May 21, 2018 at 06:05AM
via The Verge

Huge groups of vulnerable people looking for help are a rehab marketer’s dream

When Laurie Couch first joined the Affected by Addiction Support Group, a closed Facebook group with 70,000 members, she felt a sense of belonging. Here were people who understood her struggle to care for a son addicted to drugs, and they were there to support her, any time of the day or night. She began regularly responding to people who were dealing with cravings and comforting parents devastated by their children’s addictions.

Private addiction support groups are abundant on Facebook, and Affected by Addiction is one of the most high-profile. Last June, the group’s owner Matt Mendoza spoke at the Facebook Communities Summit, where Mark Zuckerberg unveiled his plan to get a total of 1 billion people into “meaningful groups.” In July, Zuckerberg posted a glowing review of the support group on his Facebook page. The group was profiled by Good Morning America in February, sparking a flood of new members. In the segment, Mendoza told the hosts that “there have been hundreds, if not thousands, of people that have gotten treatment as a result of this community.” He didn’t expand on the process.

In March, Couch’s son almost overdosed. They live together in rural Kansas, where she doesn’t have access to much in-person support, which is part of what made Affected by Addiction attractive to begin with. In the wake of his near-overdose, she reached out to the group for comfort and encouragement while she panicked and figured out what to do.

Shortly after that, a stranger named Garrett Hall sent Couch a Facebook message.

“Hey Lauri [sic], I saw your name on the Affected By Addiction support group, and I had this weird/strong impulse to just reach out,” Hall wrote to Couch. “[A]re you doing ok?”

Though there’s no indication of it on his Facebook page, and he never mentioned it to Couch, Hall had a professional connection to Affected by Addiction. Between 2015 and 2016, he’d worked for Mendoza’s blog company, Addiction Unscripted, which owns Affected by Addiction.

Hall never disclosed to Couch that he had professional ties to Affected by Addiction. He simply offered to put her in touch with “someone who I have come to love over the last 12 months.”

“She is the woman who helped me get sober and my life back on track and she has helped so many people and families,” he continued. “I honestly believe she is a miracle worker. She is my hero.”

Couch soon got a call from Meghan Calvert, a paid marketer for a treatment center called Pillars Recovery. It’s owned by Darren Orloff, who is part of Affected by Addiction’s volunteer leadership team. Couch, who has a background in sales, knew a sales pitch when she heard it. She told Calvert off for taking advantage of desperate people.

“I reached out to Laurie to see how I could help,” Calvert responded when I reached out to her. “I have a large list of free resources and offer assistance to anyone looking for options free or private...Garrett has never asked me for anything in return.”

After the call, Couch was surprised to find that she could not log back in to Affected by Addiction. In fact, she came to realize, she’d been banned. The experience left her feeling paranoid, like she couldn’t trust anyone. She warned her son to be careful about support groups.

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The combination of the opioid crisis and Obamacare, which made it easy to get insurance that covered addiction treatment, has driven a boom in the rehab market. Centers that manage to attract clients with the right insurance policies stand to earn massive profits, and some spend millions of dollars on marketing to do so, often wooing addicts from around the country to rehab hubs in Florida and Southern California.

It’s not uncommon for rehabs to use deceptive advertising or offer inducements like plane tickets to people with lucrative policies. Marketers often contract with treatment centers that pay them to bring in clients, whether per head or through a monthly contract. Individual patients are so valuable that the system has spawned a “patient brokering” market, where centers — sometimes illegally — buy and sell the right to treat an individual person.

It’s hard to put together a consistent set of ethical norms in treatment center marketing. Every one of the dozens of treatment center owners and operators I spoke to in the course of this reporting was swift to condemn patient brokering, but they also complained that it’s hard for them to stay open without buying clients like everyone else does. Some people say it’s okay to pay marketers monthly contracts but not bonuses; others say it’s okay to pay performance bonuses as long as they’re not strictly tied to the number of patients. But there are two general rules that come up every time: 1) don’t be deceptive about who you are, and 2) don’t blatantly pay per-head for patients.

“Outside of pay per head, it becomes a real grey, ambiguous area that people are walking in,” said David Skonezny, a consultant in the industry and the founder of It’s Time for Ethics in Addiction Treatment, a Facebook group where industry professionals discuss both general principles and specific treatment centers. He says people may be engaging in brokering while thinking they’re doing the right thing: helping people get sober and getting paid to boot. But he urges addicts to be extremely wary, especially online.

