Rehab: An American Scandal
By Shoshana Walter
Simon & Schuster 2025
In conversation with Matt Drange
Rockridge Library
Oakland
Oct. 15, 2025
“Profit and punishment have ruled our treatment system, but it is these same concepts that seem to rule the United States.
"It is an addiction, since the founding of this country, that we just can’t seem to quit.”
So ends investigative reporter Shoshana Walter’s compelling and painful new book, Rehab: An American Scandal, an exposé of this ouroboros of a treatment system we’ve forced millions to be devoured by. Following the stories of four real individuals for years—a young white southern man, a teenage single mother in Philadelphia, an alcohol-troubled and money-hungry but well-meaning doctor in the Midwest, and a justice-and-revenge-driven grieving (grand)mother in Southern California—the book paints a vivid portrait of the infinite shortcomings plaguing addicts, their families, and their caretakers alike.
Odds are you’ve at least a passing familiarity with our nation’s school-to-prison pipeline, the prison industrial complex, and the legalized slavery built into this system and our very foundation. You almost certainly are aware of the devastation the opioid epidemic has wrought across large swathes of the country, for which Purdue Pharma was largely responsible and hardly held accountable. You may, however, be unaware of the monstrous, and dare I say nearly as terrifying, Rehab Industrial Complex that slowly, and then with increasing rapidity, sprouted up like oh so many spores, infiltrating sleepy towns and unsuspecting citizens’ lives in wake of this little blue pill.
Gaping holes in regulation and a quickly growing need for treatment, coupled with an endless and fruitless war on drugs criminalizing millions for petty and personal charges, have led to our current predicament. In a capitalist country with lenient, fuzzy laws, a dearth of proper treatment and services, and a growing client base of users in need, of course private, for-profit options have risen to fill this need. Little oversight is in place, in part due to sheer volume—California boasts nearly 2,000 licensed centers and just 16 inspectors to regulate them, all based in the capital of Sacramento way up at the north end of the state, to handle the biweekly deaths occurring at these facilities.
These startling stats are just the tip of the pipe, as it were. Each layer Walter peels away reveals a darker interior. When Synanon’s founder—a for-profit forced labor center masquerading as a treatment facility and offered as an alternative to prison sentences—gets mired in too much legal trouble, relapses, and dies, the organization simply pivots. The model’s “cruelty was offset by the enthusiasm of Synanon’s participants and the novelty of freedom the program promised: unleashed anger and raw emotion….The diehards believed in Synanon’s methods, which some likened to brainwashing. ‘Yeah, we brainwash ‘em’, an early Synanon member would later say, ‘because they brain is dirty.’”
After the organization is renamed Cenikor, Rehab’s Chris, the young Southern man, was sent there for several years, enduring unimaginably long hours, hard labor, and, of course, no pay. In places of wages — he frequently worked up to 80 hours per week — he was owed three packs of cigarettes, which were then often withheld too. Cenikor’s workers—I mean patients—were routinely treated as disposable, placed in the highest risk positions with little to no consideration for their humanity. They were “…often given the toughest jobs— the ones employers had a hard time filling. Chris had heard the bosses order up more workers, like they were hamburgers. ‘Give me five more Cenikors.’ Or, they wouldn’t use his name, instead calling to him, ‘Hey, Cenikor.’”
Walter highlights the deeply steeped and forever on display racism entrenched in our country’s addictions and treatment, or lack there of, of the disease. White users are labeled vulnerable and in need of care, while black and brown folks are considered expendable, inhuman, criminal, and unworthy of consideration or saving.
Wendy “Brockabitch” McEntryre, the SoCal grandmother and crusader for those lost to the rehab industrial complex and its most nefarious players, another subject of the book, helped to provide some slightly comedic levity. Her tastes and tactics may be questionable — “vodka, ice, and Fruity Pebbles-flavored creamer” being a drink of choice and sustained, personalized harassment a primary tactic in her do-gooding mission—but she is clearly a force to be reckoned with and a light for the loved ones of those lost to the epidemic.
As mentioned, the deeper into the history and story you read, the darker the connections and choices made by the industry are. Working the bone and brain-grinding jobs demanded by facilities like Cenikor, the “dull repetitive motion and the long hours meant some workers routinely used meth to stay awake and opioids to relieve the pain. ‘A vast majority of Americans that work over a certain number of hours a week are medicated or on some sort of substance,’ said Cody Collins, the vocational manager. ‘That’s just the cold hard truth.” Fraudulent charges from rehab centers total in the millions per month for some, with urine testing alone so profitable “it had become known as ‘liquid gold’.”
In an effort to maintain their monopoly on the market, Indivior, the company manufacturing Suboxone, pivoted to a sublingual film as their orphan status expired and generics in tablet form prepared to hit the market and threaten their profits while running a campaign to discredit the efficacy and highlight the dangers of the tablet formulation. They also hired away the sales staff from Purdue, the exact people who helped create the opioid epidemic, to now woo doctors on Indivior’s miracle cure to the addictions they sold for Purdue. Indivior then went on to create a Suboxone injectable, and, naturally, to also purchase the company producing Narcan, a naloxone-based nasal spray that reverses the effects of opioids, saving thousands, perhaps tens of thousands, from overdose.
2025 saw “a nearly 24% drop in overdose deaths….the first year since 2021 that… estimated overdose deaths fell below 100,000,” inviting hope. It remains unclear exactly how much each factor may be contributing, but we are reminded of an additional, far darker cause as well: “…many users have already died. When epidemics or pandemics such as COVID-19 hit, it is the most marginalized who reap the worst consequences. ‘And a lot of vulnerable people who are buying fentanyl are already dead.”
Audience questions at the Rockridge talk focused on where to head next: harm reduction, local resources (with a special shout out to programs at Highland), and more space to talk about addiction without stigma. Community connection and access to care are paramount. It has been proven time and again that negative consequences are far less motivating than positive reinforcement, and that when provided with alternatives, people nearly always make healthier choices for themselves. They simply need the support and resources to do so.
