Your Marketing May Not Be as Ethical as You Think

 In Business

As you may know by now, news broke last week that Google has set some limits on advertisements for the addiction treatment industry. As I work with a company that does search engine optimization for many clients in the addiction treatment industry, we’ve been answering questions left and right. We’ve seen some pretty strong opinions being shared for years on social media and blogs, and this recent change has brought more voices out.

Although we know there are a lot of completely unethical people and practices in the industry, it’s time we take a look at the bigger picture. Is search engine optimization or pay-per-click really that different (or better) than client brokering and paid phone calls from call centers? We’ll take a look at what happened last week, what people are doing to market themselves, and how ethical or not these practices may be.


As an online marketer who runs PPC and SEO campaigns, I truly believe in what I do. However, there is a potential dark side. Also, when looked at from the perspective of someone who works in marketing, the process of PPC, SEO, paid calls, and brokering really isn’t that different. Yes, they are different ways to market, there may be more unethical people involved in one form of marketing than the other, and some tactics are also illegal. However, when it comes down to it, you’re making a payment to get exposure and bring people into treatment. Whether you’re paying a referral company, call center, Google, or SEO company, you’re reaching people that may or may not be the best fit.

The Recent Catalyst

As the New York Times reported last week, Google has changed its policies surrounding its AdWords program and organizations in the addiction treatment industry. Specifically, they are cracking down on people offering low-quality services that are not good treatment fits for those visiting the site. In my opinion, this is largely a crackdown on call centers, brokering services, and fake websites. This is similar to what Google did a few years ago with terms related to payday loans.

Although not every search term has been blocked, many of the big ones have. There are likely thousands of terms that have been impacted, but here are few examples we see:

  • Addiction treatment center
  • Rehab near me
  • Addiction treatment centers near me
  • Drug rehabilitation programs
  • Heroin detox
  • Sober living near me
  • Adolescent addiction treatment

There are certainly some terms that are still showing ads. Google has said they will address terms in the future, but here are a few we see that show ads as of September 19th:

  • Dual diagnosis treatment
  • Rehab Los Angeles
  • Florida rehab

Opinions on Practices

If you spend any time on social media groups about addiction treatment, talking to industry professionals, or reading blogs, you’re bound to see some strong opinions and even harsh words about call centers, client brokering, and even PPC campaigns on Google. Here’s an example of a person on Facebook sharing about their business and comparing it to the option of calling one of these 800 numbers:

Here is a post about one well-known business and individual that runs a paid call service. This company uses television, radio, and Internet ads to generate phone calls, then sells the phone calls to facilities. We have blocked out names to protect everyone, but want to be clear that we absolutely do not advocate for this organization’s practices or this person as an individual. We simply removed the names as to protect ourselves legally.

In full disclosure, we don’t know any of these people very well at all. Although they may be incredibly caring and intelligent people who help many people in the industry, it’s my opinion that this view is quite silly. I’d go so far as to say they are flat-out wrong. I neither endorse nor approve of buying phone calls, misleading clients, or brokering clients. However, not all marketing is bad marketing, and we’ll get into that in bit. First, we’ll talk about the marketing process and look at PPC campaigns, brokering clients, search engine optimization, and branding, investigating if the difference between them is really as big as you think.

The Marketing Process

Ad ListingsIn case you aren’t aware of these different marketing methods, here’s a brief overview. Pay-per-click campaigns are most common in search engines like Google. When you search something like “rehab Los Angeles,” you will see some ads pop up at the very top, before organic results and map listings. This picture shows an example of a search with four paid ads in the results. Generally, the facility is paying every time somebody clicks on their ad or places a phone call.

Paid calls are offered by businesses to addiction treatment centers and referral companies. Although they may generate leads a number of ways, they are often generating leads via advertisements on TV, radio, and the Internet. A treatment center may pay for a set amount of phone calls to be forwarded to their facility, and it’s up to them to handle it from there.

Organic ListingsSearch engine optimization is the process by which a company climbs up the organic search results (NOT the paid ads). You can see an example of organic listings to the left. This is done through a variety of methods, and you can learn more about SEO here. The basic idea is that businesses spend money with an SEO firm to bring their site up in organic results and gain traffic. Although you’re not paying by the click or lead, you’re still paying to show up in search results.

