American Rehab Chapter 7: The Work Cure - Reveal

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Al Letson: Code Switch tackles race and identity frankly and without fear. It's a podcast from NPR that makes all of us part of the conversation because we're all a part of the story. Find Code Switch wherever you get your podcasts. Laura Stareches...: Hey, this is reporter Laura Starecheski. Reveal provides independent journalism. We're a nonprofit newsroom supported by listeners like you. Become a member, and we'll send you a Reveal face mask with the word Facts embroidered on it as a special thank you gift. Al Letson: From the Center for Investigative Reporting and PRX, this is Reveal. I'm Al Letson, and this is American Rehab, Chapter Seven, the Work Cure. We left off last time with reporters Shoshana Walter and Laura Starecheski getting messages from people inside the Cenikor program. Shoshana Walter: People who are exhausted from the work Cenikor required of them, people who are scared, people who had fled, and we needed to find out what is happening to these people inside Cenikor. Al Letson: To find out, she'll spend more than a year talking to hundreds of Cenikor participants. Shoshana Walter: But, we're going to start with just one story, of one person who needed help with his addiction. On a cold, windy, winter day in December 2018, Laura and I drove from Baton Rouge to a rural parish where most of the GPS map is green covered with huge swaths of pine forest. Laura Stareches...: So, he works here or he's studying here? Shoshana Walter: He's studying here. He's studying welding. Laura Stareches...: Okay. Shoshana Walter: We pull into the parking lot at Central Louisiana Technical Community College. We're here to meet a source for the first time. Let me call him. Hey, Chris, it's Shoshana. Chris Koon: Hey. Shoshana Walter: Hey. We just got here. We pulled into the parking lot, and we're- Chris Koon walks towards us wearing a big sweatshirt and heavy work pants. He's coming from welding class, so he's sweating even though it's cold out, and he looks a bit self conscious, kind of hunched over like he's trying to take up less space than he actually does. Chris? Chris Koon: Yeah. Shoshana Walter: Hi. [inaudible] Shoshana. Chris Koon: How you doing? Shoshana Walter: Good. How are you? Chris Koon: Nice to finally meet you. Shoshana Walter: I know. Nice to meet you. This is Laura, and- Chris Koon: Trying to think. We could probably sit here or sit in your car if you all are cold. Laura Stareches...: How much time do you have? You're right in the middle of classes, right? Chris Koon: Mm-hmm (affirmative). I got til- Shoshana Walter: Chris crams himself into the back seat of our little rental car. He takes a swig of his diet Dr. Pepper and then stashes the bottle into the seat back pocket. He tells us opioids are a huge problem in this parish. Chris Koon: Meth and heroin, those are the two biggest things from what I seen. I think I did meth the first time when I was like 15, because that shit used to be everywhere around here, and then it went away, and now it's back. Shoshana Walter: Chris also discovered opioids when he was 15. Broke his ankle after crashing a three-wheeler. He started taking one prescribed pain pill, then two, and he noticed that it not only got rid of his throbbing ankle pain, it gave him this light, bright feeling. Chris Koon: You start to feel warm, like somebody put an electric blanket around you. You feel that, and you just feel euphoria, but it's a different euphoria. It's like nothing else matters. Shoshana Walter: Chris kept chasing that feeling as years passed. He also started working. He stocked shelves at a convenience store. He was a roustabout on an offshore oil rig. Eventually, Chris transitioned to heroin. On his pizza delivery job, he'd run into the bathroom at Circle K to shoot up, then get back into the car high. It wasn't long before Chris lost that job. Chris wanted to make bigger plans, but something always seemed to go wrong. He finished EMT school, but didn't take the test. His best friend died. He almost got married, then he found out his fiance had cheated on him. Then, when he was 23, Chris overdosed. A friend revived him, but Chris knew he'd been close to stopping breathing all together. Chris Koon: That was kind of eye opening. That, and one time I was at my granny's house, and I saw this paperwork out one day. She was looking into buying me a funeral plot, like a plot of land by my grandpa. Yeah. That's a eye opener, too, whenever you see that your people are buying you a fucking cemetery plot. I'm like I'm 23 years old, and they're planning on burying me. Huh. Shoshana Walter: Chris's family sent him to rehab once. He was there about a month. After he got out, he lasted one day before he relapsed. Eventually, Chris got arrested with meth. He'd been arrested before, but now he was facing his first felony conviction. For two months, Chris sat in jail waiting for movement on his case. The Grant Parish Detention Center looks like a big warehouse with a tall razor wire fence around it. Inside, men shared bunk beds in a room with a few televisions and a remote control held together with scotch tape. Chris spent his days reading, watching music videos, and trying to ignore the constant stream of Jerry Springer and Maury Povich. One day, a guard told Chris a