Podcast Summary: The Jordan Harbinger Show – Episode 1249: Rehab and Recovery | Skeptical Sunday

Date: November 30, 2025
Guests: Jordan Harbinger (host), Nick Pell (writer, researcher, co-host)

Episode Overview

This Skeptical Sunday dives deep into the world of addiction, rehab, and recovery. Jordan Harbinger and researcher Nick Pell thoroughly question the prevailing "addiction as a disease" model, the dominance of 12-step and abstinence paradigms, and the multibillion-dollar rehab industry. Together, they explore alternative approaches for recovery, scrutinize what “success” should mean, and demystify common misconceptions about substance use, moderation, and the business behind rehab.

Key Discussion Points & Insights

1. The Cultural Script of Rehab and Addiction (Starts ~01:31)

• Hollywood Narrative vs. Reality:
  • The classic rehab tale (hitting rock bottom, intervention, 40-day inpatient treatment, lifelong 12-step meetings) is dramatized and oversimplified.
  • This script is rooted in the idea that addiction is a disease, and rehab is the cure.
• Questioning the Script:
  • Jordan: “What if addiction isn’t a disease? What if rehab often doesn’t work? And what if it’s less about recovery and more about business?” (02:44)

2. Early Drug Use and Pathologizing Behavior

• Anecdotes of Youthful Experimentation:
  • Nick shares stories from his own adolescence, highlighting how some heavy users become dysfunctional while others become well-adjusted adults (04:04).
  • He challenges the impulse to pathologize all experimentation as addiction.

3. Origins and Dominance of 12-Step Programs

• Alcoholics Anonymous (AA) Emergence:
  • Formed in 1935; its model heavily influences American ideas of addiction and recovery (06:10).
  • AA’s belief: Addiction is a lifelong, incurable disease and recovery requires total abstinence (06:38).
• Minnesota Model:
  • The “abstinence-only” model proliferated through privatization of rehab during the Reagan era (07:16).
  • “Of the two guys who came up with the Minnesota model, neither had prior experience treating addicts or alcoholics.” — Nick (08:10)

4. Addiction as Personality or Disease:

• Debunking ‘Addictive Personality’:
  • No scientific recognition of an “addictive personality”—risk involves a cluster of traits, genetics, and environment (09:59).
  • DSM-5 term: “Substance Use Disorder,” though this approach has critics.

5. AA's Pervasive Influence & Skepticism

• Entrenched Systems:
  • AA is free, scalable, and shaped into court systems and societal thinking (12:57).
  • “...so many people just take it as a given that addiction is a disease rather than a set of behaviors. Or as some more extreme partisans would argue, totally fake.” — Nick (13:08)

6. Disease Model: Help or Harm?

• Powerlessness as Harmful:
  • By framing addiction as something you can't control, some people may adopt a defeatist attitude (14:24).
  • Nick: “If you tell someone they have no control... some may use this as a ready-made excuse... and it can actively harm people.” (14:24)

7. Natural Recovery: Data vs. Anecdote

• Most People Age Out:
  • “Most people just age out of substance abuse.” — Nick (15:10, 24:01)
  • Studies show that heavy use in youth often transitions to moderate or no use by adulthood.

8. The Big Business of Rehab (17:46)

• Scope and Cost:
  • US rehab industry valued at $42B annually; luxury rehabs can charge six figures per month (17:46).
  • Insurance typically foots the bill, fueling inflated costs.
• Lack of Standards:
  • No national metrics or standards for what constitutes “success.” (18:53)
  • “If a rehab program turns a non-functional raging drunk into a functional social drinker, how is that not success?” — Nick (19:05)

9. Effectiveness and Evidence Behind Rehab & AA

• Success Rates:
  • Success hard to measure due to self-reporting, varying goals, and no hard outcome data (28:33).
  • Many people recover without rehab or AA (“natural recovery”).
• AA’s Evidence Base:
  • Not truly “evidence-based.” Largest study (Cochrane Review, 2020) finds AA works “as well or better than other approaches if the goal is full abstinence”—but not for moderation (30:29, 32:19-32:49).
  • 42% abstinence at one year for AA vs. 35% for other methods (32:28).

10. Alternatives: Cognitive Behavioral Therapy, Freedom Model, Harm Reduction

• Alternative Approaches:
  • CBT, motivational interviewing, harm reduction, contingency management—all have empirical support and may define success as moderation, not just abstinence (34:35).
  • The Freedom Model treats drug use as a preference, not a compulsion—emphasizes personal agency (38:04, 38:50).
  • “Not everyone wants to quit doing drugs... what many of these people want is to actually use drugs and have a normal life. They want to have their cake and eat it, too.” — Nick (41:46)

11. Court Mandates and Motivation

• Coercion into Rehab:
  • Up to half of rehab admissions are coerced—either by court order or family pressure (54:13).
  • Compulsory attendance correlates with poorer outcomes (55:00).
  • “When people go to rehab because they have to or even because they feel like they have to, the results just aren’t as good.” — Nick (55:00)

12. Potential for Abuse: The Dark Side of the Industry

• The Florida Shuffle & Patient Brokering:
  • Relapsing patients bounce between centers to keep insurance billing active; brokers get kickbacks for referrals (63:59).
  • “It’s like if your hospital made money off of your cancer coming back.” — Nick (65:27)
• Outrageous Billing:
  • Some centers reportedly charge up to $31,000 in urine tests in a single month (66:23).

