Chronicle Book Review -- Rehab: An American Scandal

Chronicle Book Review: Rehab: An American Scandal by Shoshana Walter (2025, Simon & Shuster, 299 pp., $29.99 HB)

Even though more than half the people strung out on drugs quit their habits without going through drug treatment, the rote response to illicit drug use by the addiction treatment establishment and the criminal justice system is a stint in rehab. But besides being, in many cases, unnecessary, in too many cases, rehab is a racket.

By racket, I mean an enterprise designed to make money, not treat drug addiction. It's an oh-so-American late capitalist response that sees a social problem and asks: How can I profit from it? And with Rehab, investigative journalist Shoshana Walter, shows just how that is done. Drawing from years of research and reporting, Walter uncovers a troubling landscape where vulnerable individuals seeking help are often exploited, neglected, or even subjected to abuse. Her book is both a searing exposé and a call to action for systemic reform.

Through case studies of four people -- a young white man from Louisiana who faced a choice of prison or two years in rehab (Chris Coon), an impoverished young black woman from Philadelphia who cycled through rehabs for years (April Lee), a privileged white woman from Southern California whose son died in a drug treatment program (Wendy McIntyre), and an ethically-challenged Indiana doctor with a buprenorphine-prescribing practice (Larry Ley) -- Walter unveils the failings of and corruption within the rehabilitation industry. She demonstrates how, in the absence of robust regulation, many treatment centers prioritize profit over patient welfare.

Chris Coons' story is a case in point. He went to rehab at Cenikor, a private company that housed drug users and advertised a full complement of treatment and rehabilitation programs. But instead of treatment, Chris Coons got slave labor. Like all Cenikor residents, he had to work jobs outside the facility to pay his way -- and all his wages went to Cenikor. While the company made bank and the CEO enjoyed hefty annual pay raises, Coons and his fellow residents were worked like dogs in often dangerous jobs.

Cenikor residents suffered on-the-job injuries and got little care for them, being instead pushed to get back to work so the company could make more profits. And drug treatment? There was no time for that. Cenikor residents worked long hours, came back to the facility, gulped down cheap, crappy food, and slept until the next shift. The treatment counselors Cenikor hired who actually cared enough to try to actually do their job were reduced to knocking on room doors and chatting for a couple of minutes, then charting it as a hour of treatment.

April Lee's story is not one of abuse so much as indifference. Struggling with homelessness and a bad drug habit from an early age, she alternated between the mean streets of Kensington and a series of unregulated "sober living" homes, where cash-strapped landlords sought to bolster their incomes by warehousing referred drug users. Some were better than others, but like corporations such as Cenikor, they were more about the money than treating the needy.

While Walter's approach humanizes the treatment crisis, the book's investigative backbone is built on interviews, documents, and court records, providing a comprehensive and credible account of the scope of the problem. She writes clearly and compellingly, making complex policy issues accessible without sacrificing nuance. And she has the journalistic chops to distill large, unwieldy topics into digestible and emotionally resonant stories.

Rehab succeeds in shedding light on an industry that is often shielded from public scrutiny. Walter does not shy away from discussing the failures of the legal and regulatory systems that allow such abuse to persist. She also explores the influence of private equity and corporate interests, which have become increasingly involved in addiction treatment.

But Rehab is not just a critique; it also highlights pockets of hope -- dedicated individuals fighting for change, successful models of care, and the ongoing movement toward evidence-based treatment. Walter encourages readers to consider what real reform would look like and advocates for an approach that centers on compassion, dignity, and medical science.

Rehab is a significant contribution to the national conversation about addiction and recovery. It should be essential reading for policymakers, healthcare professionals, and anyone affected by addiction -- either personally or through loved ones. Walter's work challenges assumptions and prompts reflection on how society treats its most vulnerable members. Anyone interested in understanding the realities of addiction treatment in America will find this book both enlightening and deeply affecting.