lawyer was there to see him, a defense attorney his dad had hired. Chris shuffled into this orange plastic jail sandals and followed the guard to a kiosk. The attorney told Chris he had an idea. Chris Koon: He said, "I can get you out. You're going to a rehab." And, he said, "It's a place called Cenikor, and it's 18 to 24 months." I was like, "Yeah? That sounds horrible." He was like, "Well, you can sit here if you want to. You can stay sitting here." Shoshana Walter: Chris was facing up to five years in prison, but if he completed the Cenikor program, there was the chance the prosecutor would reduce his charges or drop them altogether. Plus, to Chris, any rehab had to be better than being locked up, so Chris chose Cenikor, and his judge signed the order sending him there. As soon as Chris made the decision to go, the clock started ticking. Chris Koon: I didn't even have time to take a shower, because the judge said I had to be at Cenikor by, I think, six hours, or something like that. I had six hours to get there, and if I wasn't checked in, they were going to revoke my bond and I'd have a warrant. Shoshana Walter: His granny picked him up from the jail. On the drive to Cenikor, Chris sat looking out the window with his mind going in circles. Chris Koon: Really, all I kept thinking was two years. Like, I'm going to be here for two years. I wonder what it's going to be like. Am I going to be able to see my familY? Are the people going to be cool? Are they going to be assholes? How long is this going to be? I know it's going to be two years, but mentally, how long? Two years can go by like that, or it could take a lifetime. It took a lifetime. Shoshana Walter: Around noon, they pulled off the highway in Baton Rouge and stopped outside a red brick building. The sun beat down on Chris's back as he hoisted his suitcase out of the car. Chris Koon: As soon as I walked in, there was some people there just yelling at each other, telling people to go sit in time out, and I was like what is this? Shoshana Walter: If Chris couldn't make it at Cenikor, he would face up to five years in prison. The first step was to get through 30 days of orientation. Chris Koon: I'll never forget it. I came in, and it was just this classroom, and there was, it was like 30 of us. You come in, they tell you to sit down, and then they start handing out the Cenikor handbook that's like this thick. They just go over it page by page every day until you can just damn near recite everything. Shoes tied, belt on, shirt tucked in. Your shoes all had to be at the foot of your bed going around it, work boots to flippity flops. Shoshana Walter: There was an instruction on how to behave for every moment of the day, which Chris could adapt to. Cenikor was grimy. He got used to that. Chris Koon: We're living in a run down, renovated fucking psych ward with mold everywhere. Shoshana Walter: He got used to the mice making nests in his sock drawer and the bigger rodents that scurried inside the ceilings and got into the food. Chris Koon: Rats. Dude. Shoshana Walter: The rules and the punishments, that was another thing. One wrong step would send Chris into a whole Labyrinth of protocols. Many of them came straight from Synanon, the cult-like rehab that spawned Cenikor in the 1960s. Like a pull up, it's a correction. Cenikor's founder, Luke Austin, called it a verbal chastisement that could be given out by any member of Cenikor. Chris Koon: Since I was younger, all I ever thought was if you mess up, you man up and you take your lick. You don't tell on nobody else. Shoshana Walter: Any time he saw someone messing up, the rules said Chris had to correct them, and then report that person to a staff member. Chris Koon: The first time I did it, I felt like a piece of shit. Shoshana Walter: Chris gave out his first pull up when he reported to staff that a guy washing dishes in the kitchen had threatened him. He didn't realize that the threat meant the guy had broken one of the original cardinal rules at Cenikor. No acts or threats of physical violence. Chris Koon: This dude was trying to avoid a 10-year prison sentence, so I told on this guy for a big deal. He could have gotten kicked out my first time. That put a bad taste in my mouth. This dude came up to me afterwards, and he was like, "If I think I'm going to get kicked out," he said, "you better sleep with one eye open, because I ain't going back to prison." I was like oh, shit. I was like here I go. It just starts putting off all these different scenarios in your head, like I get this person kicked out, all their friends are going to be pissed at me, and what if I get kicked out and then get sent to the same prison as him? Shoshana Walter: The guy didn't get kicked out, but Chris had to keep giving pull ups. He says Cenikor required people to give out 10 every week. Chris says he followed the rules as best he could. He wanted to believe that Cenikor could help him, so he went with the program. Chris Koon: I actually taught orientation for about three months. I did all the little Cenikor games. Shoshana Walter: The punishments were supposed to give you insight, transform you, but they didn't feel transformative to Chris. Chris Koon: They do what's called a hot seat if you really mess up, like if you relapse. They make you sit in this chair, an office chair, so you can spin around, and then they get 