Reveal’s American Rehab series investigates drug rehab facilities that send people to work but don’t pay them. In this final chapter, we answer two of the biggest remaining questions.

Since beginning this series, listeners have asked if rehabs are allowed to do this. Can they make participants work without pay as long as they’re providing housing and treatment? Does the work pay for the therapy? 

This question was raised by another cultish organization that recruited dropouts from the hippie movement and had them sew bedazzled designer jean jackets. The clothes became a Hollywood fashion trend, and the unpaid labor propelled a case all the way to the Supreme Court. 

There’s one other question that has driven our reporting from the beginning. How big is this? How many work-based rehabs operate across the country? The federal government doesn’t track them, and no one knew how many were out there. So reporter Shoshona Walter spent a year counting them herself, and she learned that they’re all around us.

Finally, the coronavirus pandemic has made the opioid epidemic even more deadly. As one crisis slams into another, we look at how work-based rehabs are turning participants into unpaid essential workers.


• Listen: The American Rehab podcast series
• Read: Reveal’s reporting on All Work, No Pay.
• Learn: American Rehab resources


Reporting team: Shoshana Walter, Laura Starecheski and Ike Sriskandarajah

Chapter 8 production: Ike Sriskandarajah

Edited by: Brett Myers

Production manager: Mwende Hinojosa and Najib Aminy

Production and mix assistance: Najib Aminy, Amy Mostafa, Katharine Mieszkowski and Claire Mullen

Original score, mix and sound design: Jim Briggs and Fernando Arruda.  Special thanks to Priska Neely.

Reporting help from Amy Julia Harris; original art by Eren K. Wilson; web design by Gabriel Hongsdusit and Sarah Mirk; fact checking by Rosemarie Ho; editorial support from Andrew Donohue, Esther Kaplan and Narda Zacchino

Special thanks: WHYY in Philadelphia for production help, and to Will Carless, Sohyeon Hwang, Quinn Lewis and Heidi Swillinger

Executive producer: Kevin Sullivan

Host: Al Letson

Support for Reveal is provided by the Reva and David Logan Foundation, the John D. and Catherine T. MacArthur Foundation, the Jonathan Logan Family Foundation, the Ford Foundation, the Heising-Simons Foundation, Democracy Fund, and the Ethics and Excellence in Journalism Foundation.


Reveal transcripts are produced by a third-party transcription service and may contain errors. Please be aware that the official record for Reveal’s radio stories is the audio.

