Nick Jaworski: Ethical Addiction Marketing With Circle Social

Dr. Mark Leeds [00:09] Welcome to The Rehab on the Mental Health News Radio Network. I am Dr. Mark Leeds and I will be your host. Join me in exploring the world of addiction treatment. How can we improve the ways that we help individuals to overcome addiction? The goal of treatment is to save lives and help people to get back on track to a path towards success and happiness in life. Nick Jaworski is the host of the Recovery Executive Podcast and CEO of Circle Social. He is a proponent of ethical addiction marketing and he is a mental health advocate as well as an addiction recovery center growth strategist. Nick, welcome to the podcast. Thank you.

Nick Jaworski [00:59] Hey, Mark. Thanks for having me on. I appreciate it.

Dr. Mark Leeds [01:01] I followed you online on LinkedIn, and I’ve seen you’re extremely knowledgeable about social media marketing, internet marketing in general. And it’s really a deep and complex field. And some of your articles are – I mean, all of your articles are great, but some of them are just incredible, the depth that you go into of how to do this. And it’s very impressive. Now, can you tell me a little bit about what ethical addiction marketing is?

Nick Jaworski [01:30] Sure. So not sure how familiar your listeners are with the space. So if you have watched the news or if you see anything around addiction treatment, it’s usually negative these days, unfortunately. Obviously, there are people out there trying to do good work, but there’s also there was a lot of money in it for quite a while. Still kind of is. And for that reason, a lot of unscrupulous players were brought into the market. And they would do a lot of shady tactics. This could be anything from literally paying for people to live in a hotel and giving them heroin so that they would relapse, and then they could send them back into treatment and rebill insurance. I mean, that was kind of the worst of it. To smaller things like stealing people’s Google My Business listings or running ad campaigns for major famous centers, just basically copying their ads, but then putting your center’s phone number in there, things like that. So there’s a lot of really negative practice. There still is, unfortunately. And one of the things that we do with clients is we show them that you don’t have to do that. A lot of the big fears, especially with some of the smaller organizations, is that they have to do that to compete. They’re like, well, all these other guys are doing it, and so that’s why they’re successful. And our answer is no. Actually, good marketing is more successful. Branded marketing is more successful, you know, if you do it right. And so we show them how to do it right to still drive reasonable cost admissions, grow the business, but also be able to sleep at night.

Dr. Mark Leeds [02:55] If someone right now, someone were locked up in a room using heroin and, you know, they’re sick of being sick, they want to get help, they want to quit. And they take out their phone and go online on Google or they go on the computer and they search, you know, for example, they search for how do I quit heroin? What happens? You talked a little bit about that, about these unethical practices, but what’s the next step in someone getting help, and what might happen if they do that as opposed to what should happen?

Nick Jaworski [03:25] Oh, great question. So this has changed a little bit since last summer where Google updated their algorithms a lot and have pushed down some of the shady practices, but they definitely haven’t got rid of all of them. So if I went online and did the search for heroin addiction treatment, you’ll see a lot of different things pop up. Google has actually pinned the SAMHSA website to the top of the search results now. So that always appears as number one. And then you’ll see some other government stuff pop up from time to time that didn’t used to be the case. What you used to see was the general looking sites where they had 800 numbers, no real brand on there, really generic names like rehabs.com or addictioncenter.com, you know, or addictionhelpnow, that kind of thing. And when you called them, you thought you were calling some kind of like free help number Right. But really what they were is either they were just some marketing agency that was really good at SEO. And so they would get these sites ranked and then they would take your name, your number, find out if you had good insurance or not. And then they basically sell you to the highest bidding treatment center. So no clinical behind it. You know, they didn’t really know anything about addiction treatment. They were just selling your name and your number. On the other end of it, you have a lot of rehabs. Rehabs, same thing. I mean, some of the bigger rehabs own over 100 web properties, and they try to rank them all. And so you think you’re on some website about, you know, dual diagnosis or something like that. And it turns out that it’s owned by a treatment center. And when you call that number, you’re actually forwarded to their call center. So there’s a lot of just deceptive advertising or lack of transparency in the advertising that I find very unfortunate. It’s not illegal, right? You can debate whether it’s ethical or not, but definitely deceptive and lack of transparency. And again, even from the data that we have on the back end with our clients, if they focus those efforts, that time and that money to run it to their own website, they’d actually get three to four times more admissions. It’s just a weird belief and mythology in the field that they need to run all these kind of unbranded, untransparent tactics to get clients.