15 chairs and put them around you in a circle. Shoshana Walter: The hot seat is a kind of mutated version of the Synanon game. The person in the hot seat can't speak, and the people in the circle can say anything they want. Chris Koon: You'll hear people getting told the worst shit about themselves. You're a stupid, you're a fucking whore, and you're nothing but a junkie. Supposed to be therapeutic in some way, because they say that you can't see your own flaws, but other people can. Shoshana Walter: Many of the people I talked to who went through Cenikor's program talked about the humiliation they felt when subjected to these punishments. People like Paul [Porsche]. He spent almost a decade in and out of Cenikor, both as a participant and a staff member. Paul Porsche: And, they have a tool that's called the Verbal Chair, and it's essentially a time out tool used for adults, and you have to go sit in time out, right? Shoshana Walter: [Kristen Carrol] has been to three Cenikor locations, Houston, Forth Worth, and Baton Rouge. She remembered getting in trouble after she came into Cenikor off the streets court ordered. She didn't have a bra, and some guy reported her. Kristen Carrol: He's like sit in the Verbal, and I sit down. They're allowed to get in your face and scream at you, in your face and scream at you, and they're like, "Who do you think you are coming here and trying to tempt us?" In my face, guys yelling at me like this, and I'm like so... my face is so red, I'm on the verge of tears, and it goes on for like 15 minutes. Then, they're like, "Okay, go back to what you were doing," just like it was nothing. Chris Koon: They are trying to brainwash you. You're not an individual. You're just part of Cenikor. Shoshana Walter: The whole culture of Cenikor, all these rules and punishments designed to break people down, it's all part of the treatment. Chris Koon: The other big part, work. They had a guy who was doing electrical work, doing electrician's job. This guy was not an electrician by any means. Jason May: I broke my foot at work in Cenikor. Scaffold fell on my foot. Chris Koon: There was a bunch of people ended up hurting their backs, hurting their legs, slipping in holes. They'd go to the hospital and they'd go back to work most of the time. Al Letson: That's ahead after the break. Hey, hey, hey, Al here, and a quick heads up that we'll be dropping an extra episode of the podcast this week. We'll be releasing Chapter Six of American Rehab on Wednesday. Be sure to check your podcast feed. And, now, back to the show. From the Center for Investigative Reporting and PRX, this is Reveal. I'm Al Letson. We're back with American Rehab, picking up Chris Koon's story of going through the Cenikor program in Baton Rouge, Louisiana. Chris made it through orientation, but now it was time for the rest of his treatment to begin. Here's Reveal's Shoshana Walter. Shoshana Walter: Once Chris learned all the rules and tools, Cenikor started him with what the program calls Work Therapy. Chris Koon: One day, you might go to work at a restaurant. The next day, you might go work at a place that bags up mulch, where you're throwing 50 pound bags of mulch for 12 hours. That was usually a punishment job. If you got in trouble, that's where they sent you. I did scaffold building, painting, insulation, and power washing and sandblasting. Shoshana Walter: Chris worked on the catering staff at an event with a guest list including the governor of Louisiana. He had to clean up all the trash, food, and spilled drinks in the stands after LSU football games. He says he climbed high in the air to pressure wash pigeon poop off of grain silos that towered over the Mississippi River, slipping and sliding around with no respirator. Chris Koon: I think the worst job I ever had there was rod busting. I'd never heard of it, and what rod busting is, is you take the rebar and you got to make cages out of it, so when they pour the concrete, it supports it. That is some back breaking ass labor. Shoshana Walter: Chris had worked tough jobs before, like on that offshore oil rig, but he wasn't used to the conditions on the Cenikor job sites. Chris Koon: They send you to work with donated bread and ham. Most of the time, whatever your lunch is, the bread will be moldy. The ham, I didn't touch the ham. I'd eat a bag of chips if it wasn't opened and they give you one bottle of water for a 12 hour shift. You kidding me? Twelve hour shift in 99, 105 degree heat? Shoshana Walter: Chris told his family what was going on. He'd sneak a phone call here and there to Granny, and he saw his parents a few times at visitation. They'd listen, then tell Chris it was better than jail. Once the staff at Cenikor realized Chris had offshore experience, he spent most of his time working in the petrol chemical plants near the Mississippi River. Cenikor also sent people to work for companies you know, national and global corporations, Exxon, Shell, Walmart. Shell told us they didn't find any evidence that Cenikor participants worked there, and Exxon denied our findings, but we confirmed that subcontractors for the companies did use Cenikor workers. Walmart told us that they expected their subcontractor to follow the law. Chris says a lot of these jobs were dangerous. Chris Koon: There was a bunch of people ended up hurting their backs, hurting their legs, slipping