Trigger warning! Shoshana Walter’s new book, Rehab: An American Scandal, is going to make you cry and scream. Cry for how people in need are treated with such cruelty in addiction rehab programs, and scream that for-profit sober living homes are so poorly run by untrained or indifferent staff that some residents die. Each chapter contains revelations that should prompt Congressional investigations.
The book builds on Walter’s years of in-depth reporting for Reveal, the investigative radio show and podcast, which made her a finalist for a Pulitzer Prize. In American Rehab, she exposed how mandated drug treatment forced hundreds of people to work for corporations for no pay! Her riveting exploration of “work-based rehab” programs showed that there is no such thing; it’s slave labor and wage theft.
In Rehab: An American Scandal, Walter describes a world of “desperate and addicted people who had been lured to rehab with the promise of a cure … only to repeatedly falter and fail inside a system that treated them like dollar signs.”
The book follows four individuals, each vulnerable in their own way to a dysfunctional system. Chris Koon and April Lee are trapped inside brutal treatment programs that offer nothing but work for no pay, punishment or prayer. Larry Ley, a physician who prescribes Suboxone, is harassed by the Drug Enforcement Administration. And Wendy McEntyre is a grieving mom turned uber-activist, whose son died of an overdose in a sober living home.
Koon is a young, white man from Pineville, Louisiana, with opioid use disorder (OUD). A drug court judge offers him rehab at Cenikor or five years in prison. It’s an easy choice, so Koon thinks. Cenikor is a program based on the therapeutic community model that uses confrontation and punishment. Soon, Koon has to sit in the “verbal chair,” as Walter writes, “with arms locked, his knees bent at a 90-degree angle, staring at the wall, not speaking, not making eye contact. Anyone could scream at him and he couldn’t do anything about it.”
Why? Because his shirt was untucked. Koon is soon employed, and forced to do back-breaking, dangerous labor for 80 hours a week. His only compensation is a pack of cigarettes each week! Koon can’t complain, because if he doesn’t complete the program and follow all the rules, he’ll go to prison. Walter’s writing about his harrowing two years at Cenikor reads like a horror novel depicting a violent cult. I feared for Koon’s life until he finally got out.
April Lee is a Black mother of three who lives in Philadelphia on a low income. She becomes homeless on the streets of Kensington, but she is tenacious and motivated to stop using drugs. Walter chronicles how Lee faces down one soul-destroying obstacle after another to get into rehab, belying the prevalent idea that “addicts don’t want treatment.”
When Lee enters a 28-day inpatient program, all her belongings are taken and she isn’t allowed to use her cell phone, mouthwash or razors. She attends 12-step groups. Walter writes:
“Look around,” a teacher said during one of her groups. “Only one out of 100 of y’all are going to make it.” Excuse me? April raised her hand. “That’s bullshit,” she said. How good is your fucking program if only one out of 100 make it? she thought. “It’s like you’re prepping people for failure.”
Dr. Larry Ley loves to prescribe Suboxone (buprenorphine). He sees how the medication transforms and saves the lives of his patients with OUD in Carmel, Indiana. The DEA does not love his prescribing practices. Ley bristles against patient caps—first it was 30, then raised to 100—and prescribes Suboxone off-label for pain, in order to treat more patients. The DEA sends an undercover agent into his clinic to find evidence that he’s running a “pill mill.” Ley is eventually arrested and goes on trial.
Vitally, readers will be left with an understanding of how drug treatment fails people with addiction—not the other way around.
Walter explains in granular detail how the DEA at every turn makes the prescribing of Suboxone a bureaucratic nightmare. How doctors’ fear of losing their license means many refuse to prescribe it, and how patients pay the price with their lives. This section made me so mad that my margin notes read, Fuck the DEA!
If you own a sober living home, watch out for Wendy McEntyre—she could be coming after you. The overdose death of her son Jarrod, 20, at Safe House in Van Nuys, California, triggered her years of investigation into these facilities. Walter explains how McEntyre discovered, “Safe House was part of a growing industry of sober-living homes … Anybody could buy or rent a property, and then stick three or more people into a bedroom at $600 a month each. There were virtually no regulations or oversight … clearly, it was a moneymaker.”
