Chris Koon didn’t read the fine print. Sitting in the Cenikor Baton Rouge rehab center’s intake office in 2015, flanked by his mom and grandmother, he signed where told.
“A lot of it read like legalese,” writes Shoshana Walter in “Rehab: An American Scandal” (Simon & Schuster, Aug. 12). “Incomprehensible but also innocuous, like something you might see before downloading an app on your phone.” Koon felt lucky. He wasn’t going to prison.
Just days earlier, he’d been arrested for meth possession. The alternative to five years in state prison? A brutal two-year Cenikor inpatient program. Koon took the deal.
In signing the intake documents, he agreed to “receive no monetary compensation” for work he did, with wages going “directly back to the Foundation.”
He signed away his right to workers’ compensation if injured. He forfeited his food stamps, disability payments and any other government assistance. And he agreed to “adopt appropriate morals and values as promoted by the program.”
Koon’s story isn’t an outlier — it’s a glimpse into what Walter calls “America’s other drug crisis.” While overdoses and opioid deaths dominate headlines, far less attention goes to the “profit-hungry, under-regulated, and all too often deadly rehab industry,” writes Walter.
Across the country, thousands of treatment programs are propped up by federal policies and rooted in a distinctly American blend of punishment and personal responsibility.
People were “lured to rehab with the promise of a cure for what ailed them,” Walter writes, “only to repeatedly falter and fail inside a system that treated them like dollar signs.”
The idea hard labor can cure someone isn’t new. After the Civil War, US slavery was abolished except as punishment for a crime. That loophole became the foundation for a forced-labor system that conveyed newly freed black people into prisons and chain gangs. Over time, prison officials began marketing this arrangement as “rehabilitation.”
As Walter writes, this legacy has been repackaged for the modern drug crisis.
The Affordable Care Act promised expanded treatment access through Medicaid. But the rehab industry that exploded in response was lightly regulated, profit-driven and increasingly dangerous. The result: thousands of people like Chris Koon, lured into treatment by courts, cops or family members, only to find themselves stuck in a system that looked less like therapy and more like punishment.
They include women like April Lee, a black woman from Philadelphia. Despite growing up in addiction’s long shadow — her mother died from AIDS when Lee was just a teenager, after years of selling sex to support a crack habit — Lee didn’t start using drugs herself until after having her second child, when a doctor prescribed her Percocet for back pain. That opened the door to addiction.
Child-welfare authorities eventually took her kids. Fellow users nicknamed her “Mom” and “Doc” for her uncanny ability to find usable veins, no matter how damaged.
She entered recovery in 2016. Every morning at 6, 18 women gathered in the dining room of one of two overcrowded houses to read from the Bible.
Lee stayed 10 months. With nowhere else to go, she returned — this time as a house monitor, working without pay in exchange for a bed. “She was still early into recovery, and she felt stressed by the intensity of the job,” Walter writes. “On top of that, she wasn’t getting a paycheck, so she couldn’t save up money to leave.”
“Don’t really know how to feel right now,” Lee wrote in her journal. “The lady I work for — for free, mind you — wont me to watch over women witch mean I have to stay in every night.” She felt physically and emotionally trapped. “I wanted to snap this morning. Miss my children so much.”
Like so many others, Lee found herself stuck in the recovery-house loop — forced to work, unable to leave and earning nothing. She helped with chores, mainly cooking and cleaning. Residents’ food stamps stocked the kitchen. Lee loved to cook, and she made comfort food for the house: mac and cheese, fried chicken, beef stew. But all the warmth she gave others couldn’t buy her a way out.
For others, like Koon, it was about more than just forced labor. During his first 30 days at Cenikor, the other patients policed each other. If one person broke a rule, the entire group might be punished with a “fire drill” in the middle of the night. “If anyone stepped out of line or did something wrong during the drill, they’d have to stay awake even longer,” Walter writes.
Discipline was obsessive. In his first month, Koon sat in a classroom with about 30 other residents, most sent by courts like he was, reciting rules out loud, line by line. There were more than 100. “He could get in trouble for not having a pen, not wearing a belt, for an untied shoelace, for leaving a book on the table, for his shirt coming untucked,” Walter details.