in holes. You're always bending down lifting heavy shit up. Shoshana Walter: What happened in those situations when people were hurt like that? Chris Koon: They'd go to the hospital, and they'd go back to work most of the time. Shoshana Walter: In the '90s, one man died on the job after falling off scaffolding. Afterwards, OSHA fined Rhodes Office Products, the company where he was working, $2,250. They also recommended that Cenikor better train and prepare residents for safety hazards on the job. Here's just a sample of the injuries that have happened at other job sites since then. Jason May is from New Orleans. He was court ordered to the Baton Rouge facility about a decade ago, and he happened to love the program. Jason May: I broke my foot at work in Cenikor. Scaffold fell on my foot, broke my foot. I had a clean break is what they call it. Shoshana Walter: [Alistair] Williams fell off scaffolding at a chemical plant six years ago. Alistair Willia...: I fell, and my knee was literally shattered. Shoshana Walter: Paul Porsche told me what happened to a guy named Nicholas Culpepper. Paul Porsche: They had a guy who was doing electrical work, doing a electrician's job. This guy was not an electrician by any means, okay? Shoshana Walter: Nicholas was up on a 10 foot ladder when he touched a live wire. Paul Porsche: It threw him off the ladder and broke his back. Shoshana Walter: Cenikor participants have been seriously injured more than two dozen times in the past 10 years according to Worker's Compensation and safety records. At least one other person broke their back. Chris Koon managed to work for a few months, but eventually he got hurt, too. We asked Cenikor about Chris's injury, but they refused to talk about it. Other participants remember Chris getting hurt, though. He says it happened at that local Cajun seasoning factory in Baton Rouge, Louisiana Fish Fry. They wouldn't comment, either. It was the middle of the night. Chris and some other workers were trying to build a support for a crane that could hoist up heavy sacks of spices. A metal beam dangled from a forklift, and Chris scrambled underneath to hold it in place. Chris Koon: I really don't know how much it weighed, three to six hundred pound piece of metal. It was probably like 20 feet long. Shoshana Walter: Chris says the guy at the other end let go without any warning, and the beam fell down onto Chris's shoulder. Chris Koon: I felt something pop. I heard it pop, and then pain, just throbbing, holy shit, my arm's about to fall off pain. Shoshana Walter: Chris says he cussed a lot and sad down on the floor. Eventually, he got to see a doctor, who told him he needed an MRI, but then Chris says Cenikor's vocational services manager, the person who sends people to work and makes the work contracts with outside companies, he intervened. Chris Koon: I told him, I'm like, "Man, I kind of feel like a fly that got its wing pulled of." I was like, "I don't think I could go to work right now." And, his response was that if I'm not helping them, then they can't help me, and if I'm not making money, then I'm not helping them. He told me that if I need a MRI, then I could go back to where I came from. He's like, "I'm sure they can get you an MRI in jail." Shoshana Walter: Chris skipped the MRI. He still hasn't had one. We asked Cenikor about this, too, but they wouldn't answer our questions. To this date, Chris says his shoulder still hurts, and he doesn't have full range of motion. Chris Koon: Going up, that's not too bad, but like reaching across from me pushing something, yeah, that hurts. Shoshana Walter: Back at Cenikor, he rested for a few days, and then he went back to work. After months of working all these different, physically hard jobs, trying to follow all the rules and not get in trouble, giving out the requisite number of pull ups, not getting enough sleep or enough to eat, there was one more thing eating away at Chris. It was the things he would overhear at the job sites when he was working just as hard as anybody else. Chris Koon: They talk about you like you were just inventory, like you weren't even a person. I've heard bosses talking, being like, "Yeah, we need to order like five more Cenikor's for tomorrow," or come up to you and be like, "Hey, Cenikor, come here." I actually got in trouble because this dude kept saying, "Hey, Cenikor." I told him, I was like, "That is not my name." I was like, "My name's Chris." I was like, "You can call me man, guy, dude, hey. That works. Just don't call me Cenikor." Just to see that people just disregard you like that. Nobody should have to feel that. Shoshana Walter: For all this work, Chris wasn't getting paid anything. Cenikor kept all of his wages. Well, I guess technically I can't say he wasn't paid anything. Chris Koon: You're getting paid three packs of three dollar a pack cigarettes a week. Man, out here working 84 hours a week for nothing, for peanuts. Shoshana Walter: Chris spent about 18 months working for cigarettes as pay. That's the program policy. For all the hours he was working in the plants, subcontractors for giant oil and gas and chemical companies were paying money straight to Cenikor. Laura asked Chris about this. Laura Stareches...: Did you ever end up getting any of your wages? Chris Koon: Oh, no. You don't get that. I didn't even think that was ever a possibility. Laura