A few months ago, Skonezny posted a warning in his group, encouraging members to spread it around Facebook: “CAUTION: Often times people in social media groups are solicited or respond to posts that on the surface appear to be an offer of help when these posters actually represent unscrupulous centers and are getting compensated...for referring you or your loved one to a treatment center or sober living.”

Rehab marketers have embraced the internet, where tech companies have made it easier and easier for them to pick the most desperate targets out of a crowd. Last year, after I reported on misleading rehab ads on Google, the company temporarily banned ads from treatment centers. Google has announced it will allow them again, provided the centers and their operators pass a background check and license verification. Few stakeholders I’ve talked to have faith in that solution.

On Facebook, rehab marketers are even harder to pin down. Some publicly announce themselves as representatives of a given center and offer their assistance to people who are struggling. Others run community support groups without disclosing their financial interests, creating a pool of help-seeking people to fish for leads or hang out in groups that already exist, waiting for prospects.

Brandon Bergman, research scientist and associate director of the Recovery Research Institute at Massachusetts General Hospital, studies addiction and recovery in young adults, and he is particularly interested in the role online communities might play in outcomes. He cautioned that there’s no empirical evidence that online communities have benefits for people in recovery, but he says it’s reasonable to assume they have some of the same benefits as in-person support groups — and some of the same risks.

“There’s a very long history of people going to [12-step] meetings and being taken advantage of by drug dealers, for example,” he told me. Early recovery is a very vulnerable time, and people are desperate for help. It’s easy to use that for profit, including by convincing somebody to go to a specific treatment center. “It doesn’t surprise me this is going on online because there’s nothing special about the online space.”

In November, I wrote about Affected by Addiction, the Facebook group where Couch was pitched by a marketer, and its ties to rehab marketing companies. At the time, Mendoza, the group’s founder, was working as a marketer at a California treatment center called Windward Way, and Affected by Addiction was part of the rehab’s marketing arm, though that wasn’t disclosed in the group.

When I reached out to Facebook for that story, a spokesperson sent a bizarre response, saying they knew about the undisclosed conflict of interest, but they thought it was a good thing.

“We know that managing communities like Affected By Addiction Support Group can require a huge time commitment...We believe in sustainable business models to create positive impact in the world,” the Facebook spokesperson wrote, linking to other community groups, such as a rock collection fan page run by a store selling rocks.

Selling rehab isn’t exactly like hawking rocks and mugs. The consumers are desperate for help in their darkest hour. Laurie Couch, for instance, described herself as isolated and panicking when Garrett Hall approached her. “I wanted to hear a miracle at that point,” she said.

Hall didn’t return requests for comment.

Facebook continues to be a big fan of Affected by Addiction. Mendoza has been part of its community leadership program, Zuckerberg has called out Affected by Addiction on his own page, and multiple Facebook employees posted the Good Morning America story on their walls, including Deepti Doshi, director of community partnerships.

“Few people I have met in the last few months have inspired me as much as Matt Mendoza,” Doshi wrote. “I am so excited that leadership and courage are featured here.”

The connection between Windward Way and Affected by Addiction wouldn’t have been obvious to people in the group, but the ties weren’t particularly hidden, either. Mendoza operated Addiction Unscripted, the company that runs the Facebook group, out of Windward’s office. There was an 800 number at the top of the Facebook group that appeared to be a general helpline, but it rang directly to the rehab’s admissions department. The first time Mendoza went to Facebook HQ, he brought his boss, Windward’s owner.

Marketers from the treatment center had to approve every post in the group, which gave them the first opportunity to privately message good candidates for their rehab and try to talk them into going to Windward in California. They needed that edge, Mendoza explained to me a few weeks ago, because they knew a Facebook group that big would be full of other marketers, waiting to swoop in as soon as a juicy message was public.

Initially, after my article ran in November, Mendoza put up a disclaimer about the relationship with Windward Way. Then they broke ties entirely. At the end of March this year, Affected by Addiction added a set of rules, including:

“One of the common marketing scams used by unethical treatment centers is to PM people within support groups like these in an attempt to get a client to their treatment center, without any care for clinical assessment, for that reason . . .No recommendations of treatment centers, treatment programs, or other treatment options are allowed either publicly or privately between group members. If you are contacted privately by someone offering a place of treatment, you are required to immediately contact at least two moderators or admins.”