Koon learned the punishment system fast. A common one was “the verbal chair,” in which any participant could order him to sit, arms locked and knees at a 90-degree angle, and stare silently at the wall while others screamed at him. “Go have a seat in the verbal chair. Think about having your shirt untucked,” they’d say. And Koon, like everyone else, was expected to respond, “Thank you.”
There were others. “Mirror therapy,” where he’d stand and yell his failings at himself in the mirror. “The dishpan,” where he’d be dressed in a neon-green shirt, scrubbing floors and dishes while loudly reciting the Cenikor philosophy, “a paragraph-long diatribe about self-change,” Walter writes. And the dreaded “verbal haircut,” when another resident, sometimes even a staff member, would berate him as part of his treatment.
Dressed up as a therapeutic community, Koon thought instead, “This is like a cult.” Walter believes he wasn’t far off.
Everyone was required to tattle. Koon had to turn in weekly at least 10 “pull-ups” — written reports detailing rule infractions committed by fellow residents. If he didn’t, he could lose points and with them privileges like phone calls, family visits or permission to grow a mustache.
Confrontations were public and ritualized: Residents would sit in a circle around one or two people forced to listen as everyone else denounced them. “They took turns confronting that person, professing their faults and errors, while the person was permitted only to say ‘thank you,’” Walter writes. Staff called it “The Game.”
He saw grown men cry. He heard women called bitches and sluts. He realized many employees were former participants enforcing the system that once broke them.
Not everyone saw a problem. Many in the legal system embraced tough-love rehab programs, especially judges looking for alternatives to jail. One of Cenikor’s biggest champions was Judge Larry Gist, who ran one of the first drug courts, in Jefferson County, Texas, in the 1990s.
“The vast majority of folks that I deal with are basically bottom-feeders,” Gist told the author. “They’ve been losers since the day they were born.” Cenikor’s extreme model was ideal for “the right people,” he believed.
Cenikor rewarded such loyalty, giving judges and lawmakers steak dinners served by participants and annual awards banquets, complete with gleaming, diamond-shaped trophies. Gist “proudly displayed his” in “his chambers, where he liked to host his happy hours with prosecutors and defense attorneys.”
Koon was booted out of Cenikor after just two years, for faking a urine sample and contracting a contagious staph infection, but managed to stay sober on his own. He proposed to his childhood sweetheart, Paige, moving in with her two daughters, and finding the stability he’d been chasing for years. He went back to school to learn welding, and the daily rhythms of family life kept him grounded. “He hasn’t taken a drug recreationally for eight years,” Walter writes.
Lee’s path out took longer, and her recovery was, as Walter writes, “in some ways a stroke of luck.” She left the house after landing a job at a law firm that helped women reunite with their children in foster care — a world away from the nights she’d once spent tricking at the Blue Moon Hotel but one that barely covered her bills and pushed her just over the poverty line, cutting off assistance. She earned her GED, took online college courses, regained custody of her kids and bought her own home by 2021. “And yet many days she felt she was teetering on the edge, one crisis or unpaid bill away from making a terrible mistake,” Walter writes. That year, she returned to Kensington, where her addiction had once thrived, bringing fresh food and water to people still living on the streets.
As for Cenikor, its time in the shadows ended, at least temporarily. Investigators found evidence of exploitation: residents forced to work without pay, unsafe housing conditions, staff-client relationships, even overdoses inside the facilities. The state of Texas fined Cenikor more than $1.4 million in 2019, but the agency struck a settlement, and it continued to operate.
Koon and Lee don’t represent everyone who’s experienced addiction, treatment or recovery. But they do reflect a system that often promises far more than it delivers. “When rehab works, it can save lives,” Walter writes. “It can mend families and be among the most redemptive narrative arcs in a person’s life.”
But sometimes, rehab not only fails to help people, it actively harms them, recycling them through a gauntlet of relapse, shame and risk: “Despite the rehab industry’s many claims, there is no magical cure for addiction.”