Al Letson:From the Center for Investigative Reporting and PRX, this is Reveal. I’m Al Letson. We started American Rehab with a phone call between our reporter, Shoshana Walter, and a woman named Penny Rawlings.
Penny Rawlings:I was like, “I got to get a hold of this lady. I got to tell her that she’s on the right track, that this isn’t right. People need to know about this.”
Al Letson:Penny was worried sick about her brother, Tim Rowe. She’d sent him to a drug rehab called Cenikor.
Tim Rowe:All they do is just work the dog shit out of you, and you don’t get paid. They shaved my head while I was in there. You just have to keep saying it over and over and over and over. I, Tim R, have a consistent behavior of talking [inaudible 00:00:45]. Is that nonsupport? Go have a seat in a verbal chair for nonsupport.
Al Letson:The chanting, the strange punishments, it all goes back to one of the very first drug rehabs in the nation, Synanon.
Female:Who started Synanon?
Male:Synanon Foundation was started in 1958 by ex-alcoholic Charles E. Dederich.
Male:The asshole that’s doing all the work of course doesn’t get any of the pay. That’s the way it is all over the world.
Al Letson:At Synanon, everyone worked.
Male:You’re not getting paid minimum wage, are you?
Male:$50 a month.
Male:Do you know, is that legal?
Male:That’s a good question.
Al Letson:Unpaid work and a form of confrontational therapy called the game.
Female:You say hello to people, but that’s it, or maybe you won’t!
Female:I’m not here to show you you stupid bitch!
Male:We used to tell people we’d brainwash them, because their brain is dirty.
Al Letson:Synanon crumbled, but its members picked up the pieces and spread them far and wide.
Male:Was it similar to Synanon?
Male:Yeah, it was the same thing.
Male:By one researcher’s account, in the ’70s there were 500 rehabs in the United States that descended from Synanon.
Al Letson:One of those was Cenikor, founded by a dangerous man named Luke Austin.
Female:He came in the kitchen and he grabbed me, and he threw me on the floor and he put a gun in my face.
Female:You’re kidding. This is terrible.
Female:Oh yeah.
Female:This was not what I was expecting you to tell me.
Female:This is the truth. I’ve still got witnesses.
Al Letson:Cenikor embraced Synanon’s punishments.
Male:The first thing they did was they shaved my head. They strip you down, take away everything that you think defines you.
Male:They are trying to brainwash you. You’re not a individual. You’re just part of Cenikor.
Al Letson:A part of Cenikor is an inherently American solution to drug addiction.
Male:I was glancing through your Cenikor booklet, and I liked the very first sentence I read, “In all the years the Cenikor has been in business, rehabilitating lives, we have found that nothing works as well as work itself.”
Female:I wonder how much money you made for them while you were there.
Male:Oh god, thousands, tens of thousands.
Penny Rawlings:Yeah, now I am really serious, I really want you guys to … There has to be laws being broke here.
Al Letson:Penny Rawlings’s questions are at the heart of our investigation.
Penny Rawlings:People working like that, that’s slave labor. We outlawed slavery. I can’t wrap my head around it.
Al Letson:That brings us to our final chapter of American Rehab: Shadow Workforce. Today we’re going to answer the biggest question we have, just how large is this? How many rehabs send people to work without pay? We’re also going to answer another question that listeners have asked us since we first started the series. Is this legal? Does the work actually pay for the treatment? It’s a fair question and one that the highest court in the land has also wrestled with. Back in the 1980s, the Supreme Court heard a case from another cultish organization, the Alamo Christian Foundation. Its leaders, Tony and Susan Alamo, recruited members, many of them young people with drug addictions, and provided counseling and a place to stay, but work was also a part of the deal. Sho looked into the Alamo case to understand were the work-based rehabs illegal or not.
Shoshana Walter:Tony and Susan Alamo claim to be on a mission to save the lost souls of the hippie era. At the end of the 1960s the couple brought their own brand of apocalyptic gospel to the streets of L.A. It was a fringe form of Pentecostalism. They preached salvation in Hollywood and developed a following among the young and the desperate.
Female:What was your life like before you came to the foundation?
Female:My life was miserable. When I was about 11, 12 years old I got involved with junkies, drug addicts.
Male:For 19 years I just wandered around, just being loaded and stuff like that, and came out to California, just seeking the love and peace movement, but I couldn’t find it out here.
Shoshana Walter:Their young devotees call themselves Jesus freaks. They’d walk the Hollywood strip looking for new recruits, building the Alamos a large and passionate following with thousands of members. Soon the Alamos began putting those members to work. Just like Synanon and Cenikor, they gave them a place to stay and a job to do, but they didn’t pay them. By 1976, the Alamo Christian Foundation had thousands of members. They moved their church from Hollywood to Arkansas, and with it they also moved the Alamo businesses.
Male:From trucking companies to record labels, but none as visible as this clothing enterprise.
Shoshana Walter:Its clothing enterprise churned out bedazzled and airbrushed designer jean jackets that became a huge fad.
Male:You’ve probably seen these rhinestone-studded jackets, possibly on the backs of these celebrities.
Shoshana Walter:Dolly Parton, Mr. T, Brooke Shields, they were all wearing these sparkly denim masterpieces.
Male:They sold for up to $1,000.
Shoshana Walter:Without paying salaries or taxes, the Alamos created a financial empire with property holdings alone worth at least $25 million. In return, the workers who helped build that empire got room and board worth about $200 per month. As compensation, it worked out to about 83 cents an hour.
Female:You don’t get anything on your own. You can’t even work outside jobs. You have to work for the church.
Shoshana Walter:Some former members complained that the Alamos were breaking the law.
Female:Everything you did make goes straight to the church. You don’t keep anything.
Shoshana Walter:The law the Alamos were accused of breaking was the Fair Labor Standards Act. Passed in 1938, it defined American working life, the eight-hour day, 40-hour workweek, and overtime pay. FDR called it the most important part of the New Deal after Social Security. The act basically says if someone works for you, you have to pay them. If you don’t, you’ll be hearing from the Department of Labor.
Male:The Alamo Foundation is charged with failing to pay minimum wage and overtime compensation to several hundred employees. The Labor Department claims Alamo owes more than $15 million in back pay.
Shoshana Walter:Here’s where it gets tricky. The Alamo Foundation argued that as a religious organization, they were exempt from the law. It’s just the kind of big church versus state argument that can only be settled in one place, the Supreme Court.
Male:The court will hear arguments first this morning in the Tony and Susan Alamo Foundation against the Secretary of Labor. Mr. Dean, you may proceed whenever you are ready.
Shoshana Walter:It’s 1985, and the Alamo lawyer argues that a major part of the Pentecostal faith is doing work for the church. If the court ruled against the Alamo Foundation, it could affect the religious lives of millions of Pentecostal who volunteer their labor in the service of God. This work was how they practiced the religion.
Male:Even running the restaurant is solely of a religious nature.
Male:Yes, sir, now to explain that.
Shoshana Walter:The Alamos’ lawyer explained that the court should think of the members, even the ones cooking diner food, pumping gas, and sewing designer jackets, as pastors and evangelists. The lawyer for the Labor Department argued that dedication to a cause or even a job doesn’t mean that the person shouldn’t be compensated, and if the person doing the job doesn’t have another choice, like they depend on the organization they’re working for to give them a roof over their head and something to eat, that that’s a form of quid pro quo.
Judge:In this case, in your view, does it turn on whether the associates have the expectation of compensation in the form of room and board?
Male:I believe so, Your Honor. The District Court found as a fact, and there was ample testimony, that they contemplated that they would be fed, clothed, and sheltered as a result of their work at the foundation’s commercial businesses, quid pro quo.
Shoshana Walter:The court ruled against the Alamos. They said workers are entitled to be paid for their labor, at least minimum wage plus overtime, and it doesn’t matter if the organization they’re working for puts a roof over their head or if they’re working out of religious devotion. This church in rural Arkansas came to represent a major affirmation of the Fair Labor Standards Act.
Michael Hancock:Their businesses were located at the intersection of basically a two-lane highway and a interstate.
Shoshana Walter:Michael Hancock joined the Labor Department about a decade after the Supreme Court decision, but when he was living and working in Arkansas, he used to visit the Alamo compound.
Michael Hancock:They had a big truck stop. They had a diner attached to the truck stop, and I’m not exaggerating, the best biscuits and gravy I’d ever eaten in my life.
Shoshana Walter:Wow.
Michael Hancock:I’m a connoisseur of biscuits and gravy, and it was just marvelous.
Shoshana Walter:The secret Alamo ministry recipe is a subject for another podcast. I called up Michael because he used to be in charge of policy at the Department of Labor in the Wage and Hour Division. He was one of the more senior people in the part of government that was supposed to enforce the Supreme Court decision.
Shoshana Walter:Had you heard of this type of program before during your time at the Department of Labor?
Michael Hancock:I knew of programs that looked a lot like this, but I had no clue that it was so extensive and so widespread until you started doing your reporting. I don’t think there’s any real ambiguity about what the law requires in these instances.
Shoshana Walter:He’s saying programs are required to pay workers. They can deduct the cost of room and board from their wages, but no markups, no other charges, and at the end of the day, if a rehab really believes work is the best therapy, that’s fine, so long as it’s complying with the Fair Labor Standards Act and paying people for their work.
Michael Hancock:It’s not that they have to eliminate their treatment center and the way they operate, but there’s nothing in that treatment model that says you can’t pay the workers. There’s nothing therapeutic about not paying workers.