Stareches...: I wonder how much money you made for them while you were there. Chris Koon: Oh, god. Thousands, tens of thousands. They make so much money, it is ridiculous. They're swimming in it, and they act like they're poor. I'd really like to see all them people exposed for all they do, even if it doesn't get shut down, even if it's just enough to make people pay attention to what they're doing and have them be a lot more accountable. They preach accountability all day, but if you ask them, "Where's my money going, where's this? I'm making 1,500 a week for y'all, and y'all can't change a fucking light bulb in my room, then where's the money going?" Al Letson: Cenikor says the money is going towards room and board and treatment. That's what Chris wanted. Treatment to help him overcome his addiction to heroin. He had already overdosed once and almost died. For him, the stakes were life or death. Shoshana Walter: Chris had struggled with drug use for almost a decade by the time he got to Cenikor. He did want to stop using. His first challenge was to stay away from all the drugs people had inside Cenikor. Chris Koon: I've seen people come in with Saran Wrap sandwich bags full of pills. I saw this dude pull a hunk of heroin about this big out of his sock. I've seen people come in with meth, heroin, suboxone. I've seen people brewing alcohol in their rooms in their ceilings. Shoshana Walter: We asked Chris if he ever saw any drugs out on job sites. Chris Koon: Oh, yes. Dear Lord, yes. Shoshana Walter: Sometimes, Cenikor hired out crews to clean up Louisiana State University's stadium after football games. Technically, no drinking is allowed, but Chris says he'd find bottles of alcohol in the stands. Chris Koon: A lot of times, I'd find pill bottles that people must have just dropped, and I'd throw them away. Shoshana Walter: The university didn't respond to our questions about this. Sometimes, Cenikor sent Chris to work in restaurants serving people food. Chris Koon: Every restaurant I've ever worked at, free world and Cenikor, people are doing drugs. Shoshana Walter: He spent most of his time working long days at the petrol chemical plants on the Mississippi River. He'd be outside climbing high in the air on scaffolding or bending rebar into cages. Chris Koon: In the plants, god, let's see. There's usually going to be meth and pain pills. You got to think, you're working in a place that, depending on your job, you're working your ass off for 12 hours a day out in the elements seven days a week. Some people can do that with just coffee. Some people can't. Shoshana Walter: Given that he was constantly surrounded by drugs on job sites and inside the Cenikor building, it's pretty amazing that Chris only relapsed a few times in the program. Each time, he got in trouble. The punishment for relapsing was usually losing a month of family visits and getting set backward a month in the program, meaning you'd have to stay and work an extra month. At these moments, when Chris needed support the most, there was only punishment, and the counseling his wages were supposed to pay for, it almost never happened. Chris Koon: Two months I was there, they didn't even have counselors. I think that was supposed to be like a little hush-hush deal. Shoshana Walter: Chris was supposed to do three group sessions a week, but he worked so much there was barely time. For a long stretch, he was working 84 hours a week. Laura Stareches...: Any one-on-one counseling session? Chris Koon: Once a month, maybe, but I went like eight months without doing a one-on-one. Just the counselor forgetting. I'm like, "Hey, I need to see you." It's like, "Sorry." Melanie Cefalu: They were not getting their groups. They were not getting their individuals, and basically, they were just working. Shoshana Walter: Melanie Cefalu was a counselor at Cenikor while Chris was there. Melanie Cefalu: With them having to work so many hours and then you're chasing them down at night and begging them to come to your office, and they're tired and they're hungry, and they're wanting a bath, it wasn't getting done. Shoshana Walter: Melanie was Chris's counselor, but she doesn't remember too much about him, probably because she barely got time with clients and because her case load could be as high as 50 people at a time. Melanie Cefalu: If I had to stay til 11 o'clock, I would stay and go get them. I'd even pull them out of the bed, and they would be sound asleep, and have a session with them. Basically, we were all doing it. Shoshana Walter: Cenikor told participants they would get one individual session a week. Sessions were supposed to be an hour long, but there were only a few counselors and about 150 beds at Cenikor, so the counselors had a system. Melanie learned it when she was hired. Melanie Cefalu: Basically, come back here, sign your treatment plan, how you doing, are you staying sober? Shoshana Walter: On paper, Melanie turned those quick check-ins into full sessions. Melanie Cefalu: What should have been an hour session turned into maybe a 10 or 15-minute session. Al Letson: Melanie Cefalu has since had her counseling certification suspended for having a relationship with a Cenikor client. Other counselors at Cenikor couldn't believe what passed for treatment. Tara Dixon: Nothing was really off the table. You could bring up things from their