America's Rehab Scandal, with Shoshana Walter

Investigative reporter Shoshana Walter has spent a decade uncovering how America's $53 billion rehab industry exploits the people it claims to help. Her debut book, Rehab: An American Scandal, follows four people through a system of unpaid labour, unregulated programs, and treatment that fuels relapse. "Just because people aren't dying doesn't mean they're not still suffering, doesn't mean their families and communities aren't still suffering." In this episode with Mark Labberton, Walter reflects on the human cost of America's failed treatment system. Together they discuss court-ordered rehab as unpaid labour, the deadly paradox of thirty-day programs, faith-based facilities exempt from oversight, racial disparities in the opioid crisis, the treatment gap for mothers, and why recovery capital and low-barrier care offer a more promising path. Episode Highlights "If indentured labour could be considered a form of addiction treatment in the US today, then how common is that? What does the rest of our treatment landscape look like?" "Someone who goes to a thirty-day program and finishes it is much more likely to overdose and die in the year following treatment than someone who didn't complete that program at all." "Without that recovery capital, it's almost as much of an obstacle as the addiction itself." "Our treatment system is not serving the people the way that it should. And we could be helping people so much more than we actually are." "That exploitation is not transformative." About Shoshana Walter Shoshana Walter is an investigative reporter for The Marshall Project covering criminal justice, health care, and child welfare, and the author of Rehab: An American Scandal (Simon & Schuster, 2025). She was lead reporter on the podcast American Rehab at the Center for Investigative Reporting. A 2018 Pulitzer Prize finalist, she has won the IRE Medal, the Livingston Award, the Knight Award for Public Service, and the Murrow Award. Based in Oakland, California. Learn more and follow at shoshanawalter.com and @shoeshine on X. Helpful Links and Resources Rehab: An American Scandal (Simon & Schuster, 2025) simonandschuster.com/books/Rehab/Shoshana-Walter/9781982149826 Shoshana Walter's website shoshanawalter.com The Marshall Project themarshallproject.org/staff/shoshana-walter American Rehab podcast podcasts.apple.com/us/podcast/reveal-presents-american-rehab/id1539955572 Show Notes America's rehab crisis: a $53 billion industry failing patients Court-ordered participants making products for KFC, Popeye's, Walmart—without pay Faith-based programs exempt from licensure, barred from providing medical care "That exploitation is not transformative." Sixty thousand people a year performing uncompensated labor in rehab Thirty- to sixty-day insurance limits fueling relapse and overdose "Someone who goes to a thirty-day program and finishes it is much more likely to overdose and die in the year following treatment." Chris Koon: eighty hours/week of manual labour, compensated with a pack of cigarettes April Lee: could only access treatment by getting herself arrested Accidental overdose: leading cause of death among pregnant and postpartum women Dr. Larry Ley: early Suboxone prescriber arrested by the DEA Wendy McIntyre: lost her son to overdose, became a reform crusader More than one million US overdose deaths since the epidemic began Racial shifts in overdose from white communities to black and brown communities Recovery capital: community, housing, job training as foundations for change "Without that recovery capital, it's almost as much of an obstacle as the addiction itself." Bridge Clinic at Highland Hospital: low-barrier model keeping people in care Mobile distribution, street medicine, peer navigators "We could be helping people so much more than we actually are." #RehabAnAmericanScandal #OpioidCrisis #AddictionTreatment #RecoveryCapital #HarmReduction #InvestigativeJournalism #Suboxone #ShoshanaWalter Production Credits Conversing is produced and distributed in partnership with Comment magazine and Fuller Seminary.