Shoshana Walter:“There’s nothing therapeutic about not paying workers.” Yet ever since the Supreme Court ruling, there’s been an explosion in this rehab model. In all my years of reporting on this, I couldn’t find much evidence that the Labor Department has used its full fire power to stop it. I reached out to the head of the agency and the person in charge of their Wage and Hour Division. Every time I called or emailed, they declined to answer even basic questions.
Michael Hancock:I can’t speak for my colleagues, but up to the point that I left the Wage and Hour Division, I had no idea that there was this business model out there in the rehab community. I thought the few instances that we saw of something that approximated this was very isolating, was a one-off.
Shoshana Walter:The Labor Department may not have known how many rehabs like this were out there during Michael’s time, but they did know it was a problem, because of the Salvation Army’s longstanding work therapy programs. They run about 100 of them around the country. In 1990, Labor’s Wage and Hour Division told the charity it had to start paying its rehab workers minimum wage and overtime. The Salvation Army’s response was to totally deny that the participants were employees. They called them beneficiaries. The Salvation Army filed a preemptive lawsuit and got some politicians on their side, and the Department of Labor backed down. They even added a specific exemption for the Salvation Army in their handbook. Going forward, the Department would not enforce the law against the Salvation Army.
Shoshana Walter:There are other examples too. In 1994 a former Cenikor participant filed a complaint with the Department of Labor. The agency never even opened an investigation. In 2013 Labor was investigating the Howe Foundation in Oklahoma, but they stopped after a U.S. Senator personally intervened. That same year in North Carolina, one rehab did get in trouble with the Department of Labor for not paying their workers. The founder of the program promised to follow the law in the future, but then she went right back to doing the same thing again. In each of these cases, the dol knew individual rehabs were putting people to work without pay, but they didn’t succeed in fixing the problem. I asked Michael does he think anything will change.
Michael Hancock:I don’t think this administration would support a aggressive move by Wage and Hour to investigate these kind of programs.
Shoshana Walter:In 2017, President Trump’s first year in office, he declared the opioid crisis a national health emergency. That year, almost 50,000 people died of opioid overdoses, the worst year on record in this country. We could be responding to this emergency with proven methods that could save more lives, but too often we keep doing this, turning people who are seeking treatment into unpaid workers.
Al Letson:The federal government isn’t looking into this kind of program, and nobody could tell us how big this problem is, how many rehabs are out there.
Shoshana Walter:I’m doing a national survey of recovery programs with vocational and work therapy aspects.
Al Letson:We decided to find out for ourselves.
Shoshana Walter:I was hoping I might be able to speak with him about the Great Lakes Region. For the Gulf Region. What the Palmdale program and facility is like.
Al Letson:That’s coming up next.
Male:To me personally, it was one of the most clever, smartest scams I’ve ever seen somebody come up with.
Al Letson:This is American Rehab from Reveal.
Al Letson:Are you tired of the way media tiptoes around the subject of race? Code Switch doesn’t do that. The weekly podcast from NPR has been talking about how race impacts all aspects of American life for years now. It’s made by journalists of color and makes all of us a part of the conversation, because we’re all a part of the story. Find it where you get your podcasts and join the conversation on NPR’s Code Switch.
Al Letson:From the Center for Investigative Reporting and PRX, this is Reveal. I’m Al Letson. It was about three years ago when Shoshana Walter first started reporting on drug rehab participants who were being sent to work without pay. That story led to another and another and another. With each new rehab we found, the question remained, how many more are out there? Sho has been on a quest to find out. Many work-based rehabs are surrounded by a veil of secrecy. To get beyond it, Sho talked to hundreds of former participants about what they experienced at facilities all across the country. What you heard back started to lift that veil.
Kyle Joy:I woke up in the morning and pretty much the nightmare began.
Shoshana Walter:Kyle Joy is just one of hundreds of participants that I talk to. He went to Recovery Ranch in California. That rehab told me participants aren’t forced to work and that they agree to put their wages towards the cost of the program.
Adam Chapelle:Once you wake up you have a very limited time to brush your teeth, get dressed, and walk a quarter mile up to the mess hall in the freezing cold.
Shoshana Walter:Adam Chapelle at Potter’s Wheel Ministries in North Carolina.
Adam Chapelle:Then they feed you. You come back, you do a bible study for 30 minutes.
Shoshana Walter:Christian organizations, by the way, run a large number of these programs.
Adam Chapelle:By 8:00 a.m. you’re in that pallet shop making pallets, buddy.
Shoshana Walter:Caleb Bretsky at the H.O.W. Foundation in Texas.
Caleb Bretsky:You wake up at 6:00 a.m. and you go have breakfast. They do a little morning work meeting and tell you what truck you’re on and then you head out.
Melanie Reinhar…:We worked eight hours a day.
Shoshana Walter:Melanie Reinhart at Hope Center Ministries in Tennessee.
Melanie Reinhar…:From 7:00 to 3:00.
Male:10 hours a day.
Male:From Monday to Saturday you worked about 54 hours.
Male:God forbid it rained. If you get a week of rain, you’re working for six months straight.
Shoshana Walter:There was even a program where a few participants told me they only got one day off every two weeks. Cody Crouch at the Howe Foundation in Oklahoma.
Cody Crouch:If you’re not able to work, then they don’t need you.
Shoshana Walter:None of those rehabs responded to my questions. The type of work varied from rehab to rehab, but I noticed a lot of programs operate thrift stores.
Melanie Reinhar…:They have a Hope Center Thrift Store, and none of that money, we never seen any of that money hardly.
Shoshana Walter:One of the biggest organizations out there like this is the Salvation Army. They require religious participation and unpaid work, from picking up donated items in trucks to sorting them in big warehouses. That’s all work that’s typically done by rehab participants. I’ve shopped at their stores countless times, and I can’t help but wonder how many of the staff people who helped me were there as part of their rehab and not getting paid. In a statement, the Salvation Army said the work helps participants learn how to live balanced, productive lives. They also said they provide spiritual programming, counseling, and recreational activities. I also heard about programs that sent workers to auto detailing shops and car washes. Some places run their own landscaping companies. One program in the Midwest made and sold essential oils. Around the Gulf states, rehabs were making candles and roasting coffee. Some rehab directors reap profits by sending participants to work at businesses they personally own. In Georgia, rehab participants work at a cotton and pecan farm owned by the director.
Shoshana Walter:Many programs operate more like Cenikor does. They provide housing for participants who get sent to work at outside for-profit companies, sometimes massive corporations. There’s this multi-billion-dollar property company called Avalon Bay Communities. They built apartment complexes in the San Francisco Bay area, and unpaid rehab participants have done construction on those buildings. An Avalon-based spokesperson said that they were not aware of any laws being broken.
Shoshana Walter:Williams-Sonoma has used unpaid rehab workers in its warehouse facility. They never responded to my request for comment. Walmart has sold products made by unpaid rehab workers and used workers at a warehouse. Walmart said that a third-party logistics provider had managed the workers and Walmart expected them to follow the law.
Shoshana Walter:As I called and emailed all these companies, so many of them responded with what we started to call the subcontractor blow off, large corporations claiming that they didn’t know that subcontractors they had hired, or in turn using unpaid rehab workers in their warehouses, at their plants, and on their construction sites. The more I learned, the more I felt like I was completely surrounded by this huge, unpaid shadow workforce.
Male:All it is is a work camp. They say it’s nonprofit but it definitely is profit.
Melanie Reinhar…:Your paycheck goes directly to them for 10 months.
Male:Without a shadow of a doubt, those folks are making money on them guys.
Shoshana Walter:How much money is hard to say, but here’s one example. I got a confidential profit and loss statement from a rehab. It had about 60 participants, all men, being sent out to make steel and do other jobs. In one month the rehab brought in $327,000. That’s about $4 million per year going mostly to the rehab and not the workers. Meanwhile in some cases, the participants themselves are paying to be there.
Male:All of his clients pretty much paid thousands of dollars for us to go there, and then you work for his companies for free.
Female:If they’re paying that much money, then why are you guys working for free? Why are you not getting salaries?
Male:That’s the thing. I don’t understand why.
Male:It’s set up that way. It’s free labor.
Male:That’s what they would say. They would say, “Work ethic, we keep you sober. We’re teaching you how to become gentlemen.”
Shoshana Walter:The rehabs aren’t the only ones making money. Some of the companies that are using these workers are getting a steal. With rehab workers, these companies typically don’t pay as much as they might for a regular employee. They don’t always pay for holidays, overtime, or workers compensation insurance. Sometimes when we have workers do get hurt, they’re the ones who end up paying.
Male:It doesn’t matter if you have a headache. Pray about it. If you broke your finger, pray through it, it’ll go away.
Male:The last time I was there I fell. It was 18-23 foot from a tree. I cracked my skull and all that stuff.
Shoshana Walter:People have hurt their backs on the job. One person walked away with brain damage. At least three people have died. I’ve seen medical records and other reports confirming all of these incidents. Some workers got hurt because they didn’t get the right training or protective equipment, whether from the rehab-run business or from an outside company where they were sent to work. In some cases their conditions would only get worse, because they felt they had no choice but to keep working.
