bro.

28:54And again, you know, if a rehab center turns a non-functional raging drunk into a functional social drinker, like how is that not success? Especially if it's maintained over, we check in in five years and it's like, oh yeah, I had a drink at my kid's wedding. Who cares? There's also not hard data on how people do when they check themselves into rehab versus when they're forced to go by the courts. And that's a big deal. It lumps them all in together. So we don't have that. And we also don't really have a ton of evidence on how 12-step works versus what's called evidence-based recovery. Right, I'm somewhat familiar with the scandals on the field, like patient brokering, where people get kickbacks for bringing in addicts or centers that rely on relapse to drive repeat business, which strikes me as super gross, by the way.

29:48You also talked about the high cost and how it's mostly not being paid out of pocket. It's being paid by insurance and passing the cost along to people. That's not to malign any individual treatment center, but it is to say there's obviously some bad actors and some serious incentives for centers to be bad actors. Particularly for someone who isn't an expert and is just looking to get their life in order, knowing what's a treatment mill and what's a good facility can be really hard to figure out. So people seeking treatment are kind of almost by definition, very dysfunctional. And some of these centers can lean very heavily into weaponizing guilt and fear with their marketing materials.

30:24Yeah, yeah, that makes sense. And it's an area that's very open to abuse and corruption. You spoke a bit before about the difference between 12-step groups and evidence-based recovery. So are you saying that 12-step is not evidence-based? This is maybe the big pop shell of the episode. It's not evidence-based at all. Pardon me, this sounds really dumb, maybe, but what? Because isn't evidence based like, hey, we have data this works. That seems like the base level requirement for a treatment program of any kind for literally anything. Does it work? Do we have any evidence that this actually does anything?

30:56No, but we're doing it anyway. Like, what are you talking about? How is that a thing? Well, the evidence they were a works is anecdotal. There are some studies that will about to cite in a minute, but to establish that they're effective, you need a control group, which we have. It's called the people who stop abusing drugs and alcohol because they do something other than AA or because they do absolutely nothing but quit. Natural recovery is the term for that. The Cochran Review is the biggest and best study that we have, and it found that AA is not significantly more effective than other methods.

31:32Tell me about the Cochran Review. Who did it? What's in there? The full title of this 2020 study is Alcoholics Anonymous and Other 12-Step Programs for Alcohol Use Disorder. It's a meta-analysis of 27 studies involving 10 ,565 participants. It covers AA along with other professional efforts to get people into 12-step programs. its findings are pretty nuanced. And as always, it's in the show notes. So you're going to want to do it. So it's not just like AA sucks. Don't do it. No, it says some very positive things about AA, which performed as well or better than other approaches like cognitive behavioral therapy, motivational interviewing, or harm reduction in terms of abstinence.

32:24And those last four words are the key. Got it. Okay, so it works as good or better than other methods, provided that your goal is to completely stop drinking essentially forever. The actual numbers here are 42 % total abstinence from alcohol after a year for AA versus 35 % for those in other forms of treatment. Okay, but a 7 % edge, that's pretty good. I guess most of the people aren't abstinent at all, but like 7%, that's, you know, seven people out of 100 whose lives aren't totally ruined. I'll take it. And that's great and good for them. And that's wonderful. I agree. But it kind of gets to the heart of the issue with AA is that it demands total abstinence.

33:06I also would argue that if the goal is total abstinence, it would be good to check in on these people in five and 10 years. But this did a year. But again, like blackout drunk to a couple beers over the course of a week, that's considered the same thing to AA. I see. From the perspective of whether or not you're sober. I'm not trying to imply that people who are in AA are stupid and don't know the difference between a blackout drunk and a guy has a couple beers. But in terms of what AA considers sobriety, those are the same outcomes for them. Because the guy who's having a couple beers a week is eventually going to backslide into the guy getting blackout drunk, which is not true.