“I’ve explained the entire scam to people, that people will go out there, and they’ll do what I did,” Mendoza told me when I asked him if marketers were still using the group to find patients. “Obviously, I’ve made mistakes. You wrote about my mistakes. I own up to those mistakes.”

He said he’s removed himself from the treatment marketing industry entirely, and he didn’t make any money off of Affected by Addiction or Addiction Unscripted in 2017. He said repeatedly that he has no idea how to vet treatment centers anymore, which is why he doesn’t want to be part of the rehab industry. Instead, he wants to be part of the recovery community.

He told me that three things pushed him to change how Affected by Addiction runs. First, my article made him realize disclosure was important. Second, he had conversations with industry leaders that changed his understanding the moral ramifications. But by far the most significant catalyst came at the end of December: his father, who’d been struggling with addiction, was once again ready to get help, a decision Mendoza supported. In one of the last texts his father ever sent Mendoza, he told his son that the treatment center he had ended up at cared more about money than patient care. Shortly before the new year, his father committed suicide.

“All of these things led up to it, but it was my dad that was a huge turning point,” he told me. “I think the treatment industry is so tainted that I don’t want to be recognized as a part of the treatment industry.”

Earlier this month, Mendoza announced he’s backing away from his leadership role in the group. In a recent Facebook Live post, Mendoza said he needs to take time for himself, and he has turned power over to a team of volunteers that includes legacy moderators, people Mendoza found by posting a survey in the group, and the partner he hooked up with after leaving Windward Way: treatment center owner Darren Orloff.

Orloff owns Pillars Recovery, where Meghan Calvert, who approached Laurie Couch, works as a marketer.

Mendoza denied knowing Hall had been messaging people in the group. Calvert admitted to calling Couch, but she said there had been no money involved when she got her number. Orloff denied using the group to recruit patients for Pillars.

“I know Darren very well, and I know Darren would have no intention of setting us off-course. He’s been instrumental in what we’ve been doing as a leadership group,” Mendoza said.

On its face, the relationship between Mendoza and Orloff seems similar to the one he had with Windward Way. As he did with Windward Way’s owner, Mendoza took Orloff to Facebook HQ when he was invited in March, shortly after Couch spoke to Calvert and Hall. Mendoza made Orloff an administrator on Affected by Addiction and posted an Instagram video referring to Orloff as his “nonprofit partner.” The two share an office together on the Newport Beach waterfront.

Mendoza and Orloff maintain that the relationship is very different, and Orloff is volunteering his time without financial gain. When I first told Mendoza about what happened to Couch, he seemed horrified. “I don’t know anything about this. This is new news to me, and this would go against any of our rules, stated values,” he said. “I have absolutely no interest in trying to monetize this anymore, so I’d like to get to the bottom of that.”

After I began asking questions about Couch, I was invited into the secret Facebook leadership group where the two dozen volunteers discuss how to run the 70,000-person community.

Because Facebook relies on users to flag bad behavior, rather than actively policing groups like Affected by Addiction, it’s up to group owners to assemble their own moderation teams and train them to recognize and solve problems. In big groups, those moderators have a huge workload and enormous responsibility, dealing with everything from suicidal members to predatory marketers. It’s a lot to ask of any volunteers, especially ones who don’t have any training or experience in handling these life-or-death questions.

That’s not acceptable, according to Jesse Heffernan, a consultant who helps advocacy groups develop programs and services, branding, and outreach efforts. The Affected by Addiction moderator group invited him as an adviser while developing their rules and leadership structure. He’s no longer actively involved with the group.

“People are seeking help on these digital platforms, which makes them so vulnerable and so easy to get at if you have ill-intended purposes,” he told me. “If you’re [going to] claim to be a 70,000-person support group, you need to have more than just 20 volunteer moderators... That’s a full-time job that someone with some paraprofessional experience needs to be navigating.”

Since Mendoza is stepping back, Orloff is one of the few recovery professionals in a leadership team tasked with keeping patient brokers out of the group. Orloff admits to working with patient brokers in the past, although he says he no longer does so.

Until late 2017, according to Orloff, Pillars often paid third-party marketers to fill its beds, including a company called Sober Services, which is owned by marketer Shane Earn. Earn originally introduced Mendoza and Orloff. According to Mendoza, Sober Services also referred patients to Windward Way, Mendoza’s initial partner in Affected by Addiction.

