Treatment Center Owners - It's Time to Build a Toolkit to Tell Good Marketers from Shady Ones


You've been burned by unscrupulous marketers, but you still need admits. What are you supposed to do?

I've had the same conversation with several treatment center owners this month.

Their centers are getting all the admits they need, and they're happy with their current marketing agencies, they'll insist.

When I ask what type of offer would pique their interest/raise their eyebrows, though, they tell me a guaranteed minimum admits-per-month.

Wait - I thought you were getting all the admits you needed.

So something's askew in the treatment marketing space lately.

Many reputable centers are running below capacity...

...but they're so terrified of being "taken for a ride" by unscrupulous marketers that they'll baton-down-the-hatches and insist "we're good" to all comers, while they run at 50% census.

Last fall I wrote a guide to seeing if your marketing agency was up-to-par, but I fear that needs an update, and to understand why, here's a brief history of treatment marketing:

Before last July, the industry was in more-or-less steady-state, with most of the largest players controlling the best clicks on Adwords. Adwords is a transparent keyword auction, so there's no "secret sauce" or intellectual property in the targeting. The biggest bid usually wins.

At the same time, the abuses that would eventually bring down the ire of the media and, at least in Florida, the law, were occurring. (More about these here.)


Then, last September, The Verge and the New York Times published hard-hitting pieces about patient brokering and fraud, and Google started outlawing addiction-related keywords on Adwords.

Overnight, the Adwords ban left treatment centers without a paid internet advertising channel...

...which meant many opportunistic marketers rushed to sell alternatives. We should know. We were one of them.

We had a Facebook funnel that had worked for us in multiple industries, including cosmetic dentistry, but we weren't sure how well it would work in addiction treatment.

Here's what we did:

  • Spent thousands of dollars of our own money running ads to make sure the funnel worked and make refinements before we offered it to any clients.
  • Disclosed to the first few clients that the service was in its infancy, and offered "almost-free" trials, until the funnel had proven itself with results.
  • The more robust the results, and the more sure we were of the service, the more we changed our terms back to industry-standard (though still pennies-on-the-dollar of the results).

Some marketing agencies had had even more experience running social ads than we had. (Though we became the only firm that specialized in social ads.)

But many, treatment center owners have told me, did not.

Many of those other marketers also weren't as transparent as we were.

As I've heard it from treatment center owners I've spoken to, here's what they did:

  • Promised amazing results, and weren't transparent about their experience/past success.
  • Took retail-level up-front payments.
  • Delivered zero ROI, usually in the form of "high call volume" with zero quality.

And, as I hear it, there are a lot of these guys out there.

So, if you're a treatment center owner who'd like more inquiries from qualified people who want your help, via ethical advertising channels, what are you supposed to do?

It's time to develop a "BS detector".

Below, two questions to ask any prospective marketing agency, to let the qualified firms shine, and weed out the hucksters.

Marketing BS Detector Question One - What KPIs Do You Track?

KPIs, or Key Performance Indicators, are a good way to get a sense of what a marketer is optimizing around...

...or if they're optimizing for anything.

Here's how it works from our perspective:

We know clients won't stick around for long if they're not admitting qualified people who need their help, whom they reach as a result of our ads. That's why, ultimately, we're looking at quality leads over just quantity. More about that below.

We also know we can't completely control their intake process. That's why we screen carefully who we work with, but we also don't guarantee admits.

Now, let's look at red flags a firm is playing fast-and-loose:


If they promise "call volume". I can get clicks on Facebook ads for next-to-nothing. I can get calls all day. Here's the catch: hardly any would be qualified.

It breaks my heart every time one of my clients gets an inquiry from someone who really needs help, but who doesn't have a qualified insurance policy. We try to minimize this type of inquiry with tons of transparent disclaimers, but when our clients do receive them, we recommend they follow up and recommend other options. Bottom line, we're in this to help people.

But a marketer with fewer scruples is perfectly happy to run ads to medicare and medicaid recipients, get all those people's hopes up, then it's up to the admissions reps to field the calls and deliver the bad news.


Treatment professionals have trained marketers to optimize for "call volume", because of the misconception that "more is always better". The faster we unlearn the "high quantity/low quality" kneejerk, the better off we'll be, and the more we'll do right by the people who need help but can't afford inpatient care at a private facility.

Conversely, if marketers are guaranteeing admits, that's also a red flag. Here's why:

We've seen a big range in the number of qualified leads a center is able to admit.

We've seen a similar range in cost-per-admit, depending on the geography and attributes of the center.

If I were unscrupulous enough to guarantee admits, I'd do it one of three ways:

Make such a "low ball" guarantee I'd be underrating the average client result by a mile (and, hence, misrepresenting the results they could reasonably expect).