Dr. Mark Leeds [05:30] Now, as far as SAMHSA, I just went to that website just to look, and that’s the Substance Abuse and Mental Health Services Administration, part of the U.S. Department of Health and Human Services. You do have to scroll down just a little bit where there’s a header that says, get help. They have a National Suicide Prevention Lifeline, a link for behavioral health treatment services locator, find treatment facilities confidentially and anonymously 24-7, a national helpline. So someone could go through here and probably go to this middle link, the treatment services locator. I know that as far as like in my field of MAT, medication-assisted treatment, that if you go to the physician locator, not everybody listed is even doing that kind of treatment anymore. So it’s a little bit hit and miss when you start calling people through these kind of directories.

Nick Jaworski [06:18] Yeah, SAMHSA is not great. So they’re legit, right? It’s a government-run website. So they’re not trying to sell your name or your number. You know, they’re not trying to deceptively push you into their treatment center when you thought you were calling somewhere else. But it’s also not really organized. They don’t do any vetting processes. You apply to be on the website and they put you on the website. So you could be a really horrible provider, you know, and SAMHSA might end up recommending you because you’re the closest to that person or the closest to that center when you call. You know, so it’s not a great resource, but at least it’s honest in who it is.

Dr. Mark Leeds [06:51] I would think the best thing would be for, you know, if a family, families are trying to find help for someone in their family who’s suffering from addiction, you know, or the person who has the addiction problem themselves is trying to find help, that you’d want to be able to find some place that’s just a perfect fit for you know, a place that, and everybody’s different. So not every place is going to be ideal for everyone. Not everybody wants the same kind of treatment or is going to benefit from the same kind of treatment. So it would be really great to be able to find places that honestly are presenting themselves the way they are. And the searcher or the customer can decide, you know, is that the right fit for me?

Nick Jaworski [07:29] Yeah. So here’s one of the other problems in the field with addiction treatment. And again, this isn’t unique to addiction treatment, right? Healthcare in general does this sometimes. But so with most programs, when you first go in, there’s no connection between their clinical program and their marketing efforts, right? The two teams are completely separate. So the marketing team or their agency or whoever they’re working with is just trying to optimize to increase phone calls and increase admissions. So a really poor example of this is like, oh, they’ll see, OK, when we put an ad up about eating disorders, we get a lot more calls, even though they don’t offer eating disorder treatment at that facility. So this is the kind of stuff that happens where there’s no integrity between the clinical process and what’s being marketed on the website. Right. And so when you look at most websites in addiction treatment, they all look the same. Right. They all say that they’re dealing with dual diagnosis, co-occurring disorders. They all offer individualized tailored treatment. How true that is I mean, it’s often not, frankly, you know, when we go in again, the first thing that we do with clients who say, OK, let me see your clinical. And we’re going to make sure that your clinical is reflected in your website, is reflected in your marketing processes. Right. And that’s new for them. And they don’t like it sometimes either because it might reduce call volume. But at the end of the day, it builds a longer, more sustainable business. Because when people do call you for the right reasons, then they’re willing to refer you. They stay longer. You build a reputation in your space. So the challenge for a lot of business owners is they’ll see a short-term hit, which they freak out about. But once you get past that, your long-term results are much more sustainable and much stronger. So if you want to be in business five to ten years from now, that’s how you need to do it. If you’re just trying to make a quick buck, you know, and then going to close up shop in three years, you know, then that’s a different story. But, you know, we don’t work with the short term people anyway.

Dr. Mark Leeds [09:20] It makes sense that a treatment center would not want to have a ton of calls coming in for people who are not the best fit for them. And I see what you mean. Like, you know, there may be people in the business to make money and they just want to fill the beds regardless of who the people are and if they can help them. But the best thing would be to get the best patients where the fit is good on both sides, where it’s a good fit for the treatment center and for the patient.

Nick Jaworski [09:43] Right, exactly. And then what that does is it allows you to build a really good clinical team too, right? Because if you get the right people in, let’s say that you’re really good at working with firefighters or EMTs, for example. Well, then if you focus your marketing efforts on that, then your clinical team becomes specialized in working with those people because firefighters and EMTs have unique needs from an addiction standpoint. In a mental health standpoint that maybe other demographics don’t have. So, you know, your marketing gets better because you realize how to target them better and connect with them better. Your clinical gets better because they get used to working with them. And it’s just a virtuous cycle. I think that’s really important for people to understand is there’s so much value to running everything through clinical and making sure that there’s integrity throughout your entire process rather than just driving numbers. Because, you know, some of our clients have a million dollar a month marketing budget, right? And they’re generating 50,000 to 60,000 calls a month. They’ll have 50,000 to 60 people in their call center to answer those calls. And they’ll only actually have 1% of those calls convert to admissions. So you’re talking about 50,000 calls. You know, you’ve got to pay 50 full-time staff to handle those calls. And then you’ve only got maybe 500 people actually admitting into the program. You know, it’s just a horrible business model. It worked because reimbursements were so high for so long. But it’s not, you know, that’s not normal in most health care businesses to get that much money off of single patients.