Rehab is a must-read whistle-blower, demonstrating how many rehabs and sober living homes in the United States offer punishment for profit, not treatment. Vitally, readers will be left with empathy, and an understanding of how drug treatment fails people with addiction—not the other way around.
Filter’s interview with Shoshana Walter has been edited for length and clarity.
Helen Redmond: What shocked you the most as you did the reporting to write this book?
Shoshana Walter: I’m an investigative reporter and I’ve been doing this kind of reporting for many years now, but I’m also an optimist. But I’m still shocked when I discover that people are being mistreated. It’s horrible. I think the other thing that I was shocked by is reading these studies that show that someone who completes a 30-day treatment program is much more likely to overdose and die in the year following treatment than someone who failed to complete a program. It’s even worse for people who are formerly incarcerated.
It really shocked me because that is by and large how we’re treating addiction in the United States, with these short-term bursts of treatment that are actually placing people at higher risk of relapse and death. It’s just not working.
HR: Can you explain the difference between a rehab facility and a sober living home?
SW: A rehab is where someone goes to get treatment for their addiction and related services. It might include therapy or detox where they might receive medications to help with the withdrawal symptoms. It might include group therapy sessions, coursework, often based on the 12 Steps. A person learns the skills they need in order to enter recovery. And then a sober living home is a place where the person goes to live, ideally among other sober people, where they learn to use those skills that they have learned in rehab.
Rehabs tend to be licensed by the state and have staff who have been certified or qualified to provide services. In sober living homes there’s no oversight or regulation. There could be some programming, church services, Bible study or vocational training, which in many cases, involves uncompensated work by the participants.
“The DEA called Larry the ‘Pablo Escobar of Suboxone.’ All his patients were suddenly cut off. Some died. Larry went to trial and was acquitted.”
HR: In your book you talk a lot about buprenorphine. Can you explain the politics and the problems people experience in accessing the medication?
SW: France was experiencing a heroin epidemic and the country made Suboxone as widely accessible as possible, and that had significant results. Overdose deaths declined by more than 79 percent over four years. When the United States was considering making Suboxone available, the conversation was totally different. There was a lot of interest among certain lawmakers, particularly Senator Joe Biden. He referred to the medication as a cure. The interest among lawmakers was in finding a magic pill that will just end the problem.
When lawmakers were considering making this treatment available they had to pass legislation, and there was a huge amount of resistance from the methadone industry and from the Drug Enforcement Administration. The DEA was concerned about the drug being diverted or misused and sold on the black market. The legislation that ended up getting passed significantly restricted access to buprenorphine. Doctors had to get special training, apply for permission, and they were limited to 30 patients. And then, once they did all these things, they were subject to surveillance by the DEA. When Suboxone first came out in the United States, you had this perfect storm of scarcity caused by patient limits and law enforcement oversight.
Dr. Larry Ley, one of the characters in my book, was one of the earliest Suboxone prescribers. He had a history with alcohol addiction. Larry was one of the first doctors to get that special permission to prescribe Suboxone. He was an interesting, nuanced person. Larry passed away a couple years ago, so unfortunately, he wasn’t able to see this book come to print. He wanted to help people. He saw that there was this tremendous unmet need for addiction treatment for people struggling with opioid addiction. There were so many people banging down his door to get this medication, and he found a loophole to prescribe more medication to people than was technically, legally allowed under the law.
That drew the scrutiny of local law enforcement and the DEA. At that point, the DEA was doing regular, routine inspections of Suboxone prescribers and that led to a criminal investigation and eventually the DEA raided all of his clinics, shut them down, and arrested Larry and his entire staff. They had a press conference where they called Larry the “Pablo Escobar of Suboxone.” All his patients were suddenly cut off from their medication. Many of them couldn’t find alternate prescribers and many of them relapsed. Some of them died. Larry went to trial and he was acquitted.
“She’d poke her head into his room after a long day at work and say, ‘How are you?’ He’d say, ‘Fine.’ Then she’d mark that off as a counseling session.”
