Addressing Ethical Dilemmas

David Condos: Hi guys, welcome to another episode of Recovery Unscripted. I’m David Condos, and this podcast is powered by Foundations Recovery Network. On today’s show, I’m joined by Jay Crosson, CEO of Cumberland Heights recovery program near Nashville, Tennessee. He sat down with me at the Moments of Change conference in Florida to unpack the ethical dilemmas facing the treatment field and to share some self-assessment tools, practical tips and real world examples to help us find contrast between what’s legal and what’s ethical. He also explains how his own experience of seeking help for alcohol addiction at Cumberland Heights inspires him to fight to do what’s right for their patience and patience everywhere. Now, here’s Jay.

All right. I am here with Jay Crosson. Thank you for being with us today.

Jay: Thank you David, thanks for having me.

David: All right, first let’s have you tell us a little bit about your own personal history and what motivated you to serve in the world with addiction treatment.

Jay: My story starts really is a lot of stories do with my own personal recovery. When I was 21 years old, my family went to the family program at Cumberland Heights because I had another relative that was in treatment and due to that my parents got educated and said, “Okay, this is what’s going on with Jay”. As a requirement for me to go back to school they said, “You had to go to treatment.” I went when I was 21 and didn’t really want to go.

Had a lot of that denial like a lot of people have. Fast forward a little bit, life gets worst my addiction proceeds down that path and at age 26 I wanted to go back to treatment. I remember walking to my parents’ house and crying at 5:00 AM on a Sunday morning saying I need help. That was a big difference for me. I got sober at 26, I was working some jobs I had managed to get to with a Bachelor’s degree but was actually working, taking care of plants. You know the people come around the office buildings to water the plants.

David: Yes.

Jay: That’s what I was doing, one of my accounts was Cumberland Heights and I was like, “Okay, I’m sober but this isn’t really going anywhere.” I got a management degree, I need to go to work for some place that’s bigger than where I am. Cumberland had about a hundred employees about that time. I always ask if there was a job opening. Finally one came open, it was an assistant admissions person and I took a two dollar pay cut from watering plants to go to work and Cumberland Heights, nonprofits we don’t always pay the best money.

The good thing there was is that got my foot in the door and I’m slowly rose to the rank at Cumberland Heights. Then about 2007, I went back and got my MBA at Belmont University in preparation because the CFO was leaving and ended up getting the CFO position and then became CEO about three years later. I tell people I was pretty grandiose, a patient, but I was never so grandiose at someday I thought that I would be the CEO of Cumberland Heights the place that I was going to. Really, it’s amazing what recovery can bring if you just keep doing the next right thing and have faith that good things happen.

David: Just to go back to your story real quick. It’s interesting that you say that you, you’re the one who made the decision of the realization that I can’t go on like this and you came to your family. Could you tell us a little bit more about what went into that or how you think that helps you?

Jay: Well, what went into that was I gotten far from that graduated. I figured out how to manage my disease to graduate from college. I’ve done that I’ve got a good job, I thought I was making great pay – 20,000 a year as a warehouse manager. I was partying all the time. Anyway, I got fired from that job. They thought I’d been drinking on the job but the reality was I a drink so much at night that it was just coming out of my pores during the day time, so I smell like alcohol.

I remember one of the people that I partied with would say, “Why are you getting drunk? It’s Tuesday.” And I said, “I’m an alcoholic, I’m supposed to get drunk every day.” I have accepted that but not had not gotten really ready for recovery. It just got worse and I got to the point where it’s like, I can’t go on living like this anymore. Getting drunk three times a day, passing out, come into that sort of deal. I’m 26 and I’m starting my day by basically throwing up in the toilet.

David: Wow.

Jay: It got bad. It’s weird I was watching one of those episodes at two o’clock in the morning back when they used to have this is your brain, this is your brain on drugs with the scrambled eggs or whatever. It was like, “Oh, that’s what I need to do. I need to go back to Cumberland Heights.” That’s what I did on June 27, 1989, I went back to Cumberland Heights. The difference was my attitude a little bit. I wish that’s the one thing I wish I could convey to every patient, is just that these people really do care about you and are not just making this stuff up because we get better after a week or two. We think I got this.