Dr. Mark Leeds [11:11] That’s incredible. A million-dollar-a-month marketing budget. The other end of things as far as doctors who want to do their part, you know, individual doctors with small clinics or maybe they want to leave their current job and open a small clinic. And now there are doctors, you know, primary care, family practice, who are getting into the business of providing medication-assisted treatment with buprenorphine, suboxone, naltrexone, and those sort of things, what’s the best way to get started? You know, they do have some free programs. They have free listings, you know, where patients can find you. But what’s the best way to build a practice like that successfully?

Nick Jaworski [11:51] Yeah, you know, so we’ve talked about this back and forth, and I am not a strong advocate of going out on your own as a physician these days. You know, we can dig deeper into that. But, you know, if you talk to the hospital systems, right, all of their physician-owned practices are loss leaders. They don’t make money on any of their private physicians. The physicians and the reason for the practice is because they’re just a feeder into the larger hospital system where they do actually make money. A lot of physicians, even for the hospitals, are losing a lot of money because they’re not good at the business end of things. So if you go into private practice, you’re not focusing on clinical care anymore. You’re focusing on the business, which means sales, marketing, HR, operations. And the reasons that a lot of private practices ended up connecting with hospitals and getting bought into the hospital system is because the large expense now, right? You have to have electronic medical records. That’s very expensive to have. You know, you have to have good billing because billing for insurance is a nightmare and there’s no way in hell you’re going to be able to figure it out on your own. You know so you’re paying anywhere from six to ten percent just to do billing right you have to have someone answering the phones because if you don’t have someone answering the phones then you’re not going to be able to get patients you know so all these little things like add up very quickly you know I mean a physician’s practice is going to make what you know somewhere between 100 and 250 000 a year but you know your margins are maybe 15 you know so if you’re paying yourself let’s say 50 60 000 and then maybe you’re taking another 10 to 20 percent in distributions or dividends, you know, you’re still making less than six figures a year, but you have all the additional stress of trying to build and run a business. Now, from the MAT perspective, you know, again, we have clients where you can be successful there, but a good MAT practice is still only going to make about $200,000 to $300,000 a year. And again, it’s very lightly staffed and it’s incredibly high volume. So you’re dealing with a largely Medicaid population. You know, you’re literally having people come in for five to 15 minute sessions and just providing them a script, which is not ideal from a behavioral health standpoint. You know, there should be a behavioral health component to that, but the behavioral health margins are even lower than the deprenautic margins. So, you know, I mean, I think a lot of these things factor into it. And again, you can be successful. You know, one way to do it would be to niche down and provide specialized services, you know, that people are looking for something that maybe is not offered in different areas. But at the end of the day, it’s very, very hard to survive as an individual physician trying to offer these kinds of services. You know, the people I see making money from the MAT space, there are a couple that do really well, you know, just running MAT, but most of them just kind of do it on the side, right? So they’re working for their hospital-owned physician group, and then they’ll also moonlight and offer some bioclone subscriptions, you know, which has its ups and downs for the patient.

Dr. Mark Leeds [14:51] As far as what really works in treatment, I mean, the success rates, you know, from what I’ve seen published for addiction treatment in general are not great. You know, and there’s a joke in, you know, in recovery meetings, I’m sure you’ve heard, that you go to treatment and pay $30,000 to find out that meetings are free.

Nick Jaworski [15:11] Yeah, I love that.

Dr. Mark Leeds [15:12] So, and I know, I think that some of the treatment programs are kind of thinly wrapped around the program of AA that you go in and they use that program philosophy and they take people to meetings or bring meetings into the treatment center. And anybody can go to an AA meeting or an NA meeting or CEA or Celebrate Recovery, Smart Recovery. There’s a lot of options out there that don’t cost anything. But what is, in your opinion, the best way to treat addiction?