33:45Flatly, just is not true in every case or most cases, as we saw with people aging out of this. So when it came to simply reducing the amount of drinks a person was having, this is where it failed. AA did not consistently outperform any of the AA alternatives. Got it. And how good is the study? I know it had a lot of data, but is the study sound? Is this a good study to look at? There's a couple problems with the study, some of which are kind of baked into any study on recovery. It's not randomized. It relies heavily on self-reporting. It had a lot of dropouts. the thing is, I'm just not sure how you're going to do this type of study without self-reporting and a lot of dropouts.

34:28Like, what are you going to lock people in a room and watch them drink or not drink? No, thanks. I already went to college. But yeah, that seems like a recipe to make sure people are drinking a lot. What do you mean when you say evidence-based? What exactly are you talking about then? There's mountains of evidence to support cognitive behavioral therapy, motivational interviewing, and contingency management. It's worth noting that all of these are going to define success as something different than total abstinence for everyone. Some people just don't have that goal. Now, with that in mind, if your goal is total abstinence, they'll help you with that too.

35:06But the first thing you're going to do for some of these is figure out, what's the goal here? Where are the goalposts? Some people just want to get their drinking under control. And I think that's a fine goal. And I think it's an attainable goal for some people who are struggling with alcohol and drug amuse. So most rehab doesn't really tend to offer this. They tend to stick to the 12 step programs. Do the rehab centers offer anything other than 12 step programs? Surely they do. Well, I think one thing they offer that's important, whether you do 12 step or not is detox, because in some cases like extreme alcoholism or opioid addiction, you absolutely some kind of medical supervision while you dry out or in the opioid language kick a big, big reason why people don't quit doing drugs is that they have real serious, grave, potentially life threatening withdrawal symptoms.

36:02that go beyond just, you know, oh man, I could really go for a drink right now. How is detox different from rehab then? Well, detox is just the process of getting the drugs out of your system. In the case of extreme alcoholism, most opioid addictions, this is essential and a medical issue. It's not a psychiatric one. So you, you know, you may do rehab and detox. You may do them at different places. You may not do 12 step for your recovery. recovery. But if you're just like, hey, I'm going to quit drinking. I've been rocking back up to the Jack Daniels every day of my life for the last 30 years.

36:37You are not going to cold turkey that, my friend. Yeah, I see. Detoxing without medically assisted treatment can be dangerous for people experiencing that kind or that level of addiction. And, you know, depending on what you've been using, how much you've been using, it's not safe. Okay. Because your body relies on that stuff. Yeah. Somehow at that point. Yeah, your body thinks alcohol is a normal part of its body. And when you take it away, it freaks out. I see. Oof, that sounds miserable. Is that what people are talking about when they're shaking and they're like, it's the detox tremors or something like that?

37:11I've heard of this before. You've seriously never had the shakes? No, because. No, me neither. Yeah. Why would I have that? And I've talked to addicts many times in what I've been to these like NA and AA meetings and stuff with friends and you go to Blimpy Burger or whatever afterwards and they tell you like, yeah, I got into this because one day I was doing this and then I started having like DT tremors in the car and the police came and got me and here I am or whatever. Yeah. Another thing you talked about is that addiction isn't a disease. Okay. So if it's not a disease, what is it? You could model it as a compulsion or you could simply model it as a choice.

37:47Okay. Like everything else people do. So dumb question. Why would anyone choose to do drugs? People do drugs because they're fun yeah you know i mean that's like of course but you know what i meant by that question right yeah yeah but you know like oh man why do people do drugs i don't know because they're fun as hell the question is why people keep doing drugs when they're ruining your life because that's the real question right and the answer might be that they're choosing to avoid the discomfort of not doing drugs by doing drugs, even when this has disastrous results for their life. It may be something deeper than that that causes them to seek out the relative comfort of drugs.

