Punishment as Treatment: Historical and Cultural Roots

In Rehab: An American Scandal (Simon and Schuster, 2025), Pulitzer finalist Shoshana Walter exposes the country’s failed response to the opioid crisis, and the malfeasance, corruption, and snake oil which blight the drug rehabilitation industry. Our country’s leaders all seem to agree: People who suffer from addiction need treatment. Today, more people have access to treatment than ever before. So why isn’t it working? The answer is that in America—where anyone can get addicted—only certain people get a real chance to recover. Despite record numbers of overdose deaths, our default response is still to punish, while rehabs across the United States fail to incorporate scientifically proven strategies and exploit patients. We’ve heard a great deal about the opioid crisis foisted on America by Big Pharma, but we’ve heard too little about the other half of this epidemic—the reason why so many remain mired in addiction. Until now. In this book, you’ll find the stories of four people who represent the failures of the rehab-industrial complex, and the ways our treatment system often prevents recovery. April is a black mom in Philadelphia, who witnessed firsthand how the government’s punitive response to the crack epidemic impeded her own mother’s recovery—and then her own. Chris, a young middle-class white man from Louisiana, received more opportunities in his addiction than April, including the chance to go to treatment instead of prison. Yet the only program the judge permitted was one that forced him to perform unpaid back-breaking labor at for-profit companies. Wendy is a mother from a wealthy suburb of Los Angeles, whose son died in a sober living home. She began investigating for-profit treatment programs—yet law enforcement and regulators routinely ignored her warnings, allowing rehab patients to die, again and again. Larry is a surgeon who himself struggled with addiction, who would eventually become one of the first Suboxone prescribers in the nation, drawing the scrutiny of the Drug Enforcement Administration. Together, these four stories illustrate the pitfalls of a system that not only fails to meet the needs of people with addiction, but actively benefits from maintaining their lower status. They also offer insight into how we might fix that system and save lives.

More of Shoshana's work:

- Her reporting on hospital drug testing

- Her reporting on moms reported to child welfare authorities for taking medication-assisted treatment during pregnancy

- The American Rehab podcast

Emily Dufton is the author of Grass Roots: The Rise and Fall and Rise of Marijuana in America (Basic Books, 2017). Her new book, Addiction, Inc.: Medication-Assisted Treatment and America's Forgotten War on Drugs, will be released next year.

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