When Phillip decided to stop using heroin, he knew sticking around home was a recipe for failure.
"It's just, like, a heroin epidemic on Long Island where I'm from. So I had to get away from that and now I'm in Prescott, Ariz.," Phillip says. NPR agreed not to use his last name because he is struggling with addiction and fears it might hurt his chances of future employment.
Phillip and a handful of other young people are filtering through the line at a soup kitchen at the Prescott United Methodist Church just before noon. They are grabbing a bite to eat before their next meeting of recovering addicts nearby.
"Everybody here is basically, I feel like, in recovery and they're more serious about it," says Phillip.
Not like back home in New York, he says, where people shoot up in the parking lot before meetings.
You hear similar stories from others who come to this idyllic mountain community to shake their addiction. Outdoor recreation, a mild climate, scenic vistas and a welcoming attitude toward those in recovery is touted in a promotional video by a group called Drug Rehab Arizona.
And with its motto "Welcome to Everybody's Hometown," Prescott has become a hub for the multi-billion-dollar recovery industry. It's even listed by the recovery website TheFix as one of the top 10 destinations in the country to get sober.
This has caused a boom in sober living houses — homes where six to eight recovering addicts live under the supervision of a house manager, who is usually also a recovering addict. During the day, they typically go to outpatient treatment centers, attend meetings and once further into recovery, look for work. At last count, Prescott, population 40,000, had more than 150 of these sober living homes, with new ones opening up frequently. And some Prescott residents are upset.
Group homes have inundated the community, says Connie Cantelme, who lives in one of Prescott's historic neighborhoods where several sober houses have popped up.
"When you've got a hundred boys and men trying to kick a heroin problem, how do you feel safe living next door to them when they're falling off the wagon all the time?" she asks.
Once she remembers coming outside for her morning coffee to find that a man had overdosed under her deck.
Cantelme worries this influx of recovering addicts and the proliferation of group homes is tarnishing Prescott's image.
That's certainly a concern, says Allison Zelms, Prescott's deputy city manager, who says, "We are reaching a tipping point." But Zelms says an even greater concern is the quality of care in some of these programs.
"Are people really being sold a bill of goods, or are they going to come to Prescott to really have a good chance of success in their treatment?" Zelms asks.
That's a difficult question to answer. Group homes are generally easy to start, cheap to run and, in states like Arizona, largely unregulated, other than some city zoning and code enforcement.
In Prescott, the homes tend to be affiliated with outpatient medical treatment centers that are licensed by the state. This arrangement, known as the Florida Model, separates the residential setting from the medical components of treatment. Families looking for a safe place to send an addicted son or daughter are offered a package deal: They pay out of pocket for the living expenses and insurance generally covers the cost of treatment.
This was the case for Vincent Rienzie Jr. He flew across the country to attend the Promise Recovery Center in Prescott and stayed in an affiliated group home. But after 60 days sober, Rienzie says he was kicked out of the group home for violating a rule against socializing with women. He ended up on the street.
"Our insurance wasn't paying them and they were looking to make an excuse to throw us out," Rienzie said, moments before his plane took off, bound for his home on Long Island, N.Y.
Promise Recovery did not respond to requests for comment. But Barry Hancock, who was working as a therapist in the program at the time and was later fired, says he was told by people running the program they might need to find ways to kick out clients whose insurance wasn't paying.
"Insurance [payments] come into these programs and people make a lot of money," says Hancock.
"What we do has gotten so big. We don't necessarily have to worry about clients. We don't have to worry about them dropping out," Hancock adds. "There are plenty of them waiting in line."
While it is difficult to nail down numbers, sources inside the insurance industry say out-of-network providers can typically bill from $500 to $800 a day for outpatient treatment.
"The drive to make money sometimes gets to be a greater motivator than the drive for patient safety and clinical care," says Gerald Shulman, a clinical psychologist in Jacksonville, Fla., who studies cost and quality in addiction treatment.
A review of complaints made to the state about treatment programs in Prescott, obtained by NPR member station KJZZ through public records requests, speak to these systemic issues: Recovering addicts enter programs, often without discharge plans. Many will bounce around to three, six or more programs. Sometimes clients are kicked out, allegedly because insurance runs out. Extensive interviews with individuals echo those themes.