Nick Jaworski [15:40] Oh, excellent question. So, you know, addiction developed along a different trajectory than the rest of healthcare because healthcare rejected it. Even psychiatry, psychology rejected addiction treatment. So addiction treatment kind of formed its own path and it connected with some weird historical precedents in the U S related to Christianity and Calvinism and, you know, some, some other different kind of Protestant work ethic things, whatever filtered into the process. So over time, because it was so insular, they developed their own kind of way of treating addiction and that often ended, you know, 12 steps. And so even until like the early 2000s, you know, probably 95% of programs were really just 12 step. Nowadays, I think we’re down to about 75%, you know, there’s a lot more of alternative methodologies being built in there, but it’s still largely, you know, 12 step. And like you said, the effectiveness rates are roughly around under 10%, you know, if you define that as like a year sober after treatment. So what is effective treatment? Well, you have to have multiple pathways to recovery, Right. So different people respond to different things. That’s really important. Long term is incredibly important. So 30 days is just almost never going to be successful for someone. You know, it takes a long time to develop new habits. Right. Even if we’re trying to exercise or diet, it’s very hard for us. So trying to kick heroin or trying to drop a 20 year alcohol habit. Right. It’s not going to happen in 30 days. So really successful treatment has long-term aftercare services, at least up to a year after treatment, whether it’s outpatient or just peer recovery support, something like that. The essential key that’s missing within American addiction treatment is the psychosocial piece. So there has been a strong biomedical model in place, and this is kind of where MAT goes astray sometimes, is there’s this belief that there’s just something broken, right? If we can fix a chemical balance or if we can tweak the neurons in your brain just right, that this is going to be fixed. And that’s not correct. Addiction is really the result of dealing with pain, dealing with trauma, dealing with loneliness is a very strong issue. And people don’t have life skills. They don’t have job skills. And so it doesn’t matter if you help someone get sober, if they can’t reintegrate into their communities, if they can’t build good relationships with friends and family, if they can’t find gainful employment and find purpose and meaning in their lives. Then they’re not going to be successful in recovery. So a really, really good recovery program is going to provide life support skills. They’re going to provide vocational support. They’re going to work with people in a wraparound model. And that could be therapists. It could be case managers. It can be the family. It could be the employers. Whoever is able to kind of support that person to achieve their own life goals rather than just kind of obsessing about the sobriety. And so when you come to the MAT piece, MAT is really effective as a tool in the toolbox to add to behavioral health components because it helps reduce cravings. So when we look at SSRIs for like depression and anxiety and things like that, MAT is very similar, which kind of provides a soup in the brain, right? It’s just putting in a bunch of chemicals in there. But what it does is it really allows the person to kind of reengage the prefrontal cortex. So it kind of drops the mesolimbic system and the amygdala from being at the forefront of the decision-making process and letting emotions drive decisions. And getting the prefrontal cortex going again so that you have longer-term decision-making. And so when those drugs are in place, you kind of have that ability to step back and make smarter judgments and think long-term, rather than being focused on the immediate actions that amygdala and the mesolimbic system tend to do.

Dr. Mark Leeds [19:14] Now, as far as therapy, I mean, the importance of psychotherapy, it does seem like there’s a wide variety of options in the way that people practice, and that would be my concern, that someone goes to a therapist and they’re not getting the ideal therapy for them, or maybe the therapist is using their degree in therapy to just kind of push their own agenda and not really provide any kind of scientific or evidence-based therapy. What is the best kind of therapy, and where should a person go, or how should they find the best psychotherapy for addiction treatment?

Nick Jaworski [19:52] Yeah, great question. A lot of different factors there. So really, actually, if you look at the research, the number one factor in effective mental health, whether it’s addiction or something else, is the bond and the rapport between the therapist and the patient. So you really have to find someone that you like and that you trust. Whether they’re trying to teach you 12 steps or they’re trying to teach you cognitive behavioral therapy or motivational interviewing techniques, it doesn’t matter. That bond is more important because if you buy into the treatment that they are providing, then you’re much, much more likely to be successful. So that’s number one. Find someone that you trust and that you respect. After that, you know, really evidence-based wise, you know, you’re looking at things like cognitive behavioral therapy, dialectical behavioral therapy, motivational interviewing, family integration approaches, right? All these, you know, contingency management is really important. But so seeing people that kind of help you develop the cognitive skill sets you need, you need to think about it like the gym, right? Physical health is just like mental health. If I want to get better, if I want to be more fit, I need to go to the gym on a regular basis. I can’t just go in one day and then, you know, lose 20 pounds or gain muscle mass, right? Same thing with dieting. So mental health is just like that. I have to think about going in and what do I learn? Are they teaching me techniques to help me make better? Are my mental processes getting stronger? You know, they’ve done some research. I was just at Yale speaking to Dr. Kathleen Carroll a couple weeks ago, and she did some fascinating research where she showed that about 80% of the communication happening in therapeutic sessions is just chat. There’s no actual kind of behavioral therapy benefit because clinicians aren’t focused enough on actually providing the tool sets and the skill sets that people need. You know, so tool sets and skill sets could be different ways to think positively about things, you know, developing that mental habit. It could be how to react to triggers and whether it’s emotional triggers or addiction triggers, you know, but these kind of skills that you need, just like I need a skill in physical health, you know, how to lift right or how to run properly or, you know, how to manage my heart rate, you know, all these kinds of things that are important for health, what to eat right. You know, they should be teaching you the mental habits that are going to be important to make you successful. And if you’re not seeing them teach you those skills, if you’re just chatting a lot, yeah, it might feel good to vent, right? Because you haven’t had anyone to talk to for a long time. Some people feel benefit from that, but really they’re not setting you up for long-term success. Venting is not going to help you live your life or deal with challenges as they come up.