HR: Cenikor exploits people experiencing addiction. Can you talk about how the program operates, and Chris Koon’s experience?
SW: When Chris went into the program, he learned it would be for two years and there was counseling and medical care available. He’d be able to live and work there and save up money for after he left. And then, soon after he arrived, he discovered that actually the vast majority of his time would be spent working, sometimes up to 80 hours per week. And really, really tough, excruciating manual labor like laying asphalt in the broiling Louisiana heat, building scaffolding at chemical plants, cleaning up after LSU football games. And he wasn’t going to get paid for this work, except for a pack of cigarettes per week.
There were hardly any counselors on staff for the number of people who were at the facility. There was barely time for him to attend counseling because he was working so many hours. I remember speaking with his counselor at the time, and she told me she would poke her head into his room after a long day at work and say, “How are you?”
He’d say, “Fine.” And then she’d mark that off as a counseling session. That was called treatment.
HR: It really scared me when I read about how Chris was treated. I thought: Oh my God, he’s going into a cult and he can’t get out! He’s court-mandated, and if he leaves he’ll go to prison, and that makes him extremely vulnerable to all kinds of abuse.
SW: What you’re describing is also one of the most chilling aspects of this for me, too. Chris felt like he was a fuck-up. Then he comes into this program that is really designed to just break people down to their very essence and then build them back up into model citizens. But the building back up just was not happening for most people, and for Chris. These practices designed to break him down really gave him this feeling of complete worthlessness, like he had no future, he had no power, no sense of control.
That made it much easier to exploit Chris for unpaid labor. He was totally at the mercy of this program. I’ve learned about treatment and recovery, and there is one essential element for recovery and that is for people to feel a sense of self-efficacy, that they have the power and control to make changes in their lives and the confidence to execute those changes and envision a future for themselves. And I think that is one of the most disturbing things to me in learning Chris’s story.
“April just wanted to stop using and to be there for her children, and she was just stymied in so many different ways.”
HR: It was infuriating and heartbreaking to read about April Lee’s many attempts to get treatment.
SW: April experienced a lot of childhood trauma and ended up developing an addiction. She had three children and was taking care of them when she was sexually assaulted. April could have attended therapy at that time or gone into treatment, but she faced the predicament that so many single mothers face—which is that she has three children who are counting on her, she is their sole means of financial support and she couldn’t just take time off from doing that. Who would take care of her kids? There are few drug treatment programs that accept women with children.
So for various reasons she was unable to enter treatment at that time, and things just got worse. Child Protective Services came and took April’s children away, and then her addiction just escalated. She gave up after her children were removed, and ended up homeless on the streets of Kensington.
The only way that April could find to stop herself from using was to get arrested. So that’s what she did. She got taken to jail, and then from there she begged to be placed in a treatment program. By a stroke of luck, a person at the jail that she talked to heard of a program that might have room for her, and she jumped at the chance and made her way there. And it was just an incredible uphill battle for April every step of the way. She just wanted to stop using and to be there for her children, and she was just stymied in so many different ways.
This is one of the bigger takeaways that I had when reporting this book. I thought that I was writing a book about our addiction treatment system. But ultimately, what I found is that it’s often what happens after treatment or surrounding treatment that is more important than the treatment itself. For example, if April had child care, that would have allowed her to attend treatment and her addiction might not have escalated in the way that it did.
I learned while reporting this book about a concept called recovery capital. It’s a mixture of external and internal resources that people need in order to enter and sustain recovery. That could include community support and social networks, housing and financial security, transportation, a job, food, all the basics that everyone needs in life in order to survive. And I think this is where structural inequality just places people like April at a huge disadvantage, because she went into treatment lacking a lot of these basic necessities, and then once she entered the most serious phase of her addiction, she lost even more.
I think the longer someone remains in their addiction, the less recovery capital they have and the harder it is to accrue it. And so the punishment and marginalization that accompanies addiction can become almost as much of an obstacle to recovery as the addiction itself. And I think that is something April faced again and again, and it’s why it made it so much harder for her to enter recovery.
Top image shows detail from the cover of Rehab: An American Scandal, published August 2025 by Simon & Schuster. Photographs used with permission.