38:32And you would want to address that rather than the drug use per se. Now, the choice model comes from an alternative program called the Freedom Model. And I'm not saying that this is for everyone, but I am saying that it's good for people to know that there are alternatives to AA and 12-step and the Freedom Model is possibly the biggest one. So what are some of the key differences between the Freedom Model then and AA? One really good example is that, you know, AA says you're an alcoholic, this can't be changed, you just are you quit drinking today live another 60 years without even thinking about a drink but you're still on some ontological level you're an alcoholic okay like my father hasn't drinks it's like ronald reagan was in office he's i guess an alcoholic till the day he dies but the other thing in this model is that if you have even one drink after 50 years like oh there goes his sobriety The freedom model says addiction is not a permanent identity, that people can and do change their habits and indeed their lives without being abstinent from drugs and alcohol for the rest of their lives, without the peer accountability of AA.

39:48And they say that drug use is a preference and not a compulsion. You do it because you want to do it. The freedom model is not the only alternative. We talked about cognitive behavioral therapy and other methods. There's also smart recovery, which leans heavily on on cognitive behavioral therapy, life ring, which is very self-consciously secular. It's not all that different from 12 step and my understanding of it in that. But without the requiring a belief in higher power, there's harm reduction, which just says, OK, this guy's an addict. Let's make sure he doesn't die. Right. You see that at raves, right?

40:27the harm reduction people where they're like we know a bunch of you are on ndma and ketamine or cocaine or whatever the heck we have water we have a place where you can sit down and people aren't going to be bumping into you and you're not going to be confused or scared we can call the emts for you because we know you're not going to just don't do drugs kids like that's not realistic you're at a you know whatever lollapalooza or something so like or or maybe not You're at a warehouse party, an abandoned warehouse in downtown Detroit that were half of it burned 20 years ago. And there's a rave going on in here today.

41:00OK, so that harm reduction is it's an interesting one because it just sort of accepts that people are going to do it. And it's like, let's maybe don't just leave them on the side of the road if they start convulsive. And there's overlap between people who are very active in harm reduction and people who are very active in different sobriety communities. So I think it's not so much that they like, you know, oh, well, people are just going to do drugs. Who cares? Let them do it. But, you know, they understand that people do drugs and we don't want them to die or anything like that. The freedom model is arguably the most famous and most successful of these alternatives.

41:36I think one of the most important points to highlight here is that, yeah, like not everyone wants to quit doing drugs. A lot of people don't. and what many of these people want is they actually want to be able to use drugs and have a normal life. They want to be able to eat their cake and have it too. Eat their cake and have it too. Is that not backwards? No, no. The Unabomber was arrested, in fact, because much like me, he was pedantic about using this the correct way. Wait, so I've always thought it was have your cake and eat it too. That's what I've heard my entire life. It doesn't make any sense, and it never made any sense to me.

42:12so you're telling me that I guess I was kind of right because you're right, it should be the other way around. That makes way more sense. You eat your cake, but then you still have it. Not have your cake and eat it too. I don't know, I guess, tell me more. If you go back into the linguistic history of it, it's the older use. And Ted Kaczynski, the Unabomber, was so super insistent on saying this the correct way that it's in his manifesto and his brother read his manifesto when it was published in all the newspapers when we were in high school and went, huh, that's weird. My crazy brother I've seen in like 20 years used to say it that way.

42:47Wow. And so he was like, hey, this is a weird hunch FBI, but I'm just saying I got a brother who's a little bit nuts and he's the only person I've ever heard say this exact phrase. Yeah, it was that and like other weird stuff like his manifesto used the style guide that you would have used as a Harvard grad student in the late 60s. And he had like weird spellings of words that only appeared in Chicago newspapers in the 50s. That is bizarre and interesting. Also, kudos to whoever figured that out. That's amazing to figure that out without the aid of a like you could use AI to figure out something like that, maybe.

43:21But somebody to do that manually. Holy smokes. Well, when you read it, it's like it's weird, you know, like some of his spellings are like, that's not how anybody spells that today. It's like, yeah, because this guy hasn't read a newspaper since 1971. So it's like if somebody writes encyclopedia, but they write P-A-E-D-E-I or they use the A-E thing and you're like, this person is either British or just a big weirdo or both. Yeah. OK. Anyway, what's the evidence like in terms of how well the freedom model works? I think the first thing we have to say is that works is defined very differently in the freedom model.