Male:They have absolutely burned down every structure in their life and bridge in their life, and they have nothing, nowhere to go, nothing to turn to. Sometimes you don’t have another option.
Shoshana Walter:If you don’t have insurance or you’re facing a prison sentence, these rehabs could be the best option you have, but sometimes this kind of treatment just leaves people worse off than when they came in the first place.
Melanie Reinhar…:At times I felt so trapped.
Male:This place took a real mental toll on me. I felt like I was a slave there.
Melanie Reinhar…:It’s almost like they tried to literally brainwash you.
Male:For me personally, it was one of the most clever, smartest scams I’ve ever seen somebody come up with.
Al Letson:How many rehabs are out there putting people to work with no pay? The federal government doesn’t track it. In fact, nobody has counted how many there are, so we set out to do it ourselves, and the only way to figure it out was to make phone calls, lots of them, to participants like you’ve heard and to rehabs themselves.
Shoshana Walter:Hey. My name’s Shoshana Walter. I’m a reporter with Reveal. Shoshana Walter, I’m a reporter with Reveal. 3:45 on Tuesday? 12:30 on Thursday afternoon.
Shoshana Walter:We created a short survey, about seven or eight questions.
Shoshana Walter:I’m doing a national survey of recovery programs with vocational and work therapy aspects.
Shoshana Walter:I told whoever I spoke with that it would take no more than 10 minutes.
Shoshana Walter:I was hoping I might be able to speak with him about the Great Lakes Region. For the Gulf Region. What the Palmdale program and facility is like.
Shoshana Walter:Some programs will want to tell me way more information than I was asking for, so I’d just listen and take notes. The rest of the time, it took some prodding.
Shoshana Walter:A year to two years. How long has it been operating? About how many people go through the programs every year? Can you walk me through what a day in the program looks like? What’s the daily schedule like? What’s it consist of? What time is bedtime? Can you tell me a little bit about some of the skills they’re learning or jobs they’re doing?
Shoshana Walter:I spent months making these calls, in a windowless booth at the office, at my desk at home, or on my couch.
Shoshana Walter:Excuse me, I’m losing my voice a little bit.
Shoshana Walter:A lot of programs would talk about the value of work and what it teaches participant or how job training was preparing people for life on the outside, but when it came time to talk about whether or not people get to keep their pay …
Shoshana Walter:What does the program cost, the residential program?
Shoshana Walter:The programs would just clam up.
Shoshana Walter:Hello? Hello, are you there?
Shoshana Walter:For every successful call I made, I probably had another five calls that went absolutely nowhere.
Shoshana Walter:All right, that’s a no.
Shoshana Walter:Over the course of a full year of calling, only a fraction of rehabs agreed to participate in the survey. Most programs were just not transparent about how they operate. When I tallied up these rehabs in March, before the coronavirus shut down the economy, I found 300 rehab facilities in 44 states that required unpaid work. That’s more than 60,000 people per year.
Al Letson:300 rehabs, and almost every state in the country, 60,000 people a year who need treatment but get work. Some of those rehabs offer a nominal stipend, like $20 per week or a onetime bonus of $1,500 at graduation, but none of the workers receive anything close to minimum wage.
Al Letson:For years, the opioid epidemic was the public health emergency, but in March, back when we first planned to air this series, a new crisis emerged. As the coronavirus spread are the world, we started to hear how it was affecting people inside rehabs like Cenikor.
Female:Obviously they don’t care about the health of everyone in the place, because they would’ve closed the doors and made us stay in and not sent us in and out, in and out, in and out. If you cared about our well-being, you wouldn’t do that.
Al Letson:When one public health emergency, runs into another.
Female:You hear all these cases come up now, so many in Louisiana. We’re out here. Now my life is at risk.
Al Letson:That’s coming up next on American Rehab from Reveal.
Al Letson:From the Center for Investigative Reporting and PRX, this is Reveal. I’m Al Letson. Sho found similarities about the 300 rehabs she counted. Long days and dangerous jobs were common, but every now and then Sho would hear about a rehab that surprised even her.
Shoshana Walter:Did you know much about the program at the time?
Brendan Earl:No, I didn’t know anything about the program.
Al Letson:A judge ordered Brendan Earl to serve a year at a work rehab called Synergy Foundation in Tennessee. Brendan says the program sent him out to do jobs like janitorial work at a hospital.
Brendan Earl:We had to clean up blood and stuff, which I didn’t feel comfortable doing, because you’re supposed to have a hazmat team supposed to be doing that stuff.
Al Letson:His next gig was even grittier, cleaning up at the Memphis Zoo. Sometimes this involved carrying dead animals to the incinerator. Once, and this is real, Brendan had to move a drugged bear.
Brendan Earl:Yeah, we did. It took six people to pick it up.
Shoshana Walter:Wow. What was that like?
Brendan Earl:It was pretty sketchy, considering the fact that it rolled over and growled at you a little bit, but it was still under … It was asleep, but it was just scary.
Al Letson:Brendan says the worst jobs would go to rehab workers because they didn’t have a choice.
Brendan Earl:It was literally one of them situations where I was never able to say no.
Shoshana Walter:Did you ever try?
Brendan Earl:Yeah, I tried to say no a couple times. They were like, “I guess if that’s the case, you can just go home.” I’m like, “I can’t go home, because if I get kicked out, I’m going back to jail. Then I’ll go to prison.”
Al Letson:Carry a bear or go to jail? When we heard Brendan’s story, we thought that’s an impossible situation, but in March, things got worse. While many Americans were sheltering in place to avoid getting sick, work-based rehabs like Synergy Foundation where Brendan went, were still sending people out to job sites. Synergy had participants cleaning a factory for the major food distributor U.S. Foods. We asked that company for a response, but they never got back to us. Neither did Synergy. In the middle of a global pandemic, other rehabs were doing the same thing. Sho learned that Cenikor was also turning participants into unpaid essential workers.
Shoshana Walter:As the pandemic spread in March and April, I started to hear about new concerns from Cenikor participants at their facility in Fort Worth, Texas.
Shoshana Walter:Sorry, go ahead. You were saying?
Shoshana Walter:I reached Brittney Cardenas on the phone.
Brittney Carden…:They don’t enforce social distancing or anything like that. They were making us go to work.
Shoshana Walter:They were going to a factory called CKS Packaging to make plastic bottles for cleaning products.
Brittney Carden…:Had to touch the bottles and put them into the boxes. You’re supposed to wear gloves, but they didn’t have any gloves for the past few days.
Shoshana Walter:They didn’t have any gloves?
Brittney Carden…:For the past few days they haven’t had any gloves.
Shoshana Walter:Several Cenikor participants told me they went without basic protective equipment. In a statement, Cenikor denied that, saying it was following local, state, and federal guidelines related to the coronavirus. CKS, the bottling company, said they kept workers six feet apart, sanitizing surfaces and limiting visitors. Then around that same time, two workers at that factory tested positive for the virus. Some Cenikor participants found that out while they were on shift there. They wanted to leave and go back to the rehab, but Cenikor wanted participants to keep working. Later on, staff told them they’d be punished if they refused to go to work. The Cenikor participants were shuttled to and from the factory in a packed work van. They slept in 30-person rooms in bunk beds. Brittney said somebody inside Cenikor was already sick.
Brittney Carden…:There’s a girl there that’s been, I just found this out last night, that she’s been in a meeting room that’s been set up for somebody got sick. She’s been in there with 102 fever for the past two or three days.
Shoshana Walter:Cenikor put the woman in a conference room by herself. Then others started getting sick. Cenikor kept sending people out to work.
Brittney Carden…:Obviously they don’t care about the health of everyone in this place, because they would’ve closed the doors and made us stay in and not send us in and out, in and out, in and out. If you cared about our well-being, you wouldn’t do that.
Shoshana Walter:After I wrote about all of this, the Texas Health and Human Services Commission opened an investigation into the rehab. By mid-April, I learned that at least one participant at the Fort Worth Cenikor had tested positive for COVID-19, while about 10 others were being quarantined. According to a leaked document I received, staff accused participants who were sick of being lazy and trying to get out of work. As cases around Texas continue to climb, Cenikor’s director of nursing was downplaying the threat of the virus. In an email to staff, he called media reports hyperbole and the data exaggerated. Then Cenikor staff started getting sick too. Employees said they were ordered not to talk to residents about it, and that if any staffer talked to a reporter, they’d be fired on the spot. After I first wrote about Cenikor, I kept asking them for comment, but they repeatedly declined and eventually hired a crisis PR firm. As we were getting close to publishing this series, I gave them a final chance to respond to a detailed list of questions. Almost half were about problems at their Baton Rouge facility, where Tim Rowe and Chris Coon went. The PR firm wrote me in an email that Cenikor was too focused on their clients and the pandemic to answer my questions. The next day I got big news.
Cara Almond:Hey.
Shoshana Walter:Hey, it’s Shoshana. How are you doing?
Cara Almond:I’m in a grateful spirit, and I’m just doing what I can.
Shoshana Walter:Cara Almond woke up feeling blessed. She’d been living at Cenikor and Baton Rouge for almost 15 months. She was in the reentry phase, when you get a job and actually get paid, while still living inside the rehab. She was working as a waitress and paying Cenikor $500 a month in rent. She felt like she was doing pretty good for the first time in a long time. Then around 9:00 a.m. on a Wednesday in late March, executives from Cenikor, including CEO Bill Bailey, called Cara and about 60 other participants into a meeting room to break the news.