Run my own call center, which is an ethical gray area.


So what do we focus on?

Average client result, and ROI.

This keeps us zeroed-in on the part of the process we can control: lead quality.

We'll send you the best inquiries possible, and show you a range of what other clients have been able to do with them.

Another thing to beware: any mention of "building your brand", or "engagement", without specific KPIs attached.

If one camp of shady marketers wins business by over-promising, another attempts the hat trick of not being accountable for anything.

Some of the euphemisms for the "no-results-necessary" approach:

"Multi Channel Marketing Strategy"

"Growing Your Influence"

"Getting You In Front of The Right People"

I'm suspicious of brand marketing writ-large, because I like "skin in the game" (i.e. I don't win unless you win).

However, there are agencies that do the "multi-channel" thing very well, and produce results.

How do you tell those agencies from the hucksters?

Simple, as above, ask "how do you define success", and "how will we know if this is successful".

If they say "we can track all your inbound via Analytics or UTMs, so we'll have a good picture of how well our stuff is working", alright then;)

If they equivocate, or give one of the "magical thinking" answers from above, run. 

Marketing BS Detector Question Two - How do You Demonstrate Competency?

A "spidey sense" for whether a marketing strategy makes sense, or is utter BS, is, in my opinion, the most valuable, and most-sorely-lacking skill in the treatment space right now.

(In fact, we may write a book;)

After nearly a decade doing direct-response marketing directly for clients (never as an employee), my brow will crinkle when somebody floats something "too good to be true."

Here's an example:

This center or agency is running this ad...


...directly to this "lead form".


The odds that they're collecting quality leads from it are rock-bottom low, in my opinion, for two reasons:

First, there's experience. I know what type of results different funnels (combinations of ads and what the reader sees after the ad) produce, and how difficult it is to get quality results. This would be the marketing equivalent of your neighbor training for two months then winning the Tour de France.

(For more about one version of a real results-producing funnel, read this.)

Second, there's "would I click on this" dead-reckoning. Here's an ad for a little-known treatment service. With no information about them besides that they're running ads, and they purport to treat addiction, would you enter your details on that form if you were serious about receiving treatment in this climate of John Oliver and The Florida Shuffle, let-alone for a loved one?

That's a useful (though incomplete) rule-of-thumb if you don't have any background in advertising: "would I click on this".

Which brings us to the topic of this section: how is a marketing agency demonstrating competency?

As we've covered, huuuuge guarantees = too-good-to-be-true, unless an agency is going to take charge of your entire intake process. (I have extremely competent marketing colleagues who do this, some of whom refer their clients to us.)

But those firms who make zero effort to prove their competence won't last long, since many of even the most marketing-naive center-owners have by now been burned at least once.

Here's how we do it:


Teach our prospective clients as much as they can absorb about marketing. We're even starting to sell the Strategy, since it's so detailed a treatment center could take it and hand it off to a reasonably competent employee and still get results (though not as good as we'd get for them, and they'd still have to pay that person, probably more than they'd have to pay us ;)

Demonstrate real client results. This is also sticky, since we don't do references (we respect our clients and don't like to require them to field phone calls), and many clients prefer to keep their names...discreet...due mostly to negative attitudes toward advertising in the field.

Proof with drop shadow.png

We'll provide anonymized client results all over the place, including in case studies on our website, with hard-to-fake elements like redacted screenshots of real campaigns.

For anyone who's looking at a proposal, we'll disclose the identities of a couple of clients whose permission we've sought.

Get Your MA in BS

I hadn't finished my narrated-history.

The last chapter is that, around March of 2018, treatment centers started getting wise to bad marketers.

After March, nearly every center owner we spoke to had had at least one negative experience.

All-of-which resulted in the current climate: owners in need of advertising, but too afraid to trust anyone.

And, to be honest, it's great for us...

We'll just keep creating results and getting new clients by referral, while all the hucksters either go-out-of-business or move on to a more gullible industry.

But it sucks if you run a treatment center owner that's operating at 50% census.

But - and here's "the medicine" - treatment center owners have themselves to blame to a small degree:

By refusing to learn the bare minimum of direct-response marketing to distinguish legitimate offers from fishy ones...

By continuing to insist on guarantees from people in no-position-to-provide-them, like marketers with no control over your call center...

By insisting on instantaneous results and "call volume", which incentivizes marketers to sell you low-quality/BS calls and leads...

...and by continuing to fiend for a "quick fix" in general.

As long as there are still people gullible enough to believe that an average person can get rich overnight, without any hard work, there will be "22-year-old billionaires" with bridges to sell on the internet.

And as long as operators of treatment facilities keep jumping from shiny-object-to-shiny-object, continuing to fall for hucksters because they insist on too-good-to-be-true results, those hucksters will be out-in-force, happy to oblige.