Earn has stated in public records that, during the time Orloff was getting patients from him, Earn’s business practices included trading clients for per-head fees and getting kickbacks from insurance claims. Last fall, he filed a lawsuit claiming he’d been stiffed by the owner of a different rehab, who owed him $7,000 for every patient Earn had brought in, plus a cut of the money a drug-testing lab was paying the treatment center for referrals. In total, according to the claim, Earn was owed over $700,000 in fees and kickbacks for around a year and a half of referrals to that one rehab and its related businesses.

“Two years ago, people didn’t look at client brokering in a bad light,” Orloff told me when I asked about his dealings with Sober Services. “I look at it in a bad light now, but at the time, everybody thought it was okay and that there was nothing wrong with it.” Earn’s claim was filed in September 2017. Orloff told me he stopped getting patients from Sober Services in “late 2017,” but said he couldn’t pinpoint an exact date.

The connections between Sober Services and Pillars went beyond patient referrals during 2016 and 2017. Orloff ran Pillars out of Earn’s office in Irvine, California, between August and December 2017, at which point he says they parted ways. In the mid-2016, Orloff and Earn registered a corporation called Sober Services LLC, which Orloff maintains never did business but was intended to capitalize on the marketing company’s good reputation while providing other treatment-related services.

During much of 2017, Sober Services’ phone number was listed on the Pillars website. In October 2017, the Sober Services Facebook page posted, “Sober Services presents Pillars Recovery: Powerful and affordable addiction treatment,” with a link to the site and an 800 number for Sober Services.

This period of overlap came to an end, Orloff claims, when he discovered Earn was siphoning off potential Pillars clients to send to other rehabs using the Pillars website. Once Orloff realized what was going on, he severed ties with Earn, and moved into his own office.

The Verge tried to reach Earn for comment on multiple occasions, but he never responded.

Meghan Calvert, the marketer who called Laurie Couch, had been working for both Sober Services and Pillars in 2016 and 2017, according to Orloff and her LinkedIn. When Orloff left the Sober Services office, she went with him, Orloff said. Calvert confirmed she began a full-time job at Pillars in November 2017. When I asked about Sober Services, she cited a nondisclosure agreement.

When I asked Calvert if she’d ever received money from or referred patients to Mendoza’s old partner, Windward Way, she responded, “Since my full time employment with Pillars no I have not.” When I asked about whether she was involved in patient brokering, she told me at the job she held before Pillars, she had “only received a paycheck from my employer.”

Despite the breakup, Earn still seemed to be entangled in Pillars’ digital presence until I started asking questions about the relationship at the end of April. At that point, there were two Facebook pages for Pillars. One of them listed Shane Earn at Sober Services as the contact. There was nothing on either Pillars page to suggest the two pages were run by separate people. After I asked Orloff specifically about the two Facebook pages, the one connected to Earn was taken down.

The other Pillars page, run by Orloff, is an administrator on Facebook’s star community group, the 600,000-member health care provider gathering place called Show Me Your Stethoscope, which Facebook used as an example of “leaders inspiring change” in an October press release. In an effort to do transparent outreach, as advised by Mendoza, Pillars now publically runs a treatment center referral hotline for the group.

Facebook has spent a year acting as a cheerleader for community support groups, especially those focused on addiction recovery. But scratching the surface of these organizations reveals the need for a referee, instead. Without that, there’s nothing to protect the most vulnerable people on the platform from this impenetrable tangle of altruism and e-commerce.

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It’s not just Affected by Addiction. There are enormous numbers of Facebook groups and pages targeting addicts and their families, and it seems like every one, big or small, is a potential hunting ground for marketers, whether the admins intend for them to be or not.

Last month, a woman posted in another closed group, Addiction Recovery Support Group, complaining that a member had given her phone number to a marketer.

“[W]hen I told them I wasn’t interested in going that far away they got very rude to me. He kept asking for my insurance info and even told me how wrong it was for me to keep hurting my family by not coming to [their] rehab center,” she wrote.

When contacted by The Verge, the woman said she’d been contacted by six different treatment center marketers since joining the group. “Most messages start out kind and supportive but I’ve had several that get right to asking about my insurance and address.”

She stayed in the group, despite the marketing. “If it wasn’t for a few people in the group I interact with, I’d leave.”