Cara Almond:They said, “You guys have to get out as soon as possible.”
Shoshana Walter:Cenikor was shutting down the long-term rehab facility in Baton Rouge. Cara and other participants were told they had about 48 hours to pack up and get out.
Cara Almond:I don’t have any family here or nobody here, so it was just like, “Oh my god, where am I going to go?”
Shoshana Walter:Patients yelled and cried. Some sat in shock. Former staffers said most of them were told to immediately pack up and leave. They weren’t allowed to counsel, comfort, or even say goodbye to clients. This is back when COVID-19 was exploding in Louisiana. The state had one of the fastest-growing rates of new cases in the world.
Cara Almond:You hear all these cases come up now, so many in Louisiana, and we’re out here. They put us out during this to try to find a place to live. Now my life is at risk.
Shoshana Walter:As residents of Cenikor scrambled to find another place to go, Wendy [Duyal’s] son called his family in a panic.
Wendy Duyal:None of them have cellphones, because you can’t have that there. They were all standing in line calling people, because they just told them they’re just going to put them out on the streets. They’re going to be homeless.
Shoshana Walter:Wendy’s first thought, “Is this true? Is Cenikor actually closing?” She called them to confirm. There was some confusion at the front desk. Everyone seemed to be taken by surprise.
Wendy Duyal:I haven’t heard back from them, so I don’t know what’s going on.
Shoshana Walter:In this moment she had no way to reach him. She was worried sick that her son was already back on the streets where he could relapse on heroin. Studies show that when people leave rehab after a long period of abstinence, they’re at a much higher risk of overdosing and dying, because their tolerance is much lower. Wendy was deeply concerned for her son.
Wendy Duyal:It’s a horrible situation to be in. It’s heartbreaking. It’s just not a life that you’d want to live, for him or for people that love. Something like this just makes it even worse.
Shoshana Walter:Cenikor kept two employees around to help people. They did find some places for people to go. They also offered to transfer participants to Cenikor facilities in Texas. With such short notice, the staff was overwhelmed. For participants who were court-ordered, the offer to transfer was an empty gesture, since they couldn’t cross state lines. Cara herself was still on probation.
Cara Almond:I still can’t leave the state of Louisiana, so at least give me a week or two weeks notice.
Shoshana Walter:They were walking out of Cenikor with no money, food, transportation, or a place to live. The last I talked with her, right after the closure, Cara’s was crashing on a friend’s family’s couch while looking for an apartment. We recently heard back from Wendy. She says her son was living on the streets for a couple days. Then they were finally able to get him into a sober living home. In a statement, a Cenikor spokesperson called the closure temporary and said it was because of declining demand for long-term treatment in Louisiana and related concerns over coronavirus impacting economic operations. During my years of reporting on Cenikor, I have tried so many times to set up an interview with their CEO Bill Bailey. In the end he wouldn’t talk to me, but a few weeks after Cenikor’s abrupt closure of their Baton Rouge program, Bill Bailey did grant a television interview to CW-39’s Morning Dose in Houston, Texas.
Maggie:Thank you so much for what you’re doing.
Bill Bailey:Maggie, thank you so much for giving us this opportunity today to share about our mission and our cause for the Cenikor Foundation.
Shoshana Walter:Bill and the reporter are standing about six feet apart. He’s wearing a crisp white shirt, no tie, and a blazer. They’re talking in a reception area with a big Cenikor sign on the wall.
Maggie:Tell us a little bit about what you are seeing and have you seen an increase in people reaching out for help?
Bill Bailey:We actually have, in the last four weeks. The first two weeks we saw about a 10-20% increase of people calling for assistance. The last couple of weeks has really leveled off. We’re still now seeing between 28 and 32 admissions a day into one of our 10 facilities.
Shoshana Walter:This is the version of reality Cenikor presented, how they’d like to frame what’s happening. I really wanted to ask Bill Bailey, why did they tell us there was declining demand for long-term treatment in Louisiana when we know the pandemic has unleashed a rise in fatal drug overdoses across the country? Why were they pushing vulnerable residents out into homelessness during a pandemic? Why were they still making participants go to work?
Maggie:Lastly, for anyone out there that may be struggling, what is your message to them?
Bill Bailey:There is hope. There is a safe place to receive treatment today. Don’t wait. Don’t think that you have to wait until the virus is passed. Now is the time to come in. We’re here for you.
Shoshana Walter:In this whole interview, Bill Bailey never mentions that Cenikor had just shuttered its Baton Rouge facility. I decided to call Chris Coon and let him know that the place he spent 18 months working with no pay was closing its door.
Shoshana Walter:Did you ever expect it would happen?
Chris Coon:No. I always hoped it. Thank god.
Shoshana Walter:Thank god? Why do you say that?
Chris Coon:I wouldn’t wish that place on my worst enemy.
Shoshana Walter:I told him that I’d just sent a list of questions to Cenikor, some about his own injury. I also told him Cenikor said they had to close because it was costing too much to stay open with so many empty beds during the pandemic.
Chris Coon:That’s bullshit. Economic concerns? They’re trying to save face. To say there’s no need for long-term, as a ex-addict in Louisiana, let me tell you, there are some junkies here that need some long-term treatment, but they need actual treatment and not just to work.
Shoshana Walter:I also called up Tim Rowe, who we heard from in the very beginning of this series.
Shoshana Walter:Apparently Cenikor is shutting down their Baton Rouge facility.
Tim Rowe:Really?
Shoshana Walter:Tim fled the Baton Rouge facility and called his sister, Penny Rawlings, for help. He was glad they were shutting it down, but he was also a little concerned.
Tim Rowe:Some that probably, I don’t know if they have any options of any other place to go. I feel bad for them, because some of those people, they don’t have a choice.
Shoshana Walter:One of my last calls was with Tim’s sister Penny. She’s the one who first asked me how this could possibly be legal and whether other people were having the same disturbing experience as her family. I told her what happened.
Penny Rawlings:I think that’s great in the sense that I don’t think anybody should have to go through what my brother went through there.
Shoshana Walter:In an ideal world, government agencies would step up and ensure that rehab programs are not exploiting people for financial gain, but that hasn’t happened. There’s no national agency responsible for making sure all rehabs are safe and providing actual treatment. There’s just the Department of Labor, which is supposed to make sure working people get paid. I asked Penny what she’d say to them if she could, but she didn’t really have a message for them. Instead she had an indictment on the entire system of work-based rehabs in this country.
Penny Rawlings:You’re killing them. You’re killing people, sending them to these places where they have no chance. You’re selling a lie. It’s a lie, “We’re going to get you better.” No, you’re not. You’re going to use that human being up like a piece of trash and throw them away and then get the next one to fill his shoes. It’s a lie.
Shoshana Walter:Americans have struggled with opioid addiction for over a century. At this point we have a good idea of what works, but instead of offering people proven methods of treatment and increasing access to that treatment, American presidents and politicians, judges and regulators, have allowed an age-old American ideal to prosper, hard work cures all. The gap between the rich and poor is widening. People are feeling more isolated, more desperate. Thousands more are likely to become caught in the gears of this rehab machine, caught in a cycle of fear and pain, greed and profits, until one day some people find their cure, and for others, everything just stops.
Al Letson:For most of this year, the coronavirus has dominated people’s attention, but just because we have a new epidemic to contend with doesn’t mean the last one stopped. In fact, it’s the opposite. The opioid epidemic has gotten worse since the coronavirus outbreak. In March, drug overdoses were up by 18% compared to 2019. By May, they had increased by 42%, but unlike a vaccine for COVID, we don’t have to wait for an effective treatment for opioid addiction. We know the medications that work. This doesn’t have to be a double epidemic. If you’re considering treatment for yourself or a loved one, we put together some tools, including a database of all the rehabs we found around the country that use unpaid labor. We also have a list of questions that you should ask any rehab you might be considering. You can find all of that on our website, Again, that
Al Letson:Thanks for listening to American Rehab. For you it was six weeks of listening. For us it took years of reporting and producing. If you appreciate deep investigative journalism like this, there are two ways you can help us. One is by making a donation to Reveal. We’re a nonprofit newsroom that depends on listeners like you. The other involves no money. It’s just leaving us a review on Apple Podcasts. This has been an experiment for us, and we want to know what you think.
Al Letson:The American Rehab reporting team is Shoshana Walter, Laura Starecheski, and Ike Sriskandarajah. Brett Myers is our editor. Amy Julia Harris helped us report this story from the beginning and launch this project. We had additional editorial support from Narda Zacchino, Andy Donohue, and Esther Kaplan, and production help from WHYY in Philadelphia. Special thanks to Will Carlos, [Sok-yong Hwong 00:48:50], Quinn Lewis, and Heidi Swiller. Fact checking by Rosemarie Ho. Victoria Baranetsky is our General Counsel. Our production managers are Mwende Hinojosa and Najib Aminy. Our production team includes Katharine Mieszkowski, Amy Mostafa, and Claire C Note Mullen. American Rehab’s theme song, Lifelong, an original score, are composed and performed by some of the very best sound designers in the business. Put money on it. Jay Breezy, Mr. Jim Briggs, and Fernando, my man, yo, Arruda. Our CEO is Krista Scharfenberg. Matt Thompson is our Editor in Chief. Our Executive Producer is Kevin Sullivan. Support for Reveal is provided by The Reva 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.
Female:From PRX.

