In a two-story Salvation Army building in Sarasota a bustling, multi-agency program helps people with substance abuse issues.
Here, the focus isn't on the alcohol, or the heroin, or the prescription painkillers. It's about addressing trauma and preparing people for sober life after.
The Voluntary Interim Placement Enhanced Recovery program, or VIP-ER, is run by seven agencies that collaborate to provide comprehensive rehabilitation. Experts say the program sets itself apart in a rehab industry that is fraught with corruption and fraud.
"It's not enough just to provide the treatment for recovery,” said Chuck Henry, the director for Sarasota County Health and Human Services. “If you're not helping them get back into the workforce, if you're not ensuring their physical health is there, their mental health is there.
“In order to be successful with recovery, you really have to address all components of our human nature, and help people get back on their feet and back to the real person that they once were."
As state and local governments prepare for an influx of money to treat opioid addiction from a possible settlement with drug maker Purdue Pharma, they will be looking for ways to spend it.
Dave Aronberg, the State Attorney for Palm Beach County, says some of it could go to programs like VIP-ER because the current system for rehab is broken and mostly unregulated.
He says the current rehab model was devised by insurance actuaries with no medical experience.
"But they've come up with a framework that is now called the Florida model, which is in general, a short detox period, followed by a couple of weeks in inpatient treatment, followed by 30 to 60 days and outpatient treatment, which offers no housing."
Aronberg says this just doesn't work. Rehabilitation only has a 10% success rate -- which he says would be laughable in any other industry.
VIP-ER boasts a 90% success rate, and it's leaders partially credit the length of the program for that. Participants live at the Salvation Army for 10 weeks.
Their days are filled with career prep, family reunification and GED classes. They also get physical exams and tests for HIV and other diseases.
Roxanne Morrow is a clinician for First Step of Florida who also oversees classes at VI-PER.
"We have our 10-week curriculum, which is an evidence-based curriculum that hits on such topics as stress and emotional well being. Sex, drugs, alcohol, anger management, you and your parents. So it hits a gamut of different types of things that a person encounters or experiences in their life.”
Up to 30 residents at a time live at the Salvation Army in dorm-style rooms with twin beds and tall, metal lockers.
It's clean, it's safe, but it's not luxurious. And it's a far cry from many of the rehabilitation programs that are little more than vacations for the rich or well insured.
Madison Johnson is just over halfway through the program. She's originally from Tampa, but after being in and out of jail for heroin and other drugs ended up in a California rehab program.
"It was the most unrewarding experience. I really don't even remember it," Johnson said. "We were in a $2 million house, overlooking the Pacific Ocean that I don't think I ever looked at once.”
Aronberg says that's not uncommon. Many people struggling with addiction get caught up in insurance scams. Bad actors from outpatient treatment centers and sober living homes can make a lot of money charging insurance companies for treatment and testing -- sometimes even paying people to stay addicted.
Florida has cracked down on that, but there's still no regulatory framework in place to ensure people get the help they need -- at the best cost.
Johnson says her insurance company paid out $30,000 for her last month-long stint in rehab. VIP-ER, on the other hand, is free for participants. It’s funded by county property taxes and costs about $6,600 dollars a person.
Aronberg says that when settlement money from the opioid crisis comes down to states and cities, it needs to be used to keep people out of the endless cycle of relapse, jail, overdose - and eventually death.
"There should be a 12-month recovery period, with lower level standard of care where you don't need to be drug tested three times a week. You can just have outpatient care with a peer counselor who checks up on you, who makes sure that you're filling out job applications and engaging in healthy habits."
The National Institutes of Health says that successful treatment for addiction “typically requires continual evaluation and modification as appropriate, similar to the approach taken for other chronic diseases.”
Substance abuse costs the United States over $600 billion annually and treatment can help reduce these costs.
Every dollar invested in addiction treatment programs yields a return of between $4 and $7 in reduced drug-related crime, criminal justice costs, and theft. When savings related to health care are included, total savings can exceed costs by a ratio of 12 to 1.
Research indicates that most addicted individuals need at least three months in treatment to significantly reduce or stop their drug use and that the best outcomes occur with longer durations of treatment.
VIP-ER is pretty close to what Aronberg envisions as an ideal rehabilitation program.
The National Association of County and City Health Officials recently honored VIP-ER, saying “We think Sarasota's program is unique.”
One of its key components is a year of aftercare, therapists, career specialists and more at the ready to help participants.
Madison Johnson says her relapse prevention plan lays it all out.
"This is like a 13-page document that goes detailed into like every manipulation tool I ever used on my parents," Johnson said. "It's like I've outed myself completely.”
The plan includes a list of people she shouldn't hang out with, what her warning signs and angry outbursts look like, and how she can cope instead of turning back to substance abuse.
Johnson says she should be in prison. Instead, she's on the verge of being among the roughly 1,500 people who have graduated from VI-PER so far. Most of the participants report back as committed to sobriety more than a year later.