Dr. Mark Leeds [22:22] And that’s the thing, as far as, you know, finding someone who’s actually qualified to provide those sort of therapies and give the person the tools that they need for long-term success. What do you think about telemedicine? And it does seem that psychotherapy would be ideally suited for telemedicine because the therapist doesn’t really have to be in the same room, or I don’t think they do, or they don’t have to touch the patient like a doctor would have to do for a physical exam.

Nick Jaworski [22:45] I’m a big fan of telehealth. You know, we have a couple of clients that we do telehealth marketing for. It’s still newer, right? People aren’t adopting it at fast rates. I think they’re still a little bit cautious with it. They’re used to being face-to-face with people. But it’s a huge advantage for people. Let’s say you’re in a rural area where you don’t have access to experts, right? Or you’re on the go all the time. You’re a busy executive. Or you’re disabled. Or you’re a mom that can’t leave her kids, right? There’s all these advantages just in terms of access. So I think telehealth is hugely beneficial there. It’s also beneficial from a cost standpoint, right? I can deliver telehealth services cheaper than it can at a physical brick and mortar patient. So there are advantages to the patient and the insurance payers and stuff like that there. The research that’s still preliminary hasn’t shown any increased benefit to telehealth versus face-to-face. And I’m not sure that we would expect any. Right. Seems to be about the same, but that’s fine. So I think it’s just a matter of time for people to adopt it and be more comfortable with it. And I think newer generations that are more comfortable with technology will continue to adopt the practice. So I’m an advocate, but I think there’s just still some we still need some data back in terms of efficacy and what the proper mix is of telehealth versus in person, at least when there is a choice.

Dr. Mark Leeds [24:07] Even in my practice, which is not in a rural area, but I can see that some of the characteristics of a rural area do exist in a big city where there’s a lot of traffic and congestion. And for a patient to come to my office during my office hours, it might take them an hour to drive through the traffic to get here. And when they’re first getting started and the heroin dealer is willing to show up at their door and deliver drugs to them, it can be a tough decision. You know, do I call the dealer or do I drive across down to the doctor? You know, and, you know, so maybe telemedicine or telehealth would be ideal for addiction treatment, you know, everywhere, not just in rural areas, just to make it easier to make that the first choice and the first step, you know, that a person can reach out and get therapy or treatment immediately.

Nick Jaworski [24:54] Yeah, I completely agree with that. You know, and there’s a lot of advantages that we’re starting to see with doing like face to face care. Right. Maybe do a residential model or detox or something like that. But like you said, the person doesn’t want to drive an hour every day. Right. Or it’s too disruptive to their family life and to their work life to have to go and, you know, get a script or whatever it is. So for them to be able to just immediately call, you know, through a HIPAA compliant video interface. And yeah, there’s huge advantages. And I think we’re seeing people stay in treatment longer because of it. So people that maybe didn’t want to do an outpatient program because of the hassle are now more willing to do like a telehealth-based outpatient, you know, following a more intensive treatment stay.

Dr. Mark Leeds [25:37] Now, what do you think of the relevancy today of methadone? I know it has a bad reputation. There’s a lot of myths about methadone and things that it does, which a lot of them are not true. In one book that I read, and actually a book that I recommend to a lot of people states that methadone has a 75% success rate. And I listened to one of your podcast episodes, which was excellent, and the guest that you had on talked about the possibility of providing more treatment centers getting certified to perform methadone treatment in the treatment programs, and especially in light of the state of heroin on the street, that a lot of heroin is contaminated with fentanyl, and it seems to be a different kind of fentanyl that stays in the system for a very long time. And it’s very difficult for a person to transition, for example, from heroin slash fentanyl onto buprenorphine because, you know, rather than the usual 24 hours, it might take two or three days or more to be prepared. And they’re suffering during that time and they may relapse. Methadone, you can go on immediately. But now you’re, when a person is on methadone, now they have to go to daily, you know, have to get their treatment daily and it’s inconvenient. And I mean, what do you think about methadone today?

