Lessons from Late Night TV

Wondering what to put on your watchlist today? Well, let me recommend checking out the latest piece of reporting by Last Week Tonight with John Oliver in which John Oliver skewered the private drug and alcohol rehab industry.

You may laugh out loud at film clips of confused clinicians, missing patients, and horses used for therapy, but the crisis of a system that includes less than effective treatment programs for substance abuse disorders is no laughing matter. High patient demand, expanded health insurance coverage, a limited evidence base for effective treatments and inconsistent regulations for non-hospital based care have contributed to a treatment system for addiction that is poorly regulated, expensive, dangerous, and deadly serious.

The issues astutely raised in the piece – the extreme marketing strategies, variable components of care, and over-promise regarding the effectiveness of treatment – do not just pertain to rehabilitation programs. These are major concerns in the for-profit health care industry more broadly. In fact, our team, along with colleagues at a number of other academic medical institutions, has written extensively about the changing healthcare landscape for eating disorders.

We have tried to shine a light on the use of marketing strategies by some of the for-profit treatment centers, including direct to consumer ads that promise recovery and direct to referring clinician initiatives that offer gifts, meals and trips to visit treatment centers that are known to greatly sway provider behaviors, and called for greater transparency. When the mainstream media picks up the gauntlet from us, as The New York Times did when they highlighted troubling, similar practices between eating disorder and substance use programs, it helps promote patient and family awareness and underscores our accountability as clinicians to those we serve.

As our field has become more aware of the wide array of practice in specialty programs, interest has grown in the consistent measurement of clinical outcomes before and after treatments that could help patients, families and referring clinicians identify program quality, and establish benchmarks for identifying useful interventions. We have applauded efforts to raise the bar, despite the many challenges in doing so, by steering programs towards increased reliance on evidence-based approaches to care.

As John Oliver points out so powerfully, mental health and substance abuse treatments matter. Ineffective treatments can contribute to poor outcomes, even death. It is on all of us – patients, families, and providers alike – to become as well informed as possible. So please consider the following tips if you, your loved one, or your patient is in need of eating disorders treatment:

  • Don’t believe everything you read on the internet; I don’t. Remember that advertisements are not the same as medical information.
  • Don’t confuse comfort with therapeutic effect. Individuals with eating disorders generally want to make some changes but may be reluctant to change all of their illness behaviors, including weight and food choices. This may make it hard to get real about what treatments are needed to feel better.
  • John Oliver recommends that addictions be treated by addiction medicine specialists; the same is true for eating disorders. Access can be challenging in certain circumstances, but your primary care physician or pediatrician may help identify eating disorders psychiatrists, psychologists or adolescent medicine physicians in your area with known expertise in conducting comprehensive evaluations for individuals with eating problems. [In the U.S., you can also find referrals via the National Eating Disorders Association or the Training Institute for Child and Adolescent Eating Disorders.]
  • Don’t expect one and done. Treatment takes time and often feels challenging along the way. If you want palm trees, you don’t need them at your treatment facility, but consider using them as motivation for where you’d like to go when you’re feeling well and ready for a vacation!


Photo credit (cover): Creative Commons by Pixabay.

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Evelyn Attia, MD

I am a psychiatrist at Columbia and Weill Cornell Medical Centers and have spent the last 30+ years working to improve our understanding of eating disorders and develop effective treatments.

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