past, you could cuss at them. You could completely degrade their character. Al Letson: Actual counseling sessions, those were so hard to squeeze in that counselors decided to fight back. Tara Dixon: Some would have 60, 70 hours a week but also never have a break, a day off. That's what we were trying to prove, like look at the pattern. Al Letson: That's coming up on American Rehab from Reveal. From the Center for Investigative Reporting and PRX, this is Reveal. I'm Al Letson. While Cenikor participants were spending all their time working, counselors back at the Baton Rouge facility were trying to figure out to help them. Counseling intern Tara Dixon came in as a master's student expecting training. Instead, she learned a system from the other counselors. Grab the participants any time they're available, no matter how short, and mark it down at a full therapy session. Here's Reveal's Shoshana Walter. Shoshana Walter: Tara also learned a list of topics that were not to be discussed during counseling sessions. Participants were not allowed to talk to her about Cenikor's program or about the staff. They were not allowed to talk about the work, and if any other staff found out somebody had broken this rule- Tara Dixon: We got blasted, too. When it would come out, we got pulled into the office with the client and yelled at in front of the client, as in this shouldn't have happened. They knew, they knew that when they told me something that there was that chance. Shoshana Walter: The whole concept of confidentiality didn't seem to apply. Tara's clients learned to sensor themselves to avoid getting themselves or her in trouble. When participants were being punished, though, nothing was off the table. Tara Dixon: I believe it was like Sundays, they did family meeting, where everybody in the facility showed up, and they'd put someone in the hot seat, and then people could just go at them. Shoshana Walter: The hot seat is that punishment Chris described where one person sits in the middle of a circle and other participants surround them and yell. Tara Dixon: Nothing was really off the table. You could bring up things from their past, you could cuss at them, you could completely degrade their character, and for me, from a psychological standpoint, it was very alarming and not something I was willing to do at all. Staff would be encouraged to yell. Shoshana Walter: The counseling staff were encouraged to do that. Tara Dixon: All staff, yeah. All staff. That was part of the program was calling people out. Shoshana Walter: What was your perspective on that as a counselor and in school? Is that anything you had learned about treatment and counseling? Tara Dixon: No. Not at all. Not even a little bit. Shoshana Walter: As much as Tara tried to avoid it, work just kept coming up in the little time she had with participants. Tara Dixon: It was very, very common in counseling sessions for people to say, "I'm working all the time." Like, "I haven't had a day off in three weeks," and be frustrated. They start to piece together, like I'm not getting a cent of this. Shoshana Walter: Tara checked the time books to see how many hours they were working. Tara Dixon: As they hit 40, it was highlighted, and so you could see that it kept going, and some would have 60, 70 hours a week, but also never have a break, a day off. Shoshana Walter: Participants were supposed to come to three groups every single week. Tara knew that wasn't happening, so she and her supervisor, clinical director Peggy Billeaudeau starting documenting it in a spreadsheet. Tara Dixon: You know, somebody who was working up to the hundred hours in a row had made zero groups, and so that's what we were trying to prove, like look at the pattern. Shoshana Walter: Tara and Peggy brought their spreadsheet to a staff meeting, but she says the facility director shut them down. Tara Dixon: "This conversation's over. If they talk in your office about how much they're working, you tell them to come to me. They can't talk about it in counseling." He was like, "And, don't look at those time books again." That was it. Shoshana Walter: As soon as she finished her internship hours, Tara Dixon left Cenikor. She has a private practice now, but she remembers seeing all the Cenikor clients who needed help, who relapsed at the facility, who left to get treatment at other places because they couldn't get the help they needed at Cenikor. She still sometimes hears about former Cenikor clients. Tara Dixon: Still today, there's a Facebook group, and still today, it's very common, RIP this person, RIP this person, and people dying constantly who were in the program. I think they need to take a took at that, what's your rate of success. Shoshana Walter: I asked Cenikor about their success rate. In an email, a spokesperson told me that fewer than 8% of people graduate from their program. Relapse is common, and when people who use opioids relapse after not using for a while, they're a higher risk of overdose. We've lost a handful of the people we've interviewed over the course of this reporting. Some of them we know died of overdoses, some we're not sure, but their deaths hammered home the reality of addiction treatment. It is a matter of life and death, which is why I called up an expert who could really evaluate what Cenikor's doing, all of it, the unpaid work, the punishments, the lack of