In his post about community groups, Zuckerberg wrote, “Online communities are a bright spot, and we can strengthen existing physical communities by helping people come together online as well as offline.” Savvy marketers understand the value of a local connection, too.

In Maryland, for instance, a group of moms associated with a nonprofit advocacy group, Maryland Heroin Awareness Advocates (MHAA), use Facebook extensively to promote their fundraisers and events, both through official groups and pages and on ones run by individual members of the group. They also use those channels to advertise treatment center “scholarships,” free stays at rehabs for those who can’t afford the often-steep costs.

Several people who are or have been associated with MHAA are paid marketers for rehabs. The son of board member Lynn Fowler, rehab marketer and convicted patient broker Howard James Fowler Jr., for instance, has used Facebook groups to approach potential clients, often with his mother’s help. They’re both administrators on a Facebook group, Recovery Resource, that’s no longer particularly active. In 2016, though, the group was full of regular posters. Both Lynn and James used it to connect with people who were looking for treatment; Lynn would suggest that people contact James, and James would offer his help by finding treatment centers and sober homes in Florida.

Neither of the Fowlers responded to detailed questions about this story.

In November 2016, James was arrested in Florida on 14 counts of aiding patient brokering. He’d been running a sober home in Delray Beach, taking kickbacks to send residents to an outpatient rehab. The owner of that center was arrested on 95 counts of patient brokering. In February 2017, James pled guilty to seven of the charges.

The conviction didn’t stop him from being involved in MHAA or referring people to rehabs. In September 2017, Fowler was the special guest at Save Our Children Family Peer Support, an in-person group run by MHAA. The next month, a mom from Maryland posted a thank you to James for negotiating a scholarship at a rehab in Delray Beach that James has claimed to be the admissions director of elsewhere on Facebook. An admissions director generally is in charge of “patient acquisition” efforts.

Though Lynn Fowler initially agreed to an interview, she stopped responding to messages after I told her more details about the story. After sending both the Fowlers detailed questions, both blocked me on Facebook rather than responding. I was also blocked from the groups and pages for Recovery Resources, Save Our Children, and MHAA.

Pamela Knight, a former MHAA representative, has worked as a professional marketer for several rehabs, mostly in Florida. She’s in recovery herself, as well as being the mom of a son who struggles with addiction. She sometimes hangs out in groups targeted toward parents of people with addiction in Maryland. One poster in the Maryland chapter of The Addict’s Mom, an enormous Facebook community with dozens of spinoff groups, wrote that her daughter wanted to stay in state for rehab. Knight responded that her son had tried staying in Maryland for rehab. “He came home and relapsed,” she wrote.

But for the most part, rather than directly reaching out to prospective clients, she would speak at community events and use Facebook to spread the word about her services. She has a Facebook page, Stigma KILLS, with 2,500 followers, which she uses to post inspirational images and warnings about the dangers of addiction, often with her phone number attached.

“At one time, I was just a regular mom navigating through parenthood just like everyone else.....and then BAM, I had to figure out how to become a Mom of a child suffering with substance abuse,” one post from April 4 reads. “There are many resources out there to achieve wellness. Recovery is possible!! Please reach out! Message me❤️”

The Verge interviewed three women who spoke with Knight about a referral for a loved one. All of them described Knight as pushy, even aggressive, in her sales tactics for rehab in Florida. One said Knight told her that treatment would cost over $20,000, suggesting she take out a home equity loan to pay. The woman declined. Another mom did let Knight place her son, scraping together over $10,000 for inpatient rehab in Florida by digging into savings and borrowing from family.

“[Knight] was trying to place guilt on me, saying, ‘You’ve got to do this now, your son could die,’” she said. “At first, she was very nice. But she’s a salesman – she will hound the hell out of you.”

The third mother I spoke to, Karen Mackey, asked Knight for help at the end of 2016. One of her sons had died of an overdose in July, and another one of her sons was spiraling.

“I was sure he was going to go too. I was sure of it,” Mackey told me. She’d gotten Knight’s card at an event where Knight spoke. “So I called Pam, and told her how I’d met her, and she met me within an hour at the local Waffle House, and you know, I’ll never forget that. It was a life preserver.”

