— Competitors hijack online traffic from established centers by buying common misspellings and iterations of rehab names and key phrases.
— Rogue treatment centers create hundreds of blogs and websites hammering crucial keywords to take advantage of Search Engine Optimization, directing addicts to sites that promise far more than they actually deliver.
— Phone banks and boiler rooms have paid hundreds of dollars for choice Google AdWords, making their sites come up first in searches such as “drug treatment Los Angeles.”
“Google is the No. 1 referrer of addiction treatment in America – not health professionals,” said Greg Williams, executive vice president of the nonprofit Facing Addiction. “And with great power comes great responsibility.”
The prevalence of paid advertising in addiction treatment, which can bury unbiased health information from governments and nonprofits, translates to danger for vulnerable people desperately seeking help for an often fatal disease, critics say.
“As I look back over my son Austin’s six-year battle with addiction, I am profoundly sad, and angry,” said Jim Hood, co-founder of Facing Addiction. “Sad that he spent one-third of his life suffering from this horrific illness, and unspeakably sad he lost his battle just days before his 21st birthday.
“Yet I am angry, too, because his journey was so incredibly difficult, uncharted, and altogether unnecessary,” Hood added.
“Austin sought help from 15 or more people or places. Most of the time, we felt like we were searching for a restaurant on Yelp.”
The Beacon House is one of the granddaddies of addiction treatment in California — a nonprofit founded in 1959, situated in a grand Victorian estate on the scenic Monterey Peninsula.
If you searched Google for “Beacon House Monterey” just a few months ago, a list of ads for Beacon would have popped up. If you clicked through and called the contact number, you might have learned that the Beacon House in Monterey was, unfortunately, full. But you also would have been told that there were great spots for you in top-notch treatment centers in Orange County or Palm Springs or Florida.
Unbeknownst to prospective patients and their families — many often searching during a time of crisis — those calls for help were routed away from Beacon to boiler rooms staffed by marketers who paid big money for rehab-related Google AdWords.
Phone operators took down names, phone numbers, addresses, and insurance information — then sold that information to treatment centers for the highest bid. Centers often paid $1,000 to $10,000 for a insured potential clients, depending on the level of care needed, said Peter Brunzelle, owner of SALS sober homes in Wisconsin.
“You’re buying and selling human beings,” Brunzelle said.
Marketers could hijack the names of established rehabs, then sell prospective patients to other centers.
The patient brokers were making money.
So was Google.
Last year, before it filed for bankruptcy, the rehab center Solid Landings Behavioral Health, in Costa Mesa, was spending $33,452 a week on marketing, according to court documents. Its Google debt, dated last March, totaled nearly $49,000.
The treatment industry is so competitive that even the word “addiction” commanded big money in the online advertising world. “Keywords,” as Google calls them — including “addiction,” “treatment,” “rehab,” and “heroin,” among others — have commanded up to $90 per click on Google, advertising experts said. And key phrases — like “rehab Los Angeles” or “addiction treatment Orange County” — could reap hundreds of dollars per click-through for Google.
“Recovery,” “rehab” and “treatment” once ranked in the Top 20 most expensive words in the entire keyword universe, according to the online marketing firm WordStream.
“It was pretty wild,” said Nick Jaworski, owner of digital marketing firm Circle Social Inc., in Indianapolis.
“The way it was set up with Google wasn’t bad (in itself). It’s just these people were doing shady practices.”
Google grant that couldn’t
Last year, Facing Addiction, the nonprofit based in Connecticut, created the Addiction Resource Hub, “a comprehensive compendium for individuals looking for unbiased information,” which was built on Google technology.
In an attempt to help the little guys, Google provided grants to nonprofits like Facing Addiction. The idea was to help them acquire important — and competitive — keywords, but set a maximum bid of $2 per word.
The little guys couldn’t compete.
“The Google Keyword Planner suggests bids of $51.61 for ‘drug rehab,’ $70.14 for ‘alcohol rehab,’ and $63.60 for ‘alcohol treatment centers,’” said a report that Facing Addiction presented to Google.
“These suggested bids are well outside the allotted $2 …. Facing Addiction is effectively unable to use our AdWords grant because the process has been hijacked by unscrupulous players willing to pay astounding – but presumably profitable – amounts to buy ‘leads’ of people who are desperately seeking help,” the report added.
Pacific Solstice, an outpatient treatment center in Mission Viejo, tried AdWords for four months more than a year ago. It set up a Google pay-per-click account with a budget of $10,000 a month.
“We ended up spending $40,000 and we got nothing,” said Evan Fewsmith, the marriage and family therapist who owns Pacific Solstice. “Not a single client. We couldn’t compete.”
The only centers who could afford to play the game, Fewsmith said, were “the big warehousing rehabs.”
Facing Addiction told Google that the search engine’s role in “system navigation” was one of the most significant barriers to accessing quality health care options and independent information.
Google was moved by these arguments. In September, the company restricted ads for some rehab AdWords in the United States. Similar complaints raged in the United Kingdom and, earlier this year, Google banned rehab-related AdWords there as well.
“We’re banning keywords in several languages. We’ll decide whether to re-enter, but it will be a thoughtful approach,” said a spokesperson for Google. “Bad actors will find a way around anything.”
The American Society of Addiction Medicine and many others praised Google’s moves as a win for patients.
“We still have a long way to go to integrate addiction treatment into mainstream medical care so that doctors are the ones making treatment referrals,” said President Kelly Clark in a statement. “In the meantime, ASAM would be pleased to work with Google to help it identify high-quality treatment providers to advertise on its site.”