I don’t really need to change my friends, my playgrounds and playmates. I don’t need to go to 90 meetings at night. I’ll just go to a week or something. We come up with our own plan for recovery and then we fall short. I just wish I could convey that to everybody not to waste that time like I did. It all takes what it takes and it took that to get me willing to do whatever was suggested for me. Then once I did that, I got what I needed every time I went to a meeting, I got something that would help me somewhere else in a crisis in my life that I could draw upon and just kept doing the next right thing.

David: In addition to your work with Cumberland Heights you’re also the Chair and the Ethics Chair for NAATP, which is the National Association of Addiction Treatment Providers. Could you tell us a little bit about that mission of that organization?

Jay: That organization is really the treatment industry’s trade association. They do lobbying, they’ve been involved in legislation, public policy advocacy, there’s membership groups, like a membership form. They also do one conference every year which is really for leaders in the treatment industry. Several years ago, members of this organization are concerned about this industry and the ethics in where we’re going to put out a value statement, they put out an ethics code, a little bit after that time, they required people that joined in NAATP to agree to the ethics code, but the industry kept getting worse.

There’s a lot of good people, there’s a lot of good treatment but there’s some bad players out there. Trying to set a standard of what ethics should look like and that continues today there’s some new initiatives with that that we’re working on.

David: Does the NAATP today offer guidelines or what do they say that specifically in regards to these ethical dilemmas.

Jay: There are five sections of the code of ethics, a lot about what we do is try to address the business side, like deceptive marketing on business practices that sort of thing, where we’re headed which is exciting there’s a new initiative of what can we do to make this industry better. We’re working on a new guide book that can be used for anybody is that or to help set your own standards for your treatment facility if you want to become a new member.

David: I also read in your bio that you’re doing some work with the state legislature there in Tennessee to get certain unethical practices band. Could you tell us a little bit about that?

Jay: That’s just starting, it’s more of a hope than a dream than an actual reality. Florida had horrific problems but out of that came the house bill and they’ve got some really good ethical legislation and probably some of the strongest in the nation. Tennessee’s not ready for that whole package because they don’t even know that much about it but one thing that’s scary is as long as conference call not too long ago and said some of these people are leaving Florida, they’re going to Georgia, they’re going to Asheville, they’re going to Nashville, that’s my backyard.

Who can’t be against patient brokering? I don’t care if you’re Republican or Democrat. On its surface, it is just appalling. Just start somewhere simple like that and then start there were in this process for them to know about what was going on. Cumberland Heights has never had a lobbyist or anything like that, so this is a new area for me of how do you get legislation passed. We’re working on that, we’ll see how far it can get this year.

David: Sounds like a tough fight but a good and important one.

Jay: Yeah, it would be.

David: In addition to all the work you do with NAATP and these other coalitions and initiatives is furthering ethics, you also did things like giving a presentation here at the conference about — that some kind of trying to help training and teaching people about ethics. Before we get into some specifics on the presentation, I guess what motivated you to become so interested in furthering this cause in teaching ethics in particular.

Jay: I go back to the analogy of — I’ve got a six-year-old girl and God forbid she get some life-threatening disease, addiction is a life-threatening disease, let’s just call it leukemia. If what I did was get on the internet and search Google and look for leukemia providers, and then pick a provider and then I find out that that person sent me to the leukemia provider, because they paid $200,000 a minute for my phone call, I would be amazed and that person would be in jail. That’s happening in the addiction treatment space today.

Part of that is we’re not as regulated as other industries, and part of that is, some bad practices have started up and so to be on the side of people that are doing the right thing, calling out what the wrong thing is, that’s just something that I want to be a part of. Always willing to do that when I can.

David: Nice. Getting into your presentation a bit more. I know, you mentioned some of the regulatory bodies and laws and accreditation associations that can govern some of this stuff, but a lot of it comes down to self-assessment. Could you say why is self-assessment such a vital part of this equation? What are some methods self-assessment that you’d recommend?