Brokering, placements, and paid referrals all refer to what is really the same practice. Organizations generate leads via a number of different methods, and sell the clients to different treatment centers. Although largely illegal, it’s a common practice in the addiction treatment industry. The treatment center agrees to pay a specific amount of money for a client, and the referral company sends the client to that treatment center.

There are also of course many other forms of marketing. Many treatment centers present at conferences, engage with local clinicians and professionals, and spend time branding their organization online and in print.

So, now to how the process works. Let’s make up a treatment center and call it Super Awesome Treatment. Super Awesome Treatment offers a truly awesome quality of care for those struggling with addiction, but does not have a strong mental health program.  They are going to spend money somewhere. For their money, they are hoping to reach more people who are suffering.

John Smith is looking for treatment online. He is using opioids, and has been diagnosed with bipolar disorder. So let’s take a few scenarios here to see how John Smith may end up at Super Awesome Treatment.

Finding Help via PPC

First, let’s consider the scenario in which John finds Super Awesome Treatment by searching Google for “addiction treatment center near me.” Super Awesome Treatment’s ad shows up in those first few listings, and John clicks on it. After looking through the website a bit, he places a call. The person who picks up the phone talks to John, collects necessary information, and John ends up going to treatment. In this scenario, John goes to treatment and Google is paid for the click or call. The treatment center may or may not be the best fit for him; just because Super Awesome Treatment showed up in the ads does not mean they were the perfect fit.

Finding Help via Paid Calls

Now, let’s say John is watching TV late at night, and sees an ad pop up that offers help for addiction. John places a call to the toll-free number, not realizing he is calling a company that sells paid phone calls. Super Awesome Treatment has paid for 50 calls this week, and John’s call gets forwarded directly to the same admissions person. The person talks to John, gets the information they need, and John goes to treatment there. In this scenario, John ends up in treatment and the paid call company is paid for forwarding the phone call. Obviously, the treatment center may not be perfect for John; the call was forwarded to this facility automatically and John did not even know what facility he was going to get when he called.

search engine rankingsFinding Help via SEO

Here, Super Awesome Treatment has been paying a company for search engine optimization (SEO). As a result of their SEO campaign, when you search on Google for  “addiction treatment in Los Angeles,” they show up on the first page of Google. John looks for addiction treatment in Los Angeles, and finds Super Awesome Treatment. Again, he speaks with an admissions person, admits, and gets help. The SEO company is paid for their optimization campaign. Even though you can optimize for specific terms, this treatment center may or may not be the best fit for John. There are treatment centers out there spending $500/month on SEO, and there are ones spending $20,000/month on SEO. Those that spend more money are more likely to reach the first page of Google and get your business, again showing that organic results do not necessarily offer you the best treatment center.

Finding Help through Placement

Now let’s say John is looking for treatment online and finds a website that says they can help you find the “right” treatment for you. John calls them, tells his story, gives his insurance information, and lets the broker take over. Although I cannot speak to how every referral company works, let’s make an assumption and say they send the insurance out to a few facilities. The facilities tell the placement company if they can take John or not, and how much they will pay for the referral. The placement company’s decision MAY be based on what is the best fit for John, but it’s way too easy to go with the facility that is willing to pay the most for the lead. Either way, John goes to treatment. The placement company is paid, and we can’t really be sure John is getting the level of care he needs.

Organic Referrals

Now, let’s take what is (in my opinion) the most ethical form of marketing. Super Awesome Treatment shows up at conferences, invites people to visit and tour their facility, and gets to know local professionals. John goes to his therapist, Fred. Fred has toured Super Awesome Treatment, is familiar with their program and offerings, and feels confident that John will have a good experience there. He recommends Super Awesome Treatment, and John admits. Nobody is paid for the referral. Fred refers John to the treatment center because he believes it’s the best fit, and Super Awesome Treatment has made the effort to share their program with Fred.

The Problem is…

People have issues with many of these methods (except the last), but the biggest issues seem to arise with patient brokering and the paid calls. Recently, shady PPC campaigns have come under fire, but many of the organizations guilty of unethical practices here are just paid call centers or referral companies. With patient brokering, the issue is that the referral company is often sending the client to whatever facility will pay the most. The people running the referral company often don’t see the client as a three dimensional human, and just as a commodity or paycheck. The referral company has no obligation to give the client the best treatment possible, and may only be looking out for their own wallets.

