What is an unethical marketing practice?

In the view of this organization, and many others who have added their voice to this discussion, unethical addiction treatment marketing practices are those that may diminish the ability of people in need of treatment, their families, professional referents, or others to effectively identify and be directed to the care best suited to their needs, or in any way leads to the mischaracterization, misrepresentation, or misdirection of addiction-related issues, treatments, practices or organizations. Essentially, treatment center marketing should in no way interfere with an individual's ability to efficiently and effectively find the care they need. Additionally, an important aspect of ethical marketing also means adherence to 42 CFR Part 2 and HIPAA guidelines and ensuring that patient privacy and peace of mind are at all times protected.

There is no one definitive list of ethical or unethical marketing practices. Most marketing tactics themselves are not the problem, it is how they are used that may pose a threat.

Some common forms of unethical marketing practices:

Lead Selling/Buying or Incentivized Referral:
When a center is contacted by a prospective client whom would be better served by a different treatment program, it is preferred and encouraged that they refer this prospective client to a center that could better meet her or his specific needs. This collegial and professional communication leads to a better patient outcome. But when the referring center asks another center to either pay for this prospective client lead or in any way expects to be compensated or receive special consideration in the future, this breaks ethical guidelines. Not only are prospective patients in this scenario treated as chattel, but creating the expectation for future repayment or preference may bias the parties and interfere with their perceived ability to do what is best for their clients. While much lead selling may be taking place between Admissions staff, for example, this issue also extends to services such as call centers and website directories that broker lead information.

Misrepresentation of Services:
Treatment organizations should accurately portray the services they provide, the types of issues they treat, the credentials of their medical and professional staff and all specific aspects of their facilities, locations and amenities. Whether a prospective client or referent is having a telephone conversation with center staff, visiting its website, or reading a press release, blog post or brochure, they should always be receiving truthful and accurate information.

Misleading Information:
It should be clear to prospective clients and referents where a treatment center facility is physically located, what types of treatment they provide, what insurance they accept and other basic information. This should be clear at all times and in all forms of communication. There have been cases, for example, of centers using websites and web advertising to make it appear that they offer help in many cities and states when, in fact, their facility is located in only one city or state. While the idea that they may be able to help people from any location, it should not appear to people seeking help near their home that a center offers treatment in their vicinity when it does not. It should also not be the case that people are led to believe that their insurance will be accepted when it will not, or that they have a program, amenity or specialty which they do not, in fact, offer. Some specific examples of misleading information in marketing include pay-per-click ad campaigns that make it appear as though one center is another, internet directories that may list many centers but drive all calls to a single call-center, and more.

Discussing Clients Without Explicit Consent (HIPAA and/or 42 CFR Part 2 violations):
Client information is private and protected by HIPAA and 42 Code of Federal Regulations (CFR) Part 2. HIPAA and 42 CFR Part 2 provide the guidelines for the proper and lawful disclosure and sharing of patient information for the purposes of their treatment. These laws explicitly govern the organizations that fall under the guidelines and the procedures, disclosures and safeguards needed to comply with regulations. 42 CFR Part 2 is a specific set if guidelines for drug and alcohol treatment services (particularly those who receive government funding or dispense substances for which DEA authorization is necessary). However, all should be aware of what they may or may not disclose about patients. In many cases, it is not lawful to disclose the identity of a current, past or prospective patient to unauthorized entities without express and specific patient approval in the form of an appropriate written disclosure document. 

The field of addiction treatment is especially collegial, and councilors, admissions staff, executive directors and others regularly connect and share knowledge. It is always important to remember that while professionals may share a close affinity and share general information freely, it is never appropriate to discuss specific clients without that client's express permission and for the purposes of medical treatment. It is also not appropriate for admission executives or others who may have an interest to ask centers they refer to if a client has successfully checked in or is under their care unless all aspects of proper authorized communication as set forth in HIPAA and 42 CFR 2 are adhered to. Discussion of clients and their treatment is generally not allowed outside of the client's treatment team for the specific purposes of their care. All treatment center professionals and marketers should be aware of and trained in adherence to HIPAA, 42 CFR 2 and any and all other relevant regulation of client information protection and confidentiality.

Inappropriate Use of Clients for Promotional Purposes:
While client testimonials, photographs and stories may seem like a valuable means of communicating a program's unique value and community, tremendous care should be taken when considering using clients in promotions. Here again, it is important to ensure that any and all use of client-specific information adheres to 42 CFR Part 2 and HIPAA regulations. If a client decides and provides written, appropriate release for the use of their image and information for use in marketing materials, they and the center should be aware that this information will become available to the general public. It should be made clear to clients who may chose to appear in marketing materials that employers, universities, family members, friends and others will be able to see this information. While some clients have the time in recovery and emotional stability and fortitude to act in their own best interest, some others, especially those still undergoing treatment, may feel obligated to comply. Clients should never be made to feel that they should/need to help the treatment program by providing any form of testimonial or provide any form of representation.

Ignorance of Third-Party Consultant Practices / Plausible Deniability:
It is the responsibility of treatment center marketers to inform their marketing agencies of ethical practice guidelines and review their marketing materials and communications for potential breaches. In some cases, centers may not have known that the work they were contracting may have led to unethical behavior. The hired contractor may also be unaware. The responsibility for adhering to ethical behavior rests with the subject matter expert - the treatment center professionals. Centers should be aware of all marketing and communication materials being generated and how their advertisements, paid search, organic SEO, public relations, directory listings, content marketing, call centers and other marketing vehicles are being used. By educating your marketing consultant partners you can better ensure accurate, ethical communication.