Kelly Dwyer has watched the proliferation of sober living homes in recent years. She came to Prescott in 2007 to give up drinking and get sober.
"My main goal was just to wake up every morning and not want to die," Dwyer remembers as she sits on a park bench in the historic town square.
Dwyer entered treatment and was placed in a sober living house.
"It was just kind of like a regular house in a regular neighborhood," says Dwyer. "We would walk to the facility every morning and do some morning groups. Then we would go to a meeting at noon."
But Dwyer's time in the group home didn't go smoothly. Her roommate kept asking her to buy alcohol, she says. And after an argument with a staff member, she was kicked out of the program.
"At that point, I told them I don't have any money. I don't know anybody in Prescott," she says.
Dwyer is sober now and works as a real estate agent in town. She wants to see more regulation and stricter guidelines for the homes. "It's not quantity. It's quality" that's important, Dwyer says.
Take the case of Joey Martin. Like so many parents, Jill and Glenn Martin never imagined their teenage son might become a drug addict.
"He played baseball a lot, and he was into school and girls and just everything a regular teenager would be," recalls Glenn Martin, as he sits with his wife, Jill Martin, at their home in Prescott.
But about a year before graduating from high school, Joey was in a head-on collision with a drunken driver. Soon he was using prescription pills and, eventually, abusing them.
"When your kid is addicted, you do whatever you can to help him, and that's what we did," says Glenn Martin.
For three years, they sent Joey to various programs. Eventually he ended up at a sober living home in Southern California. The Martins were hopeful. Joey did well and was talking about going to college. Then one evening they got a call: Joey, 22, was found dead in his room. He had overdosed.
Since their son's death, Glenn and Jill Martin have advocated for more regulation of sober living homes — first in Southern California where Joey died and again when they moved to Prescott.
Just this spring, Arizona took a significant step toward allowing more government oversight of these homes. The Arizona Legislature passed a law that allows a city, town or county to regulate health and safety standards for sober living homes — including supervision requirements and exit plans.
"If they're giving good treatment they should be open to what we are proposing," says Noel Campbell, the Arizona lawmaker who pushed through the legislation.
But some people who run group homes are pushing back.
"There's a tremendous amount of fear associated with the alcoholic and the drug addict," says Mark Temple, who operates Solutions House, which has more than a dozen homes in Prescott.
"Our focus is to help these kids. Our focus has never been on making money," he says. "We are a program based on spiritual principles. We are not a business built on profit and loss."
Temple's homes serve mostly clients of the Bridges Network, a licensed outpatient treatment program. Bridges therapist Bonnie DenDooven says the combination of the treatment program and the sober living home helps integrate people recovering from addiction back into society.
"The challenges of living in a neighborhood, the challenges of working in a community, as much as you can replicate the real world, I think you stand a better chance of them making it," she says.
Jill and Glenn Martin are adamant that more regulation is needed in Arizona and across the country.
"We are not trying to shut sober homes. We're not trying to stop addicts from getting help," says Glenn Martin. "But what we don't want to happen is what happened to us."
DAVID GREENE, HOST:
Today in Your Health - addiction recovery. This is a multibillion dollar industry. And one of the fastest-growing treatment models is the so-called sober-living home, a place where addicts pay to live while they get sober. The town of Prescott in Arizona has seen a dramatic increase in the number of these homes. But some say they need to be better-regulated, and a new law allowing that took effect this month. Will Stone from member station KJZZ reports.
WILL STONE, BYLINE: Like so many parents, Jill and Glenn Martin never imagined their son might one day become a drug addict.
GLENN MARTIN: Played baseball a lot, and he was into schools and girls and just everything else a regular teenager would be.
STONE: A family photo in the couple's living room shows a smiling young man in cap and gown.
JILL MARTIN: Well, that was Joey's graduation and...
G. MARTIN: High school.
J. MARTIN: High school graduation, yeah. This was maybe a year after the accident.
STONE: That accident was a head-on collision with a drunk driver. Soon, Joey was using prescription pills and eventually abusing them.