counseling. I reached Dr. Sarah Wakeman online in her office in Boston. Dr. Sarah Wakem...: Hi, can you guys hear me now? Shoshana Walter: Yeah. Dr. Sarah Wakem...: Okay. Shoshana Walter: Dr. Wakeman is an addiction medicine doctor at Massachusetts General Hospital in Boston. She's the medical director of their Substance Use Disorder program, and she also trains other doctors in how to treat addiction. I told Dr. Wakeman that in Cenikor's program, unpaid work is the main treatment. Dr. Sarah Wakem...: That sounds more like servitude than anything that could be considered treatment. Shoshana Walter: Dr. Wakeman says that having a stable, paying job could, of course, be helpful for somebody trying to overcome an addiction, but working itself, that's not a treatment for a condition she considers a disease like any other. Dr. Sarah Wakem...: A good sort of reality check of whether we are providing good treatment is to replace substance use disorder with another chronic illness and ask ourselves if we would treat patients with that disease the same way. Would we ever take a patient with diabetes or heart disease or high blood pressure or cancer and basically force them to work without pay and tell them that it's in their best interest? I mean, I think that would be ludicrous and obviously malpractice if we treated another patient group that way. Shoshana Walter: Decades of research show that Cenikor's other tactics, the hot seat, pull ups, mirror therapy, the game, do not work. Dr. Wakeman agrees those methods do not help people recover. In fact, they make it more likely that people will leave treatment and relapse. When I asked her about the lack of counseling at Cenikor, what she said surprised me. She told me about a study comparing different treatments for opioid addiction. Ninety-five percent of the people who got counseling alone relapsed, so just offering counseling, that doesn't actually help. Dr. Sarah Wakem...: A 95% fail rate? Again, for opioid use disorder, that's really not our standard of care. That's not what we should be offering, and then not even offering that and just working people until they're bone tired, that's not treatment. Shoshana Walter: There's a refrain here. That's not treatment. Cenikor is not offering actual treatment for opioid addiction, so what does a proven treatment look like? What does help people? The most effective treatment is daily medication. That's according to Dr. Wakeman and the US Surgeon GEneral's office, which calls it the gold standard treatment model, which can be hard for patients to accept. Dr. Sarah Wakem...: People don't want to have to manage a chronic illness. That stinks, but there's no shame in needing effective treatment for that. Shoshana Walter: People can get shamed in the recovery world for taking daily medication because that medication is a small dose of an opioid. You've probably heard of methadone. People have to show up every day at a clinic to get it. They often drink their dose as a liquid from a little cup. Buprenorphine is another effective daily medication. It can be a tablet or a strip you dissolve in your mouth. People who take buprenorphine or methadone are at much lower risk of dying from an overdose than people who only get counseling or get not treatment at all. Dr. Sarah Wakem...: They are more likely to stay alive and to not die from overdose or from other causes, and they're more likely to have improvements in their quality of life, their social functioning, their ability to stay out of the correctional system, to work, to have relationships, all the things that we want out of life and wellness and recovery. Shoshana Walter: It's not a panacea. Many people are able to reduce or stop their use of opioids without using these medications. Some people have a bad reaction to them or find them ineffective, but the numbers prove that for most people, even with no other treatment, no counseling, not living at a rehab facility at all, just taking these daily medications lowers the risk of overdosing. At Cenikor, Chris Koon didn't get access to these medications. It was a cold turkey situation. Cold turkey and work, which Chris would endure for about 18 months until a medical problem interrupted things. Chris had a cyst on his tailbone that kept getting infected, but Cenikor continued sending him to work at a company called Coastal Bridge that repairs roads and bridges for the state of Louisiana. Chris Koon: My job there was to shovel rocks for 14 to 16 hours a day. I was doing that, and this cyst busted. It's a staph infection, basically. Shoshana Walter: Coastal Bridge did not respond to multiple requests for comment. When Chris's cyst got infected a second time, Chris says he went to a hospital. They asked him if he had a history of MRSA, a kind of staph infection that doesn't respond to antibiotics and is contagious. Chris did have a history of it. Chris Koon: You can't live in community living while you have this. They set up for me to go home for a month, get it cleared up, and then come back. Shoshana Walter: Chris's mom picked him up. Cenikor said they'd love to have him come back, but they also sent a letter to the court saying he'd relapsed repeatedly, he had "left his room a mess," and he was "nonresponsive to treatment". Cenikor asked the judge to remove Chris from the program. Chris ended up pleading guilty to his