Laura Starecheski is a former senior radio editor for Reveal. Their radio work at Reveal has won a national Edward R. Murrow, a duPont-Columbia, and a Peabody, among other awards. Previously, they reported on health for NPR’s science desk and traveled the United States with host Al Letson for the Peabody Award-winning show “State of the Re:Union.” Their Radiolab story “Goat on a Cow” won a silver award for best documentary from the Third Coast/Richard H. Driehaus Foundation, and SOTRU's “The Hospital Always Wins” won a national Murrow Award. They have been a Rosalynn Carter fellow for mental health journalism and a Knight-Wallace fellow at the University of Michigan. Starecheski is based in Philadelphia.

Brett Myers is an interim executive producer for Reveal. His work has received more than 20 national honors, including a George Foster Peabody Award, four nationalEdward R. Murrow Awards and multipleThird Coast/Richard H. Driehaus Competition awards. Before joining Reveal, he was a senior producer at Youth Radio, where he collaborated with teenage reporters to file stories for "Morning Edition," "All Things Considered" and "Marketplace." 

Prior to becoming an audio producer, Myers trained as a documentary photographer and was named one of the 25 best American photographers under the age of 25. He loves bikes, California and his family. Before that, he was an independent radio producer and worked with StoryCorps, Sound Portraits and The Kitchen Sisters. Myers is based in Reveal's Emeryville, California, office.