G. MARTIN: When your kid's addicted, you do whatever you can to help them, and that's what we did.
STONE: For three years, his parents sent Joey to various programs. Eventually, he ended up at a sober-living home. His parents were hopeful. He was talking about going to college. But then they got a call.
J. MARTIN: You don't just let - send the person to bed to die.
STONE: Joey was found in his room. He'd overdosed. They later discovered he'd shown up to a house meeting that night sickly, white as a ghost. Apparently, he had not been drug tested for more than a month.
G. MARTIN: These people that live in these sober homes, they deserve the safety element as much as anybody else. They don't know. The parents don't know. We didn't know.
STONE: Since then, Glenn and Jill Martin have advocated for more regulation of these homes - first, in Southern California, where Joey died and, once they moved, in Prescott, Ariz. It's a picturesque community of 40,000, with more than 150 sober-living homes at last count.
BONNIE DENDOOVEN: That little mountain town I owe my life to.
STONE: That's what Bonnie DenDooven hears all the time. She's with the Bridges Network, a program based on the 12-step philosophy, which also includes some medication-assisted treatment for opioid addiction. When her clients are not receiving treatment, most stay in affiliated sober-living homes, which, until this month, could not be closely regulated. DenDooven says this model gradually integrates clients back into society.
DENDOOVEN: Much as you replicate real world, I think you stand a better chance of them making it.
VINCENT RIENZIE: My name is Vincent Rienzie Jr.
STONE: I caught Rienzie earlier this year, just before his plane took off, bound for his home on Long Island. Like many young addicts, he'd come to Prescott to get sober - in this case, at another program called Promise Recovery. But...
RIENZIE: Our insurance wasn't paying them, and they were looking to make an excuse to throw us out.
STONE: That excuse - he and his friend were socializing with women, which is against the rules. After 60 days sober, he ended up on the streets, nowhere to go. Promise Recovery did not respond to requests for comment, but Barry Hancock was a therapist working in that program. He says he was told by those running it that many clients didn't have insurance, so they might need to find ways of kicking some of them out.
BARRY HANCOCK: We don't necessarily have to worry about clients. We don't have to worry about them dropping out and can I pick one up. There's plenty of them waiting in line.
STONE: Promise Recovery later fired Hancock after he tried to help Vincent Rienzie.
HANCOCK: We have just people coming in and opening rehabs, and we have chaos.
STONE: Interviews with more than a dozen people who've gone through programs in Prescott plus complaints made with the state of Arizona show this to be a familiar story - recovering addicts kicked out of homes with no exit plans or accountability.
DENDOOVEN: We have never, in our entire time of operation, discontinued service just because somebody's insurance ran out.
STONE: That's Bonnie DenDooven again with the Bridges Network.
DENDOOVEN: This model has a significant treatment-outcome-positive history.
STONE: Insurance covers the treatment at programs like DenDooven's, but not the cost of living in the related group homes.
ANTHONY DEKKER: Almost any parent would say yes to that - and even a second time, and even a third time.
STONE: Dr. Anthony Dekker has worked in the field since the 1980s. He says, on average, an addict ends up in seven different programs. What's more, the failure rate in private rehab - ones without comprehensive medication-assisted treatment - generally exceeds 80 percent.
DEKKER: This is a vulnerable population that's easy to take advantage of. There's got to be some way to monitor not only the intervention and the treatments, but also the results.
STONE: Just this spring, Arizona passed a law allowing more government oversight of these homes. Only a handful of states have done that. Others have or are working on voluntary certifications - what Jill and Glenn Martin have been fighting for since their son Joey died in one.
G. MARTIN: We're not trying to shut down sober homes. We're not trying to stop addicts from getting help. But what we don't want to happen, also, is what happened to us.
STONE: They hope these new regulations will help other families like them. For NPR News, I'm Will Stone in Prescott, Ariz.
GREENE: And later today on All Things Considered, we'll hear how the proliferation of sober-living homes is changing the city of Prescott, Ariz. Transcript provided by NPR, Copyright NPR.