original felony charge, possession of meth. That charge will stick around on his committal record. He got three years probation, a $1,500 fine, plus court costs. He had to pay $71 a month for his own supervision. Everything that happened to Chris at Cenikor seemed to set him up to fail, to relapse, to risk overdose and death, but that's not what happened. Chris got on buprenorphine. He got a prescription from a doctor in town. Chris Koon: I haven't got in trouble since. People ask me, because I talk about Cenikor, and they'll be like, "Well, it must have not been that bad. Look at you. You're doing good now." I'm like, "Cenikor is not getting any of that credit. Not at all." Shoshana Walter: Chris never made it to what Cenikor calls the reentry phase. In reentry, about 18 months into the program, some participants do get some of their wages. They have to pay Cenikor rent, $500 a month, and they need to save a certain amount of money, have a place to live, and a car in order to graduate. Chris left with nothing except the plan he came up with during his stay there. Chris Koon: My plan originally was I wanted to go to undergrad, do American History and constitutional law, and then go to law school, and then get Cenikor shut the fuck down. That was going to be my little mission. Shoshana Walter: What did you decide on instead? Chris Koon: Welding, because I already know how to weld, and it was always something that just calms me down. I can be stressed out, and as long as I'm welding something... because, when you put your hood down, there's nothing. It's just you and that little spark in front of you that you have to keep going just right. It just blocks everything out. I like that. Shoshana Walter: Chris was getting a certification in welding at the community college where we interviewed him. After he got out of Cenikor, he lived with his dad for a few years. That's where we met his fiance, Paige, and their two kids, Paisley and [Airlyn]. Chris Koon: Here's my munchkins. Speaker 12: Daddy. Speaker 13: Daddy. Chris Koon: Yep. Speaker 14: They were so mad that you were not there to pick them up, Daddy. Chris Koon: Really? Come here. Speaker 14: They did not care that I was [inaudible]. Chris Koon: Yep. Hey, you. Can I have a kiss? Speaker 12: Yeah, yeah, yeah. Speaker 14: That's the ultimate daddy's girl right there in that blue dress. Chris Koon: Yep. Can I have a kiss? Speaker 14: She is Daddy's girl. Chris Koon: Did you have fun? Speaker 12: Yes. [inaudible] Shoshana Walter: A few months ago, Chris and Paige and the kids moved into their own place, a mobile home on the edge of a lake. Chris has a full-time paid job as a welder now, and he says he hasn't relapsed since he left Cenikor in 2017. Cenikor told us almost 6,500 people have participated in its work-based programs in the past five years. In 2018, the most recent year we could get records for, those programs pulled in more than seven million dollars. Seven million dollars that workers like Chris made for Cenikor. That same year, CEO Bill Bailey made more than $400,000. How many Cenikors are out there? Are there other Bill Baileys profiting? It took me three years to scour the whole country for this rehab work force, and I found out it's all around us. Speaker 15: Numbers of that magnitude, frankly, is pretty shocking. I knew of programs that look a lot like this, but I had no clue that it was so extensive and so widespread. Speaker 16: There has to be laws being broke here. People working like that? That's slave labor. I mean, we outlawed slavery. Chris Koon: To me, personally, it was one of the most clever, smartest scams I've ever seen somebody come up with. Al Letson: Next week is our eighth and final chapter of American Rehab. Our team talked to hundreds of people to report Cenikor's story. Over the course of our reporting, some of those people who helped us understand their experience with addiction passed away. Today's chapter is dedicated to them. The American Rehab reporting team is Shoshana Walter, Laura Starecheski, and Ike Sriskandarajah. Brett Myers is our editor. Laura produced today's chapter, and she's our lead producer. Amy Julia Harris helped us report this story from the beginning and launched the project. We had additional editorial support from [Narda Zukkino], Andy Donahue, and Esther Kaplan, and production help from WHYY in Philadelphia. Fact checking by Rose Marie Ho. Victoria Baranetski is our general counsel. Our production manager is Mwende Hinojosa. Our production team includes Najib Aminy, Katharine Mieszkowski, and Amy Mostafa. American Rehab's theme song, Lifeline, and original score are composed and performed by our sound design team, the Dynamic Duo, Jay Breezy, Mr. Jim Briggs, and Fernando, my man, Arruda. Our CEO is Christa Scharfenberg. Matt Thompson is our editor in chief, and our executive producer is Kevin Sullivan. Support for Reveal is provided by the Riva and David Logan Foundation, the John D. and Catherine T. MacArthur Foundation, the Jonathan Logan Family Foundation, the Ford Foundation, the Heising-Simons Foundation, the Democracy Fund, and the Ethics and Excellence in Journalism Foundation. Reveal is a co-production of the Center for Investigative Reporting and PRX. I'm Al Letson and remember, there is always more to the story. Recording: From PRX.

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