43:54Each and everyone gets to determine their own goal. That could be total abstinence, could be moderation, could be going from being our blackout drunk guy every day of the week to I just want to binge drink on weekends and be fine to go back into work or our functioning heroin addict. You know, while I was living in a gutter, I'd love to be able to keep doing heroin, but maybe I just do it on long weekends or something. The point is to take control of your substance abuse and make it intentional. So the Freedom Model's authors claim a 62.5 success rate with total abstinence over five years. That's a non-peer-reviewed statistic based on graduates from the St.

44:35Jude retreat prior to it being rebranded under the name the Freedom Model. it reportedly included individuals who voluntarily completed the full curriculum not those who dropped out that seems like a pretty big yeah asterisk to hang over that survivor bias anyone yeah there's some survivor bias in there for sure and as usual there's no control group because how do you get one yeah it's difficult and they have none at all so i'm unclear if what they mean by total abstinence means that the participants met their own definition or not. And there's also no clarity on relapse, recidivism, long term outcomes.

45:15I mean, none of this is really making the case for me, man. You know, I got to be honest here. It wouldn't be terribly compelling for me either, but for the fact that it squares with independent research on self-healing, what is called natural recovery, which I mentioned earlier, There's people kind of aging out of it or waking up one morning and going, I don't think I'm going to drink anymore. I'm going to drink less and doing it. The National Epidemiological Survey on Alcohol and Related Conditions found a 70 to 75 percent recovery rate for people using what we are calling national recovery.

45:50recovery. Stanton Peel did a bunch of research that found that changing your life circumstances was a much more successful predictor of recovery than surrendering your life for the disease of addiction. Who is Stanton Peel? A psychologist, attorney, and public health expert who has been one of the most prominent critics of the addiction as disease model over the last 40 years. He runs his own peer-reviewed program, the Life Process Program, and the most important of the papers that he has written is called People Control Their Addictions. Even the title is controversial, I think. Yeah. Of that.

46:30No, but that's his thesis is like, you're in the driver's seat here. And kind of, as I've said throughout, I think this is true of some people and not true of other people. And everyone can, you know, the papers are in the show notes and people can go look at the data and see what they say, and they can decide if, you know, they think he's onto something or if he's blowing smoke. A number of his studies and other studies have cast doubt on the predictive power and utility of the brain disease model that's very, very ingrained in both the Minnesota model specifically and our ideas about addiction more generally.

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51:32If you can't remember the name of a sponsor, you can't find the code, feel free to email me, jordan at jordanharbinger.com. It is that important that you support those who support the show. Now for the rest of Skeptical Sunday. But you're also not saying that AA never works for anyone or anything like that, right? No, but obviously people are going to hear that. Yeah. You know, but no. I'm going to get those emails from people who listened to five minutes while on the treadmill at the gym and then angrily threw their phone down and then walked over to pick it up just to email me, having not listened to anything else in the episode.

52:04Some guy's going to be on the treadmill texting his wife, being like, babe, Jordan has Nick Pell on talking about, oh, I should quit AA. Yeah. This is absolutely not what I'm saying. No, I think that honestly, if from my perspective, and I think that this is an important point of view, I don't think it really matters if the addiction as disease model is true in a scientific way. It may very well be a useful fiction, even if it's not true. You know, some people might need that identity and that model to have success. if this model works for you, if the science doesn't back it up, I don't care if it gets you clean.

52:49Yeah. Who cares? But the whole rock bottom, then surrender to disease, 12 step experience is far from universal. And even if you do decide that total abstinence is the choice for you, that does not mean it's the choice for everyone. I haven't had a drop alcohol in seven years. I'm And it also doesn't mean that AA and other 12-step programs are the way to get to that total abstinence, that they're the only way to get to that abstinence. The Freedom Model and Stan Peel, I think what they offer people is agency. AA makes them a victim of something beyond their control. And the Freedom Method says you're in control of your life.