What is "Ethical Treatment Marketing"?

"Ethical" is fast becoming word-of-the-year in the addiction treatment marketing space.

(Hey - we use it too;)

Ever since The Verge and the New York Times exposed the shadiness that passed-for-normal in treatment marketing, those who don't sell referrals or outright lie to people have had an easy differentiator.


But try finding a "how-to" on ethical marketing - especially one not written either at a third-grade reading level, or in legalese.

"Essentially, treatment center marketing should in no way interfere with an individual's ability to efficiently and effectively find the care they need," wrote one.

"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."

Great. Thanks for clearing-that-up.

Journalistic sources are also mostly unreliable, conflating unethical practices like patient-brokering with stuff that's boilerplate for any Fortune 500, like paying a lot for clicks on Google Adwords.

That's left many treatment centers in murky water as they try to sort the good-from-the-ugly.

"We don't pay for referrals," one center CEO told me last year, in response to an offer for branded internet ads.

But reputable treatment centers need a way to reach qualified people who need their help more-than-ever, as referrals slacken.

All-of-which inspired me to write a plain-english, no-B.S. guide to what's fair-game in treatment marketing, what's pushing-the-boundaries, and what's over-the-line.

Straight-Talk Ethical Guideline One - Don't Imply You're Local if You're Not

Three varietals of shady marketing brought down the wrath of the Times and John Oliver, and got the industry banned on Google Adwords.

The first was "sending patients out of state".

As one blog put it...

"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."

I start with "sending patients out-of-state" because it's probably the least-legible guideline.

After-all, if you have prospective clients in Spokane, Washington, what's wrong with advertising there, even if you're located in Costa Mesa?

Answer: nothing.

But here's where it gets a little squishy: Google Adwords is keyword-based - obviously, as anybody's who's seen the sponsored results after fat-fingering a search term knows.


Is it ethical to run banner ads for a So-Cal treatment center to people Boise? Of course.

How about if you run Google ads that display when people search "alcohol rehab boise". That's shadier. A searcher with an explicitly local intent expects his/her search results to be local.

Even if you represent your true location all over your site, should you be running out-of-state ads to local keywords?

Shadier-still, many marketers were actively representing themselves as local when they weren't.

It's my belief that the keyword basis of the Google Adwords platform was the genesis of the fake-local issue.

How to make sure you're 100% "white hat"?

Put your address right atop your website, as many of my clients do.

And if you're using Adwords, maybe don't bid for local keywords unless you're actually local to those searchers.

Oh, and while-we're-at-it...

Straight-Talk Ethical Guideline Two - Don't Buy Leads from a Third-Party Who Represents Themselves as a Treatment Center

"Pay-per-lead" still exists in treatment marketing.

Instead of running ads on behalf of client centers, pay-per-lead marketers collect leads themselves, then sell those to partner centers.

Certain flavors of pay-per-lead are illegal, and marketers who do it practice a legal "soft-shoe" to color-within-the-lines.


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Representing yourself as a third-party, offering a referral to a treatment center, and disclosing that you have financial relationships with the centers to-whom-you're-referring.

Representing yourself as an impartial third-party, who will make a recommendation for the "most clinically appropriate" treatment center, then selling the leads to centers with whom you have financial relationships.

Representing yourself as a center (even though you're a third-party lead-aggregator), often a local center (see above), then selling the leads off to the highest bidders.

All slightly shady, right?

The alternative, of course, is branded advertising.

Branded advertising just means you run ads as yourself, so potential patients know what they're getting start-to-finish.

Straight-Talk Ethical Guideline Three - Don't Pay for Referrals

The center-owner who mistook branded advertising for paying-for-referrals was confused, but he wasn't wrong about paying-for-referrals.

Treatment centers traditionally got a great many of their intakes via referral from "upstream" medical and psychological professionals.

Offing money for those referrals would obviously create a version of the same conflict-of-interest I discussed above, except way-worse, because people trust their medical professionals, a lot more than they trust Google, to make clinically-appropriate recommendations.

Here's the thing about paying for referrals, though: it's bright-line illegal, and hardly anybody does it.

So just, continue to...not do it.

Straight-Talk Ethical Guideline Four - Don't Run Afoul of HIPAA

Also, don't use patient testimonials without their permission, or discuss them by-name with colleagues except as outlined by HIPAA.

But addiction professionals know about HIPAA.

So what does that leave us?

It's pretty straightforward, right?

Don't lie...

...avoid conflicts-of-interests, online and off...

...and hew-to-HIPAA.

I suspect part of the reason for the mass-confusion was the shift to the pay-per-lead model in treatment marketing.

As long as you go branded, and tell the truth, however, there's little to worry about.