The American Idea of “Help” with Rebab

Daniel Nagornyi

Rehab is supposed to be hopeful, clean, redemptive, a second chance.

But the more I think about it, the more it feels like one of those words that hides a mess underneath it as many facets of American healthcare do - like “innovation” or “efficiency” or “reform.” Words that sound good enough that we don’t ask too many questions.

Thankfully for us though, many reporters have asked questions. Shoshana Walker in particular stumbled across a court-ordered rehab program operating in parts of Oklahoma, Arkansas, and Missouri. On paper, it looked progressive: instead of prison, judges were sending people with addiction to long-term treatment programs. This was supposed to be the humane alternative to incarceration, a sign that we’d finally started treating addiction as a disorder rather than a crime.

But as Walter looked closer, she revealed that the program had been founded by a former poultry industry executive. Participants weren’t receiving therapy, or medical treatment, or even consistent counseling. Instead, they were sent to work in chicken processing plants - without pay, with long hours and dangerous conditions that led to numerous injuries. Sometimes the only “compensation” was a pack of cigarettes for an 80-hour work week. (The chicken from these plants ended up at establishments like KFC, Popeyes, Walmart, and PetSmart). 

Somehow, forced labor has become part of the treatment landscape.

CAAIR, an addiction treatment center in Delaware County, Oklahoma where patients worked 40-60 hours per week hanging and processing meat.

So many people enter rehab through the criminal justice system, not through doctors or social workers. And many of these court-ordered programs are less about healing and more about control. Behavior modification, discipline, submission, sometimes outright abuse (i.e., patients kneeling in corners for hours). 

Walter describes an industry that is invisible because it’s everywhere. Rehab facilities operate in a gray zone between medicine, religion, business, and punishment. Many are barely regulated. Some aren’t at all. And they make a lot of money.

The Affordable Care Act changed a lot. Suddenly, millions more Americans had access to addiction treatment. On the surface, this is a huge victory. And in many ways, it is.

But the way insurance companies fund treatment is brutally short-term. Thirty-day programs exploded in popularity with the idea that, after detox, group therapy, and inspirational slogans, the patient was ready to re-enter the world. 

Research shows that people who complete these 30-day programs are often more likely to overdose and die within the following year than people who never completed them at all. This is because they leave with lowered tolerance, minimal support, and the same structural problems they had before - poverty, unstable housing, trauma, isolation.

Facility owners know this. Insurance companies know this. Treatment then becomes cyclical. People go in, come out, relapse, repeat. It’s expensive, tragic, and immensely profitable. 

Some facilities have basically turned into unpaid staffing agencies. Participants work up to 80 hours a week in factories, farms, or warehouses with counseling reduced to an afterthought. One counselor described poking their head into a room after a long day of forced labor, asking “How are you?” hearing “Fine,” and checking off a box: therapy session completed.

One of the most important ideas researchers talk about is something called “recovery capital.” Recovery capital is everything you need to rebuild a life: housing, money, food, transportation, social support, community, stability, dignity, etc. The longer someone is addicted, the more they lose access to these resources. They become more marginalized, more criminalized, more isolated. And then we expect them to recover in a vacuum.

If these programs are abusive, ineffective, and sometimes deadly, why do they persist? Because they align perfectly with one of the oldest American beliefs: that addiction is a moral failure. 

Even today, beneath all the medical language, we still believe - on some emotional level - that people with addiction deserve punishment. That suffering will humble them. That cruelty will somehow produce clarity.

But addiction is tied to trauma, inequality, loneliness, housing crises, healthcare failures, and economic precarity. Addressing it seriously would require structural change, which is expensive, messy, and political. Punishment is cheaper, easier, and more profitable.