53:35You're responsible for your own choices. Right. But if I'm allergic to peanut butter, I can make a choice to eat it. But it's just that's an incredibly stupid choice. But the choice is still there. OK. You know, again, not saying that everyone can moderate their drug and alcohol use because I'm very, very reticent to apply one broad brush to all people. I just don't think the world works that way. I very rarely think that there's a one size fits all approach that works for everyone. It is worth noting that there are tons of people who are 12 step program, quote unquote, quote, failures, who finally found what they were looking for in the freedom model and Stan Peel's methods, other alternatives.

54:15How many trips to rehab are coerced or court ordered? Like the person has to go there, basically. I mean, this is kind of the$64 ,000 question, and I suspect it's doing a lot of work in terms of why rehab doesn't work for a lot of people. Maybe it's their methodology. Maybe it's just that so many people don't want to be there or are begrudgingly there. The actual data on this is super hard to sort out, but up to half of rehab check-ins are court mandated and up to half of them are because of pressure from family. So depending on how we interpret this data, it's entirely possible that like statistically everyone in rehab is there because their family is twisting their arm or the courts demanded they go.

54:58I'd imagine that doesn't exactly set the person up for success, right? If you don't want to be there, you're probably not going to engage with the program as much. And as a result, you're maybe not going to get the best results. Right. And that's not conjecture. We have data on this. When people go to rehab because they have to, or even because they feel like they have to, the results just aren't as good. So that's another factor floating around in the soup. And I suspect it's a factor in the AA's numbers that when we were talking earlier about, you know, AA's numbers aren't great in these areas.

55:28And it's like, well, yeah, how many people are in AA? because a judge told them they had to go. Yeah, so it affects every recovery type. Yeah. So do you then think there's a similar issue within the freedom model and the 12-step alternatives you talked about? I think that there may be some coercion going on in terms of like wife, mom, whoever says you have to get some kind of help. But I could not find a single example of somebody who was forced to go into one of the alternatives to traditional 12-step programs by courts. The closest thing that I could find is that if you do get court mandated AA, you have a legal right to choose a secular alternative.

56:08That's thanks to a court case called Hazel versus Crowfoot. It kind of strikes me as unlikely that people are going to get pressured. Like you have to go do the freedom model because like nobody's heard of it. And, you know, also I get why families would maybe be skeptical of the alternatives, particularly ones like the freedom model, because you're raging. Alcoholic uncle says, well, I'm not going to quit drinking, but I'm going to moderate my drinking. I found a program that says I'm not an alcoholic. Right. You're not really going to bite on that one, probably. Right. Yeah, that's a good point.

56:40I can definitely see why people would hear that and think, yeah, sure. Uncle Bob, whatever you say, as he like falls down the living room stairs. And I get why courts want to direct people to treatment rather than to jail. And I think that's probably the right choice for a lot of people. But if people are just going to go through the motions to get the court off their backs, it's not going to end well in the long term. No, it's not. And we know this. I don't really care how we deal with drug abuse as a society. I would like to see fewer addicts. I would like to see no people dying from drug overdoses.

57:12Beyond that, the details are like, this is above my pay grade. I don't have a master's in public health to figure this out. Anecdotally, back to the jail thing, I have met some older addicts, heroin, who told me that they were able to kick their addiction because they went in a lockup for a weekend. And they had to detox in a cell. And when they got out, they were just like, I'm done. I don't care. I just want people to not be addicted to heroin or fent. I don't want them to die. That's really my only strong position here. Injection sites, Neal swaps, I have no idea. Like, whatever works. Let's do that.

57:52I can see how you can't punish people into sobriety, but I can also see how punishment is maybe the thing that makes some people come around eventually. Right. Well, I think it gets back to what you were talking about earlier, right? Different people recover in different ways. Tons of people talk about rehab. They say it saved their lives. Other people recover without rehab. Lots of people just decide to quit one day, and somehow it sticks. And I think you're right that the problem with AA isn't AA as such. It's that it's framed as the only way that exists for people to get sober. And that's not true.