Jay: The American College of Healthcare Executives have self-assessment tool that you can use to look at. Some of it just comes down to common sense, do unto others as you’d have done unto you. If you ask some of those questions and you get butterflies in your stomach or you start to worry then that might be a sign that you need to talk to someone else about it, and I think that’s always good. Ethics can fall into the gray areas, sometimes, but people really need to check themselves and what are their motives and is it in the best interest of the patient or the best interests of the facility that I represent or me personally.

I think the pendulum is really swinging. We’ve gone from the wild wild west to Google restricting certain ad words to Boston Globe article where they question people giving away pins and squeezy balls at conferences. Well, I don’t think that’s where the problem lies, but the fact that that’s even part of the conversation shows you that the pendulum is swinging away from, patient brokering, which everybody can agree is horrendous and should be illegal in every state, to nuances.

Is it okay to pay for somebody’s playing ticket to come down? Or can I pay for the halfway house where so many guys in the organizations are going to have to ask themselves these questions? I think there will be organizations like NAATP and others that will say, we believe XYZ. Then people will have to measure themselves up against that. They may say, “I disagree with that.” In ethics, there can be some disagreement, and there’ll be others that will say, “No, we need to stop this practice because I may have been doing it for the right reason, but if it’s perceived as this way, I don’t want to have any part of it.”

David: Another big distinction that you guys discussed in the presentation is how ethics are different from laws and how they there can be some overlap where things are ethical, but not legal or illegal but not ethical, briefly, how do you help people understand the contrast and the overlap of things that are technically legal, but not ethical, things like that?

Jay: Stark Laws are also good examples. They only apply to federal health programs like Medicare and Medicaid, and if they’re illegal to do in those programs, I guarantee you that there are unethical to do in private insurance or private pay. There was a reason why that was put into place.

David: Just for anyone who doesn’t know what those are all about?

Jay: It’s really written for physicians for self-referral or referral to an agency that they have an ownership interest in. If you think of an orthopedist who there might need to be PT afterwards, well, if that orthopedist refers everybody to the PT that he owns, and he doesn’t disclose, that he owns that, there’s some laws around that because whenever money gets involved, there’s a chance that the patient’s interest won’t come first.

David: There’s conflict of interest.

Jay: Conflict of interest and so those were very specific, with regards to the Fed money. As a result of, there were some unethical behaviors is going on and so to stop the unethical behaviors they file it in the law and said, “Okay, this is illegal.” What I tried to do was to give people some tools and some ideas of how to assess themselves, how to ask questions. The therapist don’t ask, “What do you charge? Or do you have your own lab? Or do you own an interest in the lab company? What’s the frequency of your bill?” They don’t think even to ask those questions, so we had to start doing that as an organization. I’m encouraging other people to do that.

David: Yes. There was something else interesting that I heard you and Rob saying in your presentation, is that when you’re looking at laws and ethics, the difference, like laws weren’t here forever. They came about because people recognized an ethical problem and they said, “Okay, can we all agree that this is how it should be.”
Jay: They can change over time because at one time we had prohibition. You couldn’t drink alcohol at all in this country because that’s where the country was at that time. Everybody kept drinking, we had the speakeasies and all that. The demon was alcohol. If we get rid of alcohol that’ll fix all the problems and so they made it illegal. Guess what, people find a way to drink the alcohol anyway and it didn’t cure the addiction.

David: It seems like a big part of this whole thing that’s going on, like you’re talking about, like the wild west and that the pendulum swinging, I feel like families would be starting to lose trust justifiably in the industry as a whole. They’re like, “Well, okay, if you guys can’t get it together, then why should we send our loved one to you.?”

Jay: There are national media stories writing about the horrible things and we’re all going to get painted by that brush, the good guys the bad guys. We owe it to each other to point out people that are doing good work, ethics is not just unethical behavior, it is also doing the right thing but to point those people out and shine those stories. There’s a lot of people doing good treatment, doing good work, that work hard, probably don’t get paid enough and are transforming lives and miracles are happening every day, and so we need to support those people and point that out too because there is a trust there.