Knight got her son into one treatment center in Maryland, but it was a bad fit. That’s when Knight told Mackey the best way to keep her son alive was send him to a treatment center she knew in Florida. Knight failed to mention she was a paid recruiter for the center, instead saying it was where both she and her son had gotten clean. (When I spoke with Knight, she told me her son had gotten clean at a different center, Recovery Unplugged, where she was working when I first called.)

“I had just lost my son seven months before,” Mackey told me. “The fear I had of losing [my other son], too – she could have said, ‘Send him to the Moon,’ and I would have done everything in my power to get him there.”

She sold her tractor and her snowblower, but she still couldn’t come up with the amount Knight said she needed to send her son to the Florida rehab. Knight texted her every day asking whether she’d come up with the cash yet.

“I said, ‘Pam, I don’t have the money raised,’” Mackey told me. “And she said, ‘Isn’t your son worth $10,000?’”

“I never said, ‘Isn’t your son worth it?’ I’m not that kind of person,” Knight told me when I reached out. “I feel awful about doing cash pay. I don’t like having to say, ‘Well, you know, do you have credit cards, or can anybody help you with money?’ And I will make the comment, ‘We should never have to put a price tag on someone’s life.’ And I do believe that because I feel sorry for the people who don’t have good insurance.”

Mackey eventually raised $7,500. Knight called her and gave her some thrilling news: the treatment center was willing to take that instead. “She goes, ‘Karen, get him on a plane. He may not live through the night.’”

When her son got to the rehab, it was nothing like Knight (or the center’s website) had promised, a common theme among the mothers I spoke with. He was in a house with a roommate. Similarly, another mother I spoke with told me Knight promised her son would be in a residential treatment setting. When he got there, he was told there was no more room at the inpatient center, and he was put in a halfway house where he could come and go freely while attending an outpatient program.

A clinician had initially recommended he stay for 30 to 45 days, which Mackey believed was covered by the $7,500. After 21 days, though, Mackey was told she would have to start paying a “reduced rate” of $1,500 a week if her son was going to stay at the treatment center. Upset, Mackey emailed her son’s case manager.

“I was so hopeful based on Pam Knight’s recommendation and determination to get him in and quick that I bought into it,” she wrote. “I sold our snow blower for a hundred less than it was worth because I was being so pressured to raise 10,000 and get him in today.”

She never got a reply. Instead, according to Mackey, the head of the rehab called her and told her she was forbidden to talk to anyone at the treatment center. She’d begun to suspect Knight had financial ties to the center and asked if she wasn’t allowed to talk to her, either. He didn’t give her a direct answer, Mackey remembers. Instead, he told her she could do what she wanted. Later, she realized the email Knight listed on her Facebook page, Stigma KILLS, was a company address for the rehab.

Mackey’s son came home. The next day, she says, he went to Baltimore, bought heroin, and overdosed at her house. EMTs came and revived him, but a few hours later, Mackey found him overdosed again. Some opioids used to adulterate heroin last longer than Narcan, the drug used to stop overdoses, which means users may need multiple Narcan injections to survive one bad dose. Mackey’s son had to be revived three times over the next few days, and had a brief stint in the hospital, but stayed alive.

A week later, he was again admitted to the hospital, unrelated to the overdose. Knight visited him there, but wouldn’t discuss what happened in Florida. Mackey’s son has since gotten clean through a methadone program.

When I spoke with her, Knight expressed shock that anyone would speak badly about her services. She insisted she would never lie to a parent or suggest they mortgage their house. Rather, she said she was very passionate about getting kids into treatment in the slim window when they’re willing to get help.

“You have to act on it, because come the next day, they’re going to use again,” she said. “I’m not the bad guy.”

I hadn’t talked to Mackey at that point, but Knight, guessing I might have, told me, “What happened with Karen was wrong. They were begging for help, he had Medicaid, I was begging the treatment center to take him for hardly any money.”

She said parents criticizing her might be looking for people to blame when their kids couldn’t stay off drugs, or the kid might not have wanted to get clean, so they’d “talked smack” about the rehab they went to. “Statistically speaking, I mean, so many people don’t make it, right? But they don’t want it. You have to want it,” she told me.

Knight told me she’d been an employee at the treatment center Mackey’s son had gone to, and that she was now an employee at a different treatment center, Recovery Unplugged. I asked Knight what her policy was around disclosing those relationships.

“Just recently, I think there’s been a real push that you do need to put on your Facebook page who you’re working for, otherwise you could get in trouble,” she told me. “I have had negative feedback, like, ‘Oh, you’re just a patient broker, you send everybody to Florida.’ Well no, actually, I don’t. A patient broker is somebody who gets paid per-head.”

