Drug addicts from Puerto Rico are being sent to Chicago with a promise that they would receive high-quality rehab services. But in fact, the places they’re sent to are more like flophouses with what some people describe as a abusive form of self-help therapy.
People who’ve been through these programs report that they were regularly humiliated and forced to live in crowded, unsanitary conditions.
WBEZ’s Odette Yousef has been learning more about these human rights concerns. She spoke with Lisa Labuz about how these supposed programs actually work.
This conversation has been edited for brevity and clarity.
First of all, remind us of how these programs work?
Residences are often run by former addicts, so there are no professionally licensed drug-addiction staff there. We’re not sure how many of these centers there are since they are not regulated. But we know scores of addicts have been sent from Puerto Rico to undergo treatment in these programs.
And what type of therapy do they offer?
They are not offering any medically-assisted drug treatment. These are not Methadone clinics. Instead they are offering an informal group therapy that is popular in Puerto Rico. Rafael Torruella, a researcher, who runs a non-government program on the island to increase access to quality to drug-treatment programs described a typical therapy session:
You’re in a circle, you sit in the middle and people tell you your faults and then just try to push you, push you, push you, until you break down and admit how bad you are or how things are bad for you. This confrontational therapy. And when we look at the literature, confrontational therapy, instead of doing good for these at-risk populations, what it does do is actually many times, re-traumatize the person.
We aired a story earlier this week about one addict who ended up homeless and died after leaving on of these programs. He told a friend he’d rather die than go back to a program like that. So what Torruella was discussing is an approach that treats addiction like a moral failing or character flaw rather than a disease or medical condition.
Why would anyone go - or agree to send their loved one - to a place like this that’s far from home?
Torruella says in Puerto Rico there’s a lack of capacity at drug treatment centers, and an even further lack of capacity at centers that take an evidence-based approach. So when families agree to have their loved ones sent to Chicago or New York or other places, they’re buying the promise that municipal figures often make that the treatment they’ll get outside of Puerto Rico will be superior to what is offered on the island.
Groups that support human rights say these privately-run programs are proliferating in places all over the world where drug addiction is a growing problem, in part because governments aren’t supporting enough beds at quality evidence-based treatment centers. I spoke with Denise Tomasini-Joshi of the Open Society Foundations and she characterized this as a natural response to a market need:
In most places in the world, you don’t find an adequate supply of drug treatment. That opens up the space for uncertified, unqualified people to develop a business model around offering what they can call treatment, because people are unaware of what treatment actually entails.
In other words - there’s money to be made here.
A growing concern among human rights organizations is that this form of privately-run residential rehabilitation program functions outside the view of government regulation or monitoring so it leaves people vulnerable to exploitation or abuse.
So what solution are people proposing?
Much of this ties back to serious issues in Puerto Rico such as the lack of a robust health care system there and now this is compounded by the island’s serious fiscal crisis. Torruella says at the very least if addicts are to be relocated here, it should be to places that are on a list of approved, certified drug treatment centers and there should be some verification that those programs have space for these people. But Tomasini-Joshi says she thinks those programs should be shut down. She says they’re exploiting addicts and giving governments a way out of dealing with a serious addiction crises that it should fix. Others say they just want to see these places regulated.