When the family has trusted us, and we’ve done good care if we make a recommendation, they’re trusting that we know what we’re doing in that level too. I asked people to think that through. It’s not just because you met them, and they seem nice, and we went out to dinner at moments have changed, that’s not good enough, that’s a good place to start. Go visit their facility, see what it looks like, find out, ask questions.

David: Yes, and have a real relationship.

Jay: A real relationship, and we owe that to our patients.

David: For anyone who’s listening and really honestly wants to strengthen their ethical leadership skills, better handle these ethical dilemmas that come up, what are some practical habits, things that you’d recommend for them?

Jay: First, go to natp.org and look at the code of ethics, read that, see if you agree with that. As your trade association, I would ask your organization to join that if you can abide by those codes. I think there’s a lot of benefits to that, almost every conference now has ethics trainings, it’s a hot-button issue, and a lot of the conferences I’ve seen even admissions and marketing meetings where they’re doing roundtables, and they’re discussing and then Rob really stressed this, the dialogue, where people can say, “Hey, do you think this is unethical?”

Because it might be the “gray area” like well, these people do it, and these people do it, and these people do it, so maybe it’s not so bad to start having those discussions. I think out of that people will become more educated, I think we all know innately a little bit the difference between right and wrong and what feels good. If you have to do a lot of justifying about it, then that’s a hint that maybe that that’s not a good idea. What I’d like to tell people is if this was on the front page of your local newspaper, would you be okay? If it doesn’t meet that test, then that’s a pretty good shot that is not an ethical behavior.

David: Yes. Just going to wrap up with this last question. You’ve given a lot of yourself, your time and your effort to this world over the past couple decades, right? Could we wrap up by having you just say a little bit about why improving the ethics of this field, and then ultimately helping more people find recovery is so important to you?

Jay: Well, unfortunately, the end is not in sight for addiction. There’s still a lot of people out there that need help, our industry needs to clean up. I do believe that treatment works, I know that treatment works, it worked for me, I know that 12 step recovery works. We need to be there for the next people of the next generation that’s going to come and the current generation.

People are dying, and if they don’t trust us then they’re going to go somewhere else. Even with all of our problems, I still think this is the best answer for most people and so until they invent that magic pill that everybody wants to find the easier softer way. I think this is the right solution but we’re going to lose the trust of the community and the families if we don’t clean up the industry. That’s why I’m so passionate about it, but I also am passionate about that good treatment works. We need to get that message out. I know a lot of people are working on outcomes, we need to show people that treatment works.

David: Yes. All right, well, thank you for your time Jay.

Jay: All right, thank you.

David: Thanks to Jay for joining us. Now I’ll close the show by featuring another story from the Heroes in Recovery community as part of our hero of the week series. Today’s story comes from Reid B. who shared it on heroesinrecovery.com, a grass roots movement, where over 1500 people have contributed their stories.
At the age of 13, Reid began experimenting with prescription drugs and over the next decade he graduated to combing alcohol with pills and heroin, after a day of partying left him passed out a friend called Reid’s dad who helped get him into treatment.

There, Reid knew what happened with the rest of his life was up to him and he needed to allow treatment to teach him what to do to stay sober. What he learnt was that he needed to go through the whole process and see it as a new life style instead of looking for quick fixes. As Reid says in his story, “I learned that I have to actually make the same decision every single day, sometimes multiple times a day, sometimes dozens of times a day, from then on for a long time”.

Since then Reid has earned a master’s in applied psychology and now just like Jay, he has gone back to work with patients at the same treatment program where he started his own recovery. Thank you for sharing that Reid and for helping to break the stigma around addiction. If you’d like to see to Reid’s full story or share your own visit heroesinrecovery.com.

This has been the Recovery Unscripted podcast. Today we have heard from Jay Crosson of Cumberland Heights. For more about their work visit cumberlandheights.org. Thank you for listening. Please take a few seconds to leave us a rating on your podcast app and subscribe, so you won’t miss any of our new episodes. See you next time.