Nick Jaworski [26:49] Yeah, you know, it is obviously, it’s had a negative history. And people in the field are, most of them aren’t comfortable with it, is what I would say. However, overall, I’m a big advocate of MAT. You know, whether you’re using Suboxone or Methadone, you know, the research is very clear that it’s very helpful for people, especially with an opioid addiction. You know, I just tell people, like, you know, just stop watching your favorite TV show or stop going on Facebook, you know, for a week. Stop eating your favorite foods, right? Stop going out to eat. It’s so hard for people to do. You know, they can’t do these simple things. They can’t stop these simple things. So imagine how hard it is to go cold turkey off of heroin, for example. And you wonder why people feel like they’re crawling out of their skin and they end up, you know, relapsing before they even get through the physical detox stage. So I think we have to be more compassionate with people, understand that there’s a large value to going into, like, tapered strategies of providing methadone and suboxone and helping people, like, slowly wean off them. Because it’s not easy to make those big changes in your lives so fast, especially when there’s an additional physical dependence that’s attached to it. On top of that, I guess, so the history of methadone has been negative because of the way that providers provided it. They were just kind of like pill shops, right? You come in, you get your cup of methadone, you’re really there for like five minutes and you’re dependent on it. A lot of the methadone clinics were kind of equated to almost prisons, right, and the uncaring way that they dealt with people and in a kind of businesslike manner that they kind of shuffled people through the lines. So I think the providers did a very, very poor job, and that’s why methadone has such a horrible reputation. I mean, obviously there is this cultural bias, right? We think drugs are bad in the U.S., especially street drugs, and we have this very strong bias against anyone using drugs. You know, that’s why you’ll see certain 12-step or AA groups saying that you’re not really clean and sober if you’re using methadone or suboxone maintenance, you know, to help with your addictions. So there’s a cultural bias there as well but no I find it extremely valuable I just think it needs to be done right I think there needs to be a strong behavioral health component I think we need to make sure that we’re providing compassion in our care and I do think that there should be strong tapering so there is sometimes an assumption especially with the biomedical model that this is a pill fix right I don’t need to give you behavioral health therapy I’m just going to give you zoloft for your depression right I don’t need to give you addiction treatment therapy I’m just going to give you suboxone or methadone and you’ll be on it forever for the rest of your life. You know, that’s not really realistic because, again, you haven’t changed the neural networks in the brain. You haven’t changed the neural pathways. And so the second that you take that away, then they’re going to go back and relapse. Just like if you gave someone a diet pill and they never got better eating habits on that or they never started exercising while they’re on the diet pill, the second you stop the diet pill, they’re going to go back to the old weight, right? So if they develop the mental habits while they’re using the substance and you slowly taper them off the substance, it can be very effective.

Dr. Mark Leeds [29:43] So therapy is important. One doctor described it to me is that addiction treatment is a three-legged stool. You have medication, therapy, and then group therapy or joining a fellowship where you’re developing a network of support. And if you take away one of the legs, you lose balance and fall over. So it is important to have a well-rounded program.

Nick Jaworski [30:03] Yeah, that’s exactly it. And that social piece is so important. I’m glad that you mentioned it. We should keep reemphasizing it. Addiction and mental health is not an individual issue. I mean, we’re so radically individualistic in the U.S. Yeah, I lived abroad for a long time, so I tend to have a non-U.S. Perspective sometimes. But we just put it on everyone. It’s like, this is your problem, whether you think it’s biological or, you know, psychological, whatever. But it’s not. You know, we are the sum of the people around us. The way that we think is the summation of the people around us. Even when you look at things like obesity rates, right? You’re much more likely to be obese if everyone around you is obese. You’re much more likely to be skinny if everyone around you is skinny, right? So our thought processes and our habits and the leisure activities that we have, if I’m around a lot of people that do drugs, I’m going to be doing drugs. If I’m around a lot of people that are sober, I’m probably going to be sober. You know, if I’m around a lot of people that drink socially but never get drunk, then that’s probably what I’m going to do. So we have to understand that psychosocial component. It’s really, really important for people’s recovery.

Dr. Mark Leeds [30:58] Now, you had mentioned that the 12-step programs have a success rate around 10%. And I think it’s also important to talk about what success rate means. You know, like he said, you know, being clean for a year. And I know that some of the drug companies in their studies have talked about success rates, or they’ve defined in their studies success rates as being how many clean urines you have over a certain period of time. But success could be defined as a person lives a certain amount of time, or they, I guess it is difficult to define success, but every day that a person’s clean, even if they do relapse, all those days that they were clean were days that they didn’t use and didn’t have that opportunity to overdose. And, you know, they can develop themselves in that time. So, I mean, are you a proponent also of 12-step recovery? And what do you think of groups of like NA, AA, or heroin anonymous, cocaine anonymous?

Nick Jaworski [31:50] So you have to use what works for you, right? Different things that work for different people. And obviously, you know, most people you meet in the recovery space have gotten sober through the 12 step, partly because that was their only option, right? There wasn’t other options presented to them. So, you know, it clearly works for some people. And so there’s value in that, right? You know, we want to use whatever works, like I’m on the boards for a nonprofit up in Chicago, and we serve the homeless population up there. And we offer a large number of modalities, you know, 12 step being one of them, because it is a good fit for some people. So I do advocate at least having it as an option and seeing, you know, if it’s going to be the right fit. But you also have to have all these other modalities in place. You can’t be solely focused and saying that 12-step is the only way because it’s definitely not, right? The research isn’t super supportive of that. But you have seen a lot of people get sober on it and they swear by it. So, you know, again, it just really comes down to the individual and what’s a good fit for them.