58:23That's just not the case. Right. And that's kind of like my only real beef with it is, you know, if you've done a six times and you keep failing it on step three, maybe you need to try something else, which is ironic considering that I believe it's them who say the definition of insanity is doing the same thing over and over again and expecting a different result. Unless it's a in which case. Yeah. Yeah. Yeah. And then there's like, well, they didn't want it hard enough. And it's like, no, I think they really want to get sober, but this just isn't working for them. And maybe they're the problem.

58:55Yeah. It's impossible to say. It's just that one answer is not the correct one for everybody. If we totally rebuilt the system from scratch, I think it would mostly be about balancing all the options out there, making people aware of all the options out there, outpatient care, harm reduction, medical-assisted treatment. I know people are critical of medical-assisted treatment, but I lost a friend to a heroin overdose some years back, and I would much rather that she was alive standing in line at the methadone clinic every day than dead. So I don't care if people want to go be suboxone addicts as long as they are walking around alive.

59:32Yeah. No, I think we can all mostly get behind that. I'm aware of medical-assisted treatment. That's where people take a drug that helps them deal with withdrawals and stuff like that. And In some cases, it can become a sort of new addiction. And I've gotten messages about this on Instagram, like, hey, man, yeah, I'm hooked on suboxone. So effing what I think was the message I got recently. But the thing is, almost nobody's dying from methadone overdoses. And we don't criticize diabetics for taking insulin. So if we think that addiction is a disease, why are you criticizing people for taking a drug for their disease?

1:00:02I don't get it. I don't either. I mean, and I think that like if somebody's quality of life is impacted by their suboxone addiction or their methadone addiction that they're using instead of heroin, there's probably ways for them to transition off of that. But if somebody's functional, you know, like I said, I just I prefer them alive is the main thing. And I think this all goes back to what's the goal? What is your goal here? If the goal is simply to live a functional life, I've definitely known way more functional methadone addicts than functional heroin addicts in my life. And I've known a fair bit of both.

1:00:36There's nothing immoral about being addicted to any drug. The issue is generally the things you do to support your addiction. Right. And I don't know anyone who's mugging grannies to pay for their suboxone or their methadone or, you know, any other nefarious or degrading things that they could be doing to support an addiction. People aren't doing that. Yeah. I love caffeine. I don't know if I'm addicted to it, but I'm not going to mug any old ladies to get my fills in the morning or Starbucks for that matter. I might. You might. You might. With your nicotine, man, I don't know. I don't know if you'd mug me.

1:01:15You might not attack someone to get the nicotine. You might attack someone because you can't get the nicotine. Right. It's just it's a mood. It's more of a mood thing. But there's also a stigma against addiction that I think potentially prevents people from getting help early. It's like, oh, I don't want to have to go in right now because then I have to admit that I got this and I have to take time off work because of this. So we have this whole narrative of hitting rock bottom where people have to just ruin their lives, right? It's like you have to lose your kids and your spouse and your job before you seek help.

1:01:43And I can also see, and some of that's the issues with addiction, but a lot of it is the stigma, I think. And I can also see that there's just a greater chance of somebody seeking out help on their own if they're pitched on moderating their drug or alcohol use rather than being like, you can never do this again, ever. Yeah. And to be in fairness to AA, they do talk about high bottoms, like people who have their bottom is not dying in a gutter, you know, running over a child while they're drunk or something really extreme. But yeah, I mean, one of the problems, though, is with the 12 step stuff is that the aftercare is just like go to meetings.

1:02:17And I think a lot of people need more than just peer support. I have heard from people in AA that sometimes they can be critical if you are getting professional counseling in addition to AA. I don't know how true that is. It's just something people in AA have told me. I'd like to see a lot more data collected so we can just have a better idea of what works and what doesn't. You can't have evidence-based therapy without evidence. What about people looking for rehab centers? What should they be looking for if they decide that that's the right track for them? Well, again, people need to remember treatment is not one size fits all, or at least it doesn't have to be.

