David Dayen | October 17 2017

A SNAP DECISION by Google has begun to reshape the drug treatment industry, tilting the playing field toward large conglomerates — the precise opposite outcome Google had hoped to achieve.

The fateful decision was made September 14. Google faced pressure from an exposé in The Verge released a week earlier, documenting how shady lead generators game its AdWords system. High-cost ads based on rehab keywords referred users to phone hotlines that gave the impression of being independent information services, but were actually owned by treatment center conglomerates. Representatives, who reap large fees based on how many patients they sign up, employ high-pressure sales tactics to push people into their favored facilities, whether or not that facility is the right one for the patient. 

This deceptive marketing can lead to substandard treatment and massive overbilling. It also made lots of money for Google, which was shown in the story actively courting addiction treatment advertisers.

And so Google made a quick call: It effectively stopped running ads from treatment facilities. At first blush, that may look like a happy alignment of the public good and a company’s need for good public relations, with Google taking a hit to make the world a better place in the midst of an epidemic.

But the problem of economic concentration is so deep in the United States today that peeling back one layer merely reveals another. Without ads, addicts or their parents are left only with the organic search results. 

Guess who wins those?

It’s not Ben Camp. He’s the CEO of RehabPath, which bills itself as a resource for addiction recovery, connecting patients with quality treatment information. Camp has been a longtime critic of the fraud rampant in the treatment industry and felt that Google was operating from the right impulse, but got it wrong — to the detriment of smaller facilities.

“I think Google made a mistake,” Camp told The Intercept. “They’re putting rehab centers out of business that are doing good work. And if they come back in a month and say, ‘We figured this out,’ the centers will say, ‘Thanks, but we’re out of business now.’”

Addiction recovery during the worst drug epidemic in American history is expected to generate $42 billion in business by 2020. Insurers are required to cover substance abuse treatment under the Affordable Care Act, and some stays can cost up to $60,000 a month, making every patient extremely lucrative. And the majority of addicts or their parents — 61 percent, according to Google’s internal statistics — use the internet to find help. 

The first click on that path is usually to Google, giving the search engine tremendous influence over how America responds to a public health emergency. Google ads gave preferential treatment to whomever paid the most, regardless of the standard of care. Kenneth Miller, who worked at community treatment centers in Florida for a decade (and, full disclosure, is my cousin), said his facility “spent an insane amount of money on advertising, specifically through Google. They used to give us flash drives with the Google logo on them.” Some facilities were spending $1 million a month on this type of advertising.

Many of those ads steered addicts to woefully substandard facilities that were little more than vehicles for insurance and Medicaid fraud. That’s been widely known and was even the subject of the industry’s 2016 conference. 

But The Verge article touched a nerve, and Google responded by stopping all AdWords marketing for addiction treatment, a blanket policy that froze out every treatment center — good and bad. “We found a number of misleading experiences among rehabilitation treatment centers that led to our decision, in consultation with experts, to restrict ads in this category,” said Google spokesperson Elisa Greene in a public statement at the time of the announcement.