The next day, I called Recovery Unplugged to confirm Knight’s role, and I was told she’d been let go. After being bounced around to different departments, I ended up on the phone with co-founder and CEO Andrew Sossin. He told me Knight had worked with his marketing team.

He was vague about why she’d been cut loose. Somebody had told someone that Knight “may or may not have done something that I would consider probably legal...but not the way we do things. And then the decision was made that I can’t be associated with that.”

He wished her well, and said he hopes she “can continue to help people” while working “for other people that don’t have the same standards we do.”

Later, I asked Knight what had happened. She said she’d told them there was an article coming out, and they’d immediately fired her. “They said, you know, they’re a national company, and they can’t have bad press.”

She started to cry. “I never intended to hurt anybody,” she said, explaining that she’d left treatment centers in the past that she didn’t feel were doing the right thing.

“It’s the craziest business I’ve ever been in. One person tells you, ‘Do this.’ The other person says, ‘No no, you can’t do that.’”

Knight sent me her texts with Barry Reiman, the vice president of business development at Recovery Unplugged, who someone in the outreach department had told me made the decision to let Knight go. “I am not taking any sides whatsoever. This is not my preference,” he wrote. “I am well aware that people run their mouths. Unfortunately this is being printed.” (When contacted, Reiman said to speak with Sossin.)

In the texts, Knight protested, saying the story wasn’t even running until a week later. “I know in my heart that I do good work and I go above and beyond with clients and families,” she texted him.

“I guess we’ll need to say what the article says,” he responded.

Many of the problems in rehab marketing are due to the fact that addiction treatment is largely unregulated. For all that pharmaceutical marketers may skirt regulations, there are clear regulations to follow, many of them federal. But, as Bergman of Recovery Research Institute at Massachusetts General Hospital pointed out to me, addiction wasn’t considered a medical problem until recently, long after patient protection standards were developed.

“Right now, treatment programs can say whatever they want. ‘Our success rates are 85%’ – those things don’t even mean anything,” he said. “For most of these treatment programs, if their goal is to keep patients coming in and be able to make money, it’s probably not in their best interest to measure outcomes over time, you know what I mean?”

Facebook, by making desperation so easily searchable, has exacerbated the worst qualities the treatment industry. A word-of-mouth industry with a constant supply of vulnerable and naive targets who feel stigmatized and alone is a scammer’s paradise. Facebook does have tools to report groups that are abusive, but given the murky definition of patient brokering, Facebook’s legendary lack of transparency, and the fact that it already went to a lot of effort to promote the earlier incarnation of Affected by Addiction, which Mendoza himself admits was a deceptive marketing scheme, Facebook hardly seems like a good arbiter.

“We have seen that Facebook products and tools, including Groups, can complement work on prevention, education, de-stigmatization, addiction support and awareness, and we continue to support community leaders that use our platform for good,” a Facebook spokesperson told me when I asked about this story. “Most of what we see in Groups is positive and meaningful to people and their communities, and we are committed to increasing the good and minimizing the bad across Facebook.” They declined to answer any specific questions about addiction-related groups, patient brokering, or Facebook’s relationship with Affected by Addiction.

When Garrett Hall reached out to Laurie Couch on Facebook, she had nothing but good things to say about the group. “I have received so many levels of healing from this group,” she told him.

But Hall wasn’t just reaching out to offer a hand; he was there to deliver her to a salesperson. And when Couch cut off the call, she was banned from the group, losing a significant support network in the process.

“It has affected my ability to share openly, because you feel a level of paranoia when you’ve been duped like this. It spreads into every aspect of my daily living,” Couch told The Verge. “Why couldn’t he just have said, ‘You’re probably familiar with Matt; we saw some posts of yours, and we’re concerned you might need some help’? I would have had no problem with that. But the backhanded, backdoor way this happened was just not right.”

Heffernan, the consultant who worked with Affected by Addiction, is deeply concerned by how exposed families are to predators in these groups, and he thinks it’s time for Facebook to take an active role.

“You’re basically operating a non-therapeutic support group with volunteers and no liability and no training,” he told me. “You’re at the point where you have to invite in some real [professionals] to sit down and say, ‘What should we do? How can we do this better before it gets out of hand?’”