"He's gone! Bryan's gone!" Carol Katz Beyer's ex-husband screamed into the phone.
Carol, on the receiving end of the call, shook sleep from her eyes as she glanced at the clock. It was just after sunrise.
"He'll be okay," she assured him even as panic rose in her throat.
"No, he's gone," Wayne sobbed. "He overdosed. He's gone."
Dread settled over Carol. It just didn't seem possible. Since he was a boy, Bryan, her eldest son, had possessed a drive and unquenchable optimism that made death seem untenable even during the most chaotic periods of his struggle with drug addiction.
"I'm fine, mom. Everything is going to be fine," Bryan used to tell Carol as he chatted about his latest plans and achievements. Despite his struggles with addiction, he had gone through school, fulfilled his dream of working as a chef, married, and made plans to buy a house.
"I just thought if anyone could pull through it, Bryan could," his mother tells me as we sit huddled under a staircase at a hotel in New Orleans. We are attending a conference here on harm reduction, but we have found a quiet place so that Carol can recount her family's fight to keep Bryan alive.
Now a resident of New Jersey, Carol grew up in New York She spent most of her career working in health care, but says her greatest joy was being a mother. With a wistful smile she describes the ball games, the parties, the music concerts, the happy moments nurturing little ones. But when she starts to talk about Bryan, her face clouds.
The story she has to tell is not uncommon. It is one that made her an expert in the struggles of addiction--and in the industry that has grown up around it. For more than a decade, before drugs claimed his life, Bryan was in and out of treatment centers. Most were private, for-profit facilities, all of which came out of the deal better off than he did.
Over the last several years, as drug overdose deaths have tripled and panicked parents search for a cure, the drug treatment industry has flourished. From 1999 to 2008 alone, opioid-related patient admissions to treatment facilities surged 600 percent, spurring a rise in the number of for-profit treatment centers. Meanwhile, in the past ten years, the number of nonprofit, state, and federally run drug treatment centers has declined.
This gold rush of treatment investors has been fueled in part by increasing demand, but also by an unlikely catalyst--the Affordable Care Act (ACA). President Obama's signature achievement, which included substance use treatment in its list of essential services covered by health insurance, greatly increased the number of people with insurance plans and allowed young adults to stay on their parents' health care until the age of twenty-six.
This law, coupled with the Mental Health Parity Act of 2008, which required insurers to cover mental health care as they do other health care, brought substance use treatment within reach to millions of families. As a result, annual spending by private insurers on opioid treatment alone skyrocketed by more than 1,000 percent in the five years following the passage of the ACA. Investors have taken note. By 2014, drug treatment and rehabilitation had become a $35 billion industry.
In Palm Beach County, Florida, alone, for-profit drug treatment providers rake in $1 billion a year. Treatment centers and detox facilities have flourished under Florida's lax licensing requirements. While most treatment programs consist of twenty-eight days of inpatient care, Florida pioneered the idea of "sober homes" or houses where patients live and pay rent as they attend an...