1:02:56So the first question I'd ask is, do you only do 12 step here or do you incorporate other methodologies? These all sound obvious, but like, what are the credentials of the staff? Are they licensed? How do they handle relapses? Is it more punitive? Is it supportive? How do they feel about medication-assisted treatment? Is methadone considered breaking your sobriety or is this a life-saving treatment for opioid addicts? What's the aftercare like? What are they gonna do for you after you graduate from the program? And most importantly, I think, what's the track record? Do they even track outcomes?

1:03:32And if so, what are they? There's gotta be some red flags that people need to look out for if they're searching for a rehab center. What might some of those be? So this is a great pivot to get back into the darker side of rehab. There's just so much overlap with red flags and what is wrong with the rehab industry as a whole. So I mentioned this is a$42 billion industry. That doesn't make it bad. But when anything starts being that lucrative and producing that much revenue, you always have the chance that people are going to start seeing it less as a way to help people and more of a way to make money.

1:04:04And that's how we get the Florida shuffle. Okay, that sounds like a new dance that's popular with guys on gas station bath salts. It's actually the term for when people keep relapsing and just bounce around different facilities. So apologies to people in Florida. I did not invent this term. It's kind of a shorthand for the abuses of the system. So remember, most of the time, people seeking treatment are not paying out of pocket. Their insurance is paying. And when that happens, bad actors can definitely use this as an opportunity to bill baby bill. As a lawyer, I definitely know what that term means.

1:04:39Yeah. Taking a piss while typing some notes about the case into my phone, that'll be$200. Man, you're really going to tell everyone about the time you billed a guy to answer a text while taking a piss at a club? I mean, it was an email and yeah, I think I just did. This is like one of the first things you ever told me about yourself, by the way, and I thought it was awesome. Yeah. I mean, look, I did the work. I just happened to have my dong in the other hand because I was drinking. It was qualified. The primary victims of the Florida shuffle tend to be young because they're still on their parents' insurance.

1:05:10Right. The other big example of abuses in the system we see is patient brokering. Rehab centers will pay kickbacks to sober home operators or even just independent recruiters to bring in patients. Some brokers will get insurance for these victims just to bill them. Oh, my God. That's illegal. It's illegal in a lot of states. I was going to say, how is that legal? But hey, well, good thing we have laws against things, so they never happen. Right. Yeah. Sheesh. Yeah. So, you know, both of these are weaponizing people's relapses for profit. It's like if your hospital made money off of your cancer coming back.

1:05:44Hospitals do actually make money if that happens, by the way. That's right. It's not a good analogy for that reason. But you understand my point. It's like they purposely left cancer in you for it to grow back. Right. OK. So there's obviously a conflict of interest here, but part of it is just endemic and baked into the system. I'm not sure how much you can actually do about it. It's just kind of like, yeah, life sucks. Get a helmet. There's bad people in the world are going to do bad things. I'm not sure how you make helping people to full recovery into permanent total abstinence more profitable than the same guy relapsing 10 times in two years.

1:06:19Like, how do you do that? I don't know. Yeah, no, you're right. Right. And if they're billing insurance, I'm willing to bet they're billing outrageous amounts of money for simple procedures and treatments as well. Right. So you're talking about like the $30 bandaid kind of deal. Oh, we're talking about$31 ,000 in urine test charges over the course of a month, which is real. And in the show notes, that is some expensive piss. Given my previous relatively small time urine related billing, I got to say, I'm quite envious. $31 ,000 in urine test charges over a month. How does that even happen? Yeah.

1:06:49You got to ask about how they bill, ask if they work with brokers, and yeah, ask about the track record. If you're listening to this show, you're probably pretty smart and you're gonna know red flags when you see them, but just a little checklist for you. Right, you need to do more due diligence about a$50 ,000 rehab program than you do about a$5 ,000 used car. The takeaway here is not, by the way, everyone who's angrily emailing and halfway through, it's not that rehab is a scam, it's not. But there needs to be more scrutiny over the system in general. The 12-step programs, they work for some people, but for others, it can be actively harmful.