The rehab ad cutback, at least in the U.S., did not appear to hurt Google’s bottom line. Advertising revenue topped $95.37 billion in 2017, up from $79.38 billion in 2016 and $67.39 billion in 2015, according to documents filed with the Security and Exchange Commission by Google’s parent company, Alphabet.
But AdWords are only part of a larger problem, many say.
Hazelden Betty Ford, perhaps the oldest and best known addiction treatment provider in the nation, said competitors have bought various misspellings of its name so even errant traffic would be directed to their websites. Hazelden has devoted staff and built tools to regularly monitor misspellings — Hazelton, Hazelten and the like — to see where searches end up.
If would-be patients are redirected to a call center, or to another rehab center’s website, Hazelden Betty Ford makes direct contact and asks that the practice cease. Usually, the offenders express surprise and the behavior ceases, said Mark G. Mishek, president and CEO of Hazelden Betty Ford.
Mishek noted there are other ways to game.
Some centers know how to manipulate search results to make sure their properties land on top of each search. “I had one CEO brag to me, ‘Yeah, Mark, I have 104 websites. I have moms laying around in their pajamas writing articles for me, getting the right words in to get to the top of the heap on search,'” said Mishek. “It’s so crass. So manipulative.”
Typically, these websites purport to be informational, but are actually owned by companies trolling for insured addicts and steering people to their centers without disclosing who they are.
“If you have the biggest budget to spend on marketing, you can create a thousand websites,” said Williams of the nonprofit Facing Addiction. “That way it’s not government or nonprofit information people find when they search; it’s treatment center marketing disguised as factual information. They disguise who they really are.”
In the ideal world, Google would deploy some kind of punishment for this manipulation, Williams said.
Google officials said they are considering shutting down every ad search related to “addiction” and are trying to hammer down other abuses as well.
“We are always looking at ways to improve our enforcement and are working with industry experts to find a robust, long-term solution,” said a Google spokeswoman.
Beyond the tricks intended to lead addicts astray, addiction ads themselves — on a variety of media platforms — often are untrue.
Addiction-related ads on TV and the web are rife with men in crisp white lab coats with stethoscopes dangling from their necks, even from rehab centers that aren’t licensed to offer medical services.
Ad copy uses scientific language like “dual-diagnosis” and “evidence-based care,” defines addiction as a disease that alters brain structure and functioning, and describes the physical risks of withdrawal in sometimes-disturbing detail. They say that recovery requires “a supervised environment where people can receive medical care to ensure their safety,” giving the impression of medical competence even at centers run by contractors or entrepreneurs with little or no medical background.
“They promote that they have everything under the sun, but they can’t deliver,” Mishek said. “Some of the things we’re seeing really make me cringe.”
Personal testimonials — perhaps the oldest form of advertising and common in the world of rehab marketing — are among the most disturbing, Mishek said.
Hazelden Betty Ford uses testimonials, too, though Mishek said its ambassadors have years of sobriety before cameras are trained upon them. Other centers often require less.
“I’ve seen ads where the guy has been sober for maybe three months,” Mishek said. “That is really awful. That sets this man up for spectacular relapse.”
Florida has a dense concentration of rehab centers and related fraud, much like California, but legislators there have taken steps to regulate rehab advertising.
Last year, Florida adopted a law that prohibits rehab-related entities from engaging in deceptive marketing and provides criminal penalties for violations. The law also touches online ads specifically, making it a felony to write coding that surreptitiously directs the reader to another website.
Could similar laws be passed in California?
“It’s certainly something we can explore,” said Sen. Richard Roth, D-Riverside, after a Senate Health Committee hearing on how rehab regulation works in California. “The procurement of clients, or patients, was concerning to most of my colleagues on the dais.”
Sen. Pat Bates and Rep. Sharon Quirk-Silva and others have introduced bills aiming at cleaning up the industry. But some say new laws aren’t necessary to address deceptive advertising.
“There are plenty of laws on the books right now, and if you had a crusading Attorney General or District Attorney could use existing law to shut them down,” said Hazelden Betty Ford’s Mishek, who is also a lawyer. “If someone like a state Attorney General were to do it, you’d get reform.”
As Google leads are drying up, some treatment centers are turning to Facebook to recruit new clients, advertising executives say.
Facebook allows advertisers to target niche markets, filtering ads by age, income, location, gender and more.
“The real power is in tailored re-targeting,” the digital marketing firm Social Circle wrote in a Digital Journal post pitching its services. “Unlike Google AdWords, Facebook has the power to choose exactly who you’re targeting…. From there, you can re-target Facebook users based on if they’ve visited your website, watched one of your videos, interacted with your ad, or liked your page.
“Once someone is on the phone,” the post added, “they are already committed to a specific center.”
These advertisements can also be much cheaper than Google: A Facebook ad can cost 31 cents to 61 cents per click, according to fitsmallbusiness.com.
It’s life or death
Williams, whose work helped convince Google to ban rehab-related AdWords, praised Google’s move, but noted that it was incremental. Google, he suggested, needs to treat addiction like the potentially lethal disease it is.
The analogy he and others point to is depression.
When you use Google to search the phrase “I want to kill myself” you don’t get a long list of for-profit therapists eager for your business; you get the toll-free number for the National Suicide Prevention Lifeline bannered across your screen.
But if you type “I need addiction treatment” into the Google search bar, you’ll get a map with little red pins representing treatment centers. All of those centers paid to be there. Free information about addiction — from the government, nonprofits and medical experts — is buried.
“We need bold action. When people search ‘how to stop doing drugs’ or ‘how to find addiction treatment,’ Google could interrupt its traditional algorithms and return validated, evidence-based information, just like they do with suicide prevention,” Williams said.
“They have the power to do that. They would save lives overnight.”