Kevin Sullivan is a former executive producer of Reveal’s public radio show and podcast. He joined Reveal from the daily news magazine show “Here & Now,” where he was senior managing editor. There, he helped lead the expansion of the show as part of a unique partnership between NPR and WBUR. Prior to radio, Sullivan worked as a documentary film producer. That work took him around the world, with stories ranging from reconciliation in Northern Ireland to the refugee crisis during the war in Kosovo.

Following the 9/11 terrorist attacks, Sullivan launched an investigative unit for CBS in Baltimore, where he spearheaded investigations on bioterrorism and the U.S. government’s ability to respond to future threats. He also dug into local issues. His exposé of local judges found widespread lax sentencing of repeat-offender drunken drivers. Other investigations included sexual abuse by Roman Catholic priests, and doctors who sold OxyContin for cash. Sullivan has won multiple journalism awards, including several Edward R. Murrow awards, a Third Coast / Richard H. Driehaus Foundation Competition award and an Emmy. He has an MBA from Boston University.

Ike Sriskandarajah was a senior reporter, producer, and fill-in host for Reveal. He has worked on projects that have won an Emmy, two medals from Investigative Reporters and Editors, and awards from Third Coast, the Education Writers Association, and the New York Associated Press Association. He was a narrative audio producer at The New York Times, making investigative episodes for "The Daily." Sriskandarajah is from Wisconsin and reports from New York City.

Shoshana Walter was a senior reporter and producer at Reveal, covering the criminal justice and child welfare systems. She's working on a book for Simon & Schuster about the failures of our country's addiction treatment system. At Reveal, she reported on exploitative drug rehab programs that require participants to work without pay, armed security guards, and sex abuse and trafficking in the marijuana industry. Her reporting has prompted new laws, numerous class-action lawsuits and government investigations. Her stories have been named finalists for the Pulitzer Prize, Selden Ring and National Magazine Awards. She has also been honored with the Livingston Award for National Reporting, the IRE medal, the Edward R. Murrow award, the Knight Award for Public Service, a Loeb Award and Sigma Delta Chi Award for investigative reporting. Her Reveal podcast, "American Rehab," was named one of the best podcasts of the year by The New Yorker and The Atlantic and prompted a congressional investigation.