1:07:21And in any event, it's not the only option out there. We need an evidence-based, nuanced approach that's tailored to the individual seeking treatment. And it's gotta be transparent, it's gotta be more honest, while also being less judgmental. And by the way, if you are struggling with substance abuse issues, you should know that people can and do either quit completely or moderate their use. You can retake control of your life. Don't feel like you have to wait to hit rock bottom before you reach out. We've put some resources in the show notes for people who want to get help. And I sincerely hope that you do, because I can't afford to lose any more listeners, folks.

1:07:54That's the truth of the matter. So I want to keep you around. Nick Pell, thank you very much. My pleasure. We worry about secret societies online, but the real danger may be hiding in trusted institutions that we see every day. I'm a financial reporter by background. I basically fell into this rabbit hole. And so I began to dig. and this Spanish priest called José María Escriva dreamed up this kind of group which called itself Opus Dei, which is Latin for the work of God. He saw his followers as part of this hidden militia that would infiltrate society and use their positions there to basically push society in the right direction.

1:08:33And he literally tasked them with infiltrating government, business, the world of education, becoming journalists, and kind of using their positions there to be this guerrilla reactionary force. The thing that makes this so much worse is that this is an organization which has been legitimized by the Catholic Church. It has the stamp of approval from the Pope, from the Vatican. The way that Opus Dei operates is that it's using scripture to push back on anything progressive and for anything kind of left-leaning, and it's a misuse of religion, really. I think the vast majority of Opus Dei members, they don't have a clue about this human trafficking and the way that, you know, certain members are being drugged, labor trafficking, I mean, grooming of children, all kinds of kind of financial fraud and spiritual fraud as well.

1:09:20All of these abuses going on, I think they would be absolutely horrified to find out what is going on inside the organization. They have thousands of members. The network runs far and wide. Assets in the billions. Anyone that isn't part of Opus Dei is an enemy of Christ. Gareth Gore uncovers how Opus Dei built a global empire of secrecy and why dismantling it might be the fight of our time. Check it out on episode 1170 of The Jordan Harbinger Show.

1:09:53This episode is sponsored in part by Conspirituality Podcast. You know how I'm always talking about critical thinking and spotting manipulation? Well, there's a podcast that's all about dismantling New Age cults, wellness grifters, and conspiracy-mad yogis. basically the wild overlap of spirituality and misinformation. It's called the Conspiratuality Podcast. The hosts, a journalist, cult researcher, and a philosophical skeptic, dive deep into how this stuff spreads, from Project 2025 and the Heritage Foundation's dystopian vision of the future to how former leftists get pulled into far-right conspiracies.

1:10:25An interesting episode to check out is called Speaking Truth to Goop, where Jen Gunter breaks down the pseudoscience behind the wellness industry in a way that is super entertaining and eye-opening. It's sharp, funny, and makes you a lot harder to fool, which if you listen to this show, you know I'm all about that. From exploring cults to analyzing our cultural and political landscape, the Conspirituality Podcast will help you stay informed against misinformation and resist fear tactics. Find Conspirituality on Apple Podcasts, Spotify, and wherever you get your podcasts. This episode is sponsored in part by the Something You Should Know Podcast.

1:10:55Finding a great new podcast can feel like searching for a needle in a haystack. Let me save you some hassle. Check Check out Something You Should Know with my friend Mike Carruthers. Every episode is packed with fascinating insights that you can actually use. Mike interviews top experts on topics that shape your life, like how to optimize your brain chemistry, the best and worst ways to apologize, probably could have used that recently, why couples hate to talk about money. No matter the topic, Mike asks the questions you'd want to ask, getting straight to the good stuff, and the conversations are always engaging, always insightful, guaranteed to leave you a little smarter than before.

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