Dr. Mark Leeds [32:49] Going back to medication, you know, we talked a little bit about methadone and buprenorphine. And then the third MAT medication, naltrexone, non-controlled medication that’s not an opioid, it’s just purely an opioid receptor blocker. And it’s been described in some reports as being equally effective to buprenorphine if a person can get on it in the first place. And that’s where the difficulty is. Methadone, you can start immediately. Buprenorphine, you have to be off of the drug for usually 18 to 24 hours or so. But then naltrexone, you have to be off for a week or two. And it just seems in the environment of a treatment program where someone goes in, they detox, say they stay for at least 30 days or even two weeks. It just seems ideal. You know, if a person is an opioid addict and they get off of their opioid and now they’re clean for about two weeks or more in the treatment program, it just seems like an ideal place to an ideal time to possibly start naltrexone for a lot of people.

Nick Jaworski [33:47] Yeah, I mean, I think there’s advantages to any kind of medication-assisted treatment. You know, whatever’s going to work for the particular individual, especially, you know, as it relates to their primary drugs of choice. You know, but again, we have to go back to that idea that the drugs aren’t super important. You know, again, this is where the U.S. Makes a big mistake is they think it’s all about the drugs. You see it in the legislature and the way the police enforcement is run, all this kind of stuff, right? But I’m not using drugs because I really like drugs, right? I mean, whatever. I don’t care about the alcohol. I don’t care about the heroin. I care about fixing the feeling I have, right? I care about the void in my life. I care about all the stress that I’m dealing with that I can’t handle without the drugs. You know, so you have to understand that if you’re not helping people with these life issues that they have, that these drug fixes are not going to solve the problem. And I guess I just see that all the time, whether it’s within treatment programs or the way that we try to improve legislation to help people. We’re too focused on the drugs. So I agree with you that there is definitely a benefit to providing naltrexone in different formats. But we also have to remember that there’s that psychological piece that’s more important.

Dr. Mark Leeds [35:02] Now, suppose that a person who’s using drugs is they’re in a bad marriage, Maybe not being physically abused, but maybe just psychologically abused or just really difficult. And maybe they’re in a job that’s not right for them. And that could be a contributing factor. And maybe the right thing for that person is to go quit their job or get a divorce or separation. But that’s a difficult thing to tell someone. I think the right thing for you is to make this huge change in your life. And someone who’s advising them on that, say a therapist, You know, how do they really know that’s the right thing for them? But, you know, I guess that’s a difficult decision. You know, how does a person really come to that final decision of, like, you know, I need to make this huge change in my life to really stay clean long term?

Nick Jaworski [35:51] Yeah, I mean, that’s where motivational interviewing comes in. You find out what people’s individual goals are, or you help them find their goals, you know, and you help them reach them because change is hard, right? People struggle with change. And so once you define a goal, they often need support, right? If we’re not talking about therapy, we often need support from our family, from our friends, from coaches. You know, I mean, that’s the value of going to a professional, right? If I’m bad at math, I hire a math tutor. I’ve never seen an Olympic gymnast that didn’t have a coach, right? Like, you don’t get to that level without, you know, professional support. So it’s understanding that, yeah, it’s definitely valuable to go to addiction specialists and therapists and stuff like that. But you’re right that we have to understand what the issue is in the person’s life. And it’s very subjective, right? You have people that are terrified of heights and they can’t get on planes or they can’t work in high rises, but that’s where their job is and this is a problem in their life. Whereas for other people, they don’t care about heights or whatever the issue is. We have to understand that psychology is subjective and what is traumatic to people or what’s stressful to people is also very subjective. And so we have to get into their head. We have to understand the world from their perspective to be able to help them, whatever you want to say, self-actualize or, you know, achieve success as their version of success. And that’ll help them get off the drug. Again, that drug, it allows them to get to a place where they can think about this stuff. Because if you’re so obsessed about getting your next hit, you’re not going to be thinking about quitting your job. You know, but if you can provide them with the medication, it’s a treatment that takes away that strong physical craving. So that you can at least just start thinking. There’s a lot of value there.

Dr. Mark Leeds [37:27] That makes sense. For example, if a person goes on Suboxone, now they’re thinking clearly, and now they can look at their life and say, well, maybe I need to start planning for a year or two years down the road to not be in this job or not be in this situation. And then they need to find the people who can help them to figure that stuff out.