With paid calls, the same thing happens. The calls are sold, and when a person calls they are reaching a treatment center based on their spending with the call center, not based on their merit as an addiction treatment program. Again, the addict’s interests are not necessarily the primary concern. The client’s call is being sold to whoever’s turn it is to receive calls.

How is this really that different from SEO or PPC campaigns? According to the opinions and views I see on social media and hear at conferences, there’s a huge difference ethically. However, I don’t think it’s as big of a difference as many people think. With PPC, people are finding treatment centers based on who is spending the money with Google. With SEO, it’s the same. The companies that spend more on SEO and have better campaigns are going to show up in search results and get the phone calls. In both cases, somebody is getting paid to provide exposure and a call. Whether it’s an ad or an organic listing, it must be noted that showing up in search results most often indicates strength of marketing campaigns and the marketing budget, not actual quality of care.

If somebody ends up in your treatment center from a referral company, it’s because you’re paying for the client to admit. If somebody admits from a paid phone call, it’s because you spent money with the call service. If you get an admission from PPC campaigns, it’s because you paid Google. If someone admits from an SEO campaign, it’s again because you paid someone, this time an SEO company. If somebody admits from an organic referral, it’s likely that it is based more on merit and quality of care than money.

I’m not saying that all PPC and SEO is unethical, and I’m not saying that patient brokering or paid calls are ethical. For example, when you search for dual diagnosis treatment, you’re likely to find many addiction treatment programs that offer some psychiatric care. However, there are programs out there that offer true treatment for co-occurring disorders and specialize in working with these individuals. They may even be licensed as a mental health primary facility. Shouldn’t the individual with a mental health disorder be at the place they are going to get the best help? My argument here is that there are a lot of people running PPC and SEO campaigns for terms they have no right targeting, and this can throw them down an ethical spiral.

Ethical Business Practices

Here’s a comment where a person shares about this “mentality” of call centers, hotlines, and brokering companies (placement companies):

So what is ideal then? What does it look like to open a treatment center that does wonderful work, helps people who are truly a good fit, and makes themselves known to individuals seeking help? If you truly provide quality care, will people just come? I’ve known quite a few people in different industries who believe if they do good work, the business will come. I love the idea of this, but it doesn’t work that way in actual practice. You have to have clients to experience your good work in order to get that word of mouth going!

One of the ways treatment centers do this is by connecting with industry professionals, showing what they have to offer, and standing out by providing unique modalities and programs. As with the example, a therapist may refer a client your way if they feel it is a good fit. However, this takes a lot of energy and time to cultivate these relationships. Many people neglect this route because of the time and effort it takes. However, it is probably one of the most ethical ways to get clients.

I have heard people talk about “getting clients” and “filling beds” in a negative manner. These addicts are humans, not just sales. I do agree with this, but I also think we need to be realistic. If you are a treatment center, you need revenue to continue helping people. If you have no people in your facility, you have no revenue, and you cannot stay afloat. Also, if you do wonderful work at your facility, how are people going to know about your program? If you don’t market yourself, advertise, or connect with professionals, few people will ever know about your offerings. There’s a middle path here, one of balance. We can help people and keep our treatment centers afloat without marketing in unethical manners or taking clients who are not a good fit for our programs.

This may seem like a harsh statement, but if you don’t want to market or advertise to “get clients,” you probably shouldn’t open a treatment center or any other business! I realize this may rub some people the wrong way, but I have talked to multiple people who are against SEO, PPC, brokering, and call centers because it all has the potential to mislead clients. They plan on running a treatment center “the right way,” helping people who come through their doors organically. With these situations, one of two things seems to happen. First, the treatment center may change their opinion and begin to spend some time marketing themselves online, perhaps with an SEO campaign or some social media work. If they don’t, they end up shutting down.

I want to believe that a good treatment center can stay afloat based purely on word of mouth, but it takes time and effort to do that. Treatment centers that have good reputations and get those organic referrals have often been around for years. It’s absolutely not impossible, but it is indeed difficult. The truth, as uncomfortable as it may be, is that even if you offer the best program in the world, the average addict won’t find you if you haven’t done some form of marketing. Maybe this means working with local clinicians and hospitals, and maybe it means running an SEO campaign. Whatever it is, it takes something to remain in business helping people.

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