Walter began her career as a police reporter for The Ledger in Lakeland, Florida, and previously covered violent crime and the politics of policing in Oakland, California, for The Bay Citizen. A graduate of Mount Holyoke College, she has been a Dart Center Ochberg fellow for journalism and trauma at the Columbia University Graduate School of Journalism and a John Jay/Harry Frank Guggenheim fellow in criminal justice journalism. She is a fellow with the Watchdog Writers Group at the University of Missouri School of Journalism and is based in Oakland, California.

Fernando Arruda is a sound designer, engineer and composer for Reveal. As a multi-instrumentalist, he contributes to the original music, editing and mixing of the weekly public radio show and podcast. He has held four O-1 visas for individuals with extraordinary abilities. His work has been recognized with Peabody, duPont-Columbia, Edward R. Murrow, Gerald Loeb, Third Coast and Association of Music Producers awards, as well as Emmy and Pulitzer nominations. Prior to joining Reveal, Arruda toured as an international DJ and taught music technology at Dubspot and ESRA International Film School. He worked at Antfood, a creative audio studio for media and TV ads, and co-founded a film-scoring boutique called the Manhattan Composers Collective. He worked with clients such as Marvel, MasterClass and Samsung and ad agencies such as Framestore, Trollbäck+Company, BUCK and Vice. Arruda releases experimental music under the alias FJAZZ and has performed with many jazz, classical and pop ensembles, such as SFJAZZ Monday Night Band, Art&Sax quartet, Krychek, Dark Inc. and the New York Arabic Orchestra. His credits in the podcast and radio world include NPR’s “51 Percent,” WNYC’s “Bad Feminist Happy Hour” and its live broadcast of Orson Welles’ “The Hitchhiker,” Wondery’s “Detective Trapp,” MSNBC’s “Why Is This Happening?” and NBC’s “Born to Rule,” to name a few. Arruda also has a wide catalog of composed music for theatrical, orchestral and chamber music formats, some of which has premiered worldwide. He holds a master’s degree in film scoring and composition from NYU Steinhardt. The original music he makes with Jim Briggs for Reveal can be found on Bandcamp.

Jim Briggs III is the senior sound designer, engineer and composer for Reveal. He supervises post-production and composes original music for the public radio show and podcast. He also leads Reveal's efforts in composition for data sonification and live performances.

Prior to joining Reveal in 2014, Briggs mixed and recorded for clients such as WNYC Studios, NPR, the CBC and American Public Media. Credits include “Marketplace,” “Selected Shorts,” “Death, Sex & Money,” “The Longest Shortest Time,” NPR’s “Ask Me Another,” “Radiolab,” “Freakonomics Radio” and “Soundcheck.” He also was the sound re-recording mixer and sound editor for several PBS television documentaries, including “American Experience: Walt Whitman,” the 2012 Tea Party documentary "Town Hall" and “The Supreme Court” miniseries. His music credits include albums by R.E.M., Paul Simon and Kelly Clarkson.

Briggs' work with Reveal has been recognized with an Emmy Award (2016) and two Alfred I. duPont-Columbia University Awards (2018, 2019). Previously, he was part of the team that won the Dart Award for Excellence in Coverage of Trauma for its work on WNYC’s hourlong documentary special “Living 9/11.” He has taught sound, radio and music production at The New School and Eugene Lang College and has a master's degree in media studies from The New School. Briggs is based in Reveal's Emeryville, California, office.

Amy Mostafa (she/they) was the production manager for Reveal. She is a UC Berkeley School of Journalism alum, where she focused on audio and data journalism as a Dean's Merit Fellow and an ISF Scholar. She has reported on science, health and the environment in Anchorage for Alaska Public Media and on city government in Berkeley and San Francisco for KQED. Her work also has appeared on NPR, KALW and KALX. Mostafa holds a bachelor's degree in English literature and public policy. She has most recently reported on housing and aging in the Bay Area. She is based in Reveal’s Emeryville, California, office.

Najib Aminy is a producer for Reveal. Previously, he was an editor at Flipboard, a news aggregation startup, and helped guide the company’s editorial and curation practices and policies. Before that, he spent time reporting for newspapers such as Newsday and The Indianapolis Star. He is the host and producer of an independent podcast, "Some Noise," which is based out of Oakland, California, and was featured by Apple, The Guardian and The Paris Review. He is a lifelong New York Knicks fan, has a soon-to-be-named kitten and is a product of Stony Brook University’s School of Journalism. Aminy is based in Reveal’s Emeryville, California, office.

Al Letson is a playwright, performer, screenwriter, journalist, and the host of Reveal. Soul-stirring, interdisciplinary work has garnered Letson national recognition and devoted fans.

Claire Mullen worked at The Center for Investigative Reporting until September 2017. is an associate sound designer and audio engineer for Reveal. Before joining Reveal, she was an assistant producer at Radio Ambulante and worked with KALW, KQED, the Association of Independents in Radio and the San Francisco Bay Guardian. She studied humanities and media studies at Scripps College.

Mwende Hinojosa is a former production manager for Reveal. Prior to joining Reveal, she was the training strategist and innovation manager for the Bay Area Video Coalition, a nonprofit media arts center in San Francisco. At BAVC, she provided resources and support to students training in video, motion graphics, web and graphic design and managed a community for creative freelancers called Gig Union. She has produced segments for public radio stations KUSP, KQED, KALW and KUOW; videos and short documentaries for nonprofits; interactive panel discussions; and immersive storytelling experiences for tech companies. .

Katharine Mieszkowski is a senior reporter and producer for Reveal. She's also been a senior writer for Salon and Fast Company. Her work has appeared in The New York Times, Rolling Stone, Mother Jones, Slate and on NPR's "All Things Considered."

Her coverage has won national awards, including the Alfred I. duPont-Columbia University Award two years in a row, an Online News Association Award, a Webby Award and a Society of Environmental Journalists Award. Mieszkowski has a bachelor's degree from Yale University. She is based in Reveal's Emeryville, California, office.