Nick Jaworski [37:46] Yeah, I mean, there’s all cultural skill sets, right? I always give the example. If you are, let’s say you’re making six figures a year, right? Okay, great. Can you make a million dollars a year? Do you know how to do that? I mean, there’s lots of people that do it, but you don’t know how to do it. Okay. So going from $100,000 a year to a million dollars a year is a huge gap, right? It’s very hard for people that don’t know how to get from one level to the next. Well, it’s no different if you’re making $50,000 a year and trying to figure out how to make $100,000 a year, you know? So then when you look at people that are struggling with these different issues, again, there’s just skill sets, there’s knowledge gaps, You know, it’s all possible. Everyone can do these things, but they just don’t have the people around them to show them how, or they don’t have the life experience that has given them the knowledge and skills to be able to achieve success in different ways. So I think it’s important for us to remember that. You know, people are smart. You know, I’ve got someone that’s struggling with heroin and they’re living on the street. Well, I don’t know a lot of people that could survive on the street with no money and no job, right? But people struggling with heroin addiction do it really well. You know, they have a very strong skill set to succeed and achieve in their particular environment to get what they want, right, that most of us couldn’t do. So remembering that people have value and that they’re very good at what works for them. So that means that they can be very good at other things that work for them, you know, to show them the right path.

Dr. Mark Leeds [39:08] Now, going back to the idea of a drug treatment center, if someone has the funding or they have investors and they, for whatever reason, and they’re determined to get into the business and they want to do it the right way. Maybe it’s somebody who’s recovering from addiction and they want to help other people and they have the resources. What would the next step be to get started in that, just going from nothing but having the motivation and the resources, the financial resources? What would be the next step to doing that sort of a thing?

Nick Jaworski [39:40] I mean, there’s so many different pieces. I mean, so we help clients do this, right? We help them start centers. We help them grow centers. So clinical is obviously your number one right you need to make sure that you have licensed clinical professionals on staff from there often the next step is getting accreditation like JCAHO accreditation or CARF accreditation you know because you don’t have those nowadays you can’t get the insurance contract that you need and you know if you don’t have insurance contracts you’re not going to get paid marketing obviously is insanely important you know if nobody knows you’re there nobody knows you’re providing quality treatment if you’re not setting yourself apart differentiating from all the competitors that are everywhere these days, you’re not going to be successful. So usually when we go in with centers, that’s what we set up. We look at the clinical, make sure that’s set up there, right? Then we make sure that they’re studying the process of accreditation, and then we start marketing. If you have those three pieces, then you just slowly build. But something I always mention to people is just making sure that they have enough runway, you know, you’re not going to open up a treatment center and be making money in six months. Like, you actually could, you know, three or four years ago. So sometimes people have false assumptions in place. But now you’re looking at a year and a half, two years, to even start getting into black. And that’s if you’re running a good program and if you have a lot of marketing dollars. You know, some guys, they don’t budget for marketing, and they just think that some are going to magically have all these patients coming to them, which will never happen. So I think those are probably the key components if you’re just trying to start up.

Dr. Mark Leeds [41:04] So starting a drug treatment center, would you say a person needs something like a million dollars in funding or $5 million to get started?

Nick Jaworski [41:13] I recommend about a million and a half minimum if you’re trying to run like a residential program. You know, if you try and open like an inpatient like IOP or just, you know, you could probably do it with under a half a million. That’s definitely possible. But for residential models, you know, you definitely want like a million and a half. And again, you got to factor in your at least $15,000 a month on marketing, including my labor for business development and things like that for a year before I even hope to be making some money.

Dr. Mark Leeds [41:44] To somebody who’s prepared for that, they have the money, the runway to get them through that time period and the motivation, they could come to you and you could help them with everything else, all the other of what they need and what to put in place and the accreditation and everything.

Nick Jaworski [41:58] Yeah, yeah. So we help with accreditation. We help with implementing your EMR, your CRM, your business processes, your operating procedures. And then obviously we help with the marketing components and making sure that you’re allocating budget appropriately so that you’re actually going to be bringing in patients at a reasonable cost so that you’re not shooting yourself in the foot.

Dr. Mark Leeds [42:17] Nick Jaworski, host of the Recovery Executive Podcast and CEO of Circle Social. Thank you for joining me.

Nick Jaworski [42:22] Thank you for having me on. I appreciate it. And if anyone wants to kind of connect with me, you can find me on LinkedIn […] or you can always check out our website. You know, we’ve got the Recovery Executive Podcast on there and a lot of free, good business advice for people.

Dr. Mark Leeds [42:39] Thank you for joining us today on The Rehab on the Mental Health News Radio Network. I hope that you have found this show to be interesting and useful. If so, please subscribe to The Rehab Podcast and share on social media. I appreciate your taking the time to listen to The Rehab. Thank you.