13. Advice for Seeking Treatment

• Questions to Ask:
  • Do they only do 12-step, or offer alternatives?
  • Staff credentials?
  • Support for medication assisted treatment?
  • Aftercare and tracking of success/outcomes?
• Red Flags:
  • Aggressive marketing, no data transparency, reliance on brokers, punitive “relapse” policies (63:32, 66:53).
• Takeaway:
  • “Rehab is not a scam. But there needs to be more scrutiny over the system in general... and in any event, it’s not the only option out there.” — Jordan (66:53)
  • If you think you need help, seek it—regardless of model, what matters is what helps you regain control and keeps you alive.

14. Stigma, Rock Bottom, and Recovery Models

• The Problem with ‘Rock Bottom’:
  • Stigma keeps people from seeking help early; the idea that you must lose everything before accepting help is faulty (61:03, 61:49).
• Personalized Recovery:
  • Some need lifelong abstinence, others succeed with moderation or medication-assisted treatment.
  • “Different people recover in different ways... the problem with AA isn’t AA as such; it’s that it’s framed as the only way that exists for people to get sober.” — Jordan (57:52)

Notable Quotes & Moments

• On Outgrowing Substance Use:

  • “Most people age out, they either quit doing drugs entirely or they start doing them moderately... It’s simply a fact. Most people age out of substance abuse.” — Nick (15:40)

• On Powerlessness Model:

  • “If you tell someone they have no control over something, some may use this as a ready made excuse to just not control it...it can actively harm people.” — Nick (14:24)

• On the AA “No True Scotsman” Fallacy:

  • “If the proof of somebody being an alcoholic is that they can only recover your way, that’s kind of strange.” — Nick (21:41)

• On Business Motives in Rehab:

  • “$42 billion a year industry in the United States alone...high end ones...six figures every month.” — Nick (17:46)
  • “When anything starts being that lucrative...people are going to start seeing it less as a way to help people and more as a way to make money. And that’s how we get the Florida shuffle.” — Nick (63:32)

• On Evidence and Ethics:

  • “You can’t have evidence-based therapy without evidence.” — Nick (62:36)

• On Agency in Recovery:

  • “AA makes them a victim of something beyond their control. The Freedom method says you’re in control of your life, you’re responsible for your own choices.” — Nick (53:30)

• On Harm Reduction:

  • “I don’t care if people want to go be Suboxone addicts, as long as they are walking around alive.” — Nick (58:35)

• On Medication Assisted Treatment Stigma:

  • “Almost nobody’s dying from methadone overdoses and we don’t criticize diabetics for taking insulin. So if we think that addiction is a disease, why are you criticizing people for taking a drug for their disease?” — Jordan (59:55)

Important Timestamps

• Cultural script of rehab & questioning the disease model: (01:31–03:41)
• Minnesota/A.A. model origins and dominance: (06:10–08:43)
• Discussion of "addictive personality": (09:59–10:55)
• Natural recovery and 'aging out': (15:10–24:01)
• Costs and standards in rehab industry: (17:46–18:53)
• Defining/redefining success in recovery: (19:25–21:53)
• A.A. effectiveness and the Cochrane Review: (30:29–33:55)
• Evidence-based alternatives to 12-step: (34:35–35:20)
• Detox vs. rehab: (36:01–36:46)
• Freedom Model and non-disease alternatives: (38:04–44:43)
• Court-mandated/pressured rehab: (54:13–55:28)
• Business abuses (‘Florida shuffle’/patient brokering): (63:32–65:27)
• Advice for seeking/choosing rehab, red flags: (62:42–66:53)

Final Takeaways

• No One-Size-Fits-All Solution:
  There are a variety of paths to recovery—abstinence, moderation, medication—that may work for different people.
• AA/12-step is not the only way, and not necessarily the best way for all.
• Rehab is a massive industry with pitfalls:
  Not all centers are created equal; some prioritize profits over patients.
• Scrutiny, transparency, and evidence-based practices are urgently needed.
• If you need help, seek it, but know you have options.

For resources on substance use and recovery, see the episode show notes on jordanharbinger.com.

Memorable Moment

“Most people just age out of substance abuse. It’s get in the show notes. Most people just... That’s... it’s so normal that we don’t see it.”
— Nick Pell (24:01)

Episode conclusion: This conversation encourages listeners to be critical, informed, and compassionate about addiction and recovery, advocating for transparency, evidence, and choice in an industry fraught with myths, profits, and often, one-size-fits-all solutions.