For years, the treatment programs providing mainly residential care for patients with substance use disorder have had a marketing quandary: how much money to spend on internet advertising in the competition for patients. This month, Google made an important policy change that dramatically alters that landscape, making it more likely for programs that do not spend a lot of money on ads to compete on a level playing field, by restricting the use of words used to sell addiction treatment. So far, Google has only done this for payday loans and locksmiths, both groups that have reputable and disreputable players — just like rehabs. All three groups serve consumers who are desperate — for money, to get into their houses or cars, or for addiction treatment.

“We found a number of misleading experiences among rehabilitation treatment centers that led to our decision, in consultation with experts, to restrict ads in this category,” said a Google spokeswoman last week. “As always, we constantly review our policies to protect our users and provide good experiences for consumers.”

The news was broken by The Verge and The New York Times on Sept. 14.

Nobody is happier about this than the National Association of Addiction Treatment Providers (NAATP). “What this says to me is they are hearing that the abuses that can occur in addiction treatment marketing are so egregious that they are analogous to the kinds of harm and victimization of people in the payday loans and locksmith businesses," said Marvin Ventrell, executive director of NAATP, which has an ethics code that includes marketing. “If one of the benefits is that when you search for a specific provider, you’re more likely to find that one and not be misdirected, that’s a major win,” he said. (Providers have used “bait and switch” methods to attract patients who don’t know which program they are actually calling.)

AdWords

The restrictions levied this month apply only to the Google “AdWords” program — paid ads that show up at the top of searches, not on “organic searches” that do not involve paid ads, but rather manipulation of search engine optimization (SEO). But the AdWords policy could expand into restrictions. And it’s not clear how long the AdWords restrictions will remain, or how far Google will go with further restrictions. Google actually verifies which locksmiths are reputable now so that people don’t end up with thieves instead; whether it could do this with treatment centers is unlikely.

Of course, there is nothing illegal or unethical about advertising, paying for ads or having good websites. “It’s unfortunate that ethical providers who market under a legitimate competitive marketing program will suffer some restrictions,” said Ventrell. “But the greater good is served by the regulatory measure.”

While the payday loan system — in which people pay a huge fee in order to cash their paychecks instead of deposit them and have to wait for them to clear — seems “highly suspect” on its own, “there is nothing wrong with the locksmith industry, and nothing wrong with doing good addiction work,” he said. “To the contrary, it’s a lifesaving service.”

“Google is actually listening to our industry, and that’s the result of advocacy,” said Ventrell.

Just because a marketing scheme is unethical doesn’t necessarily mean that the treatment program itself is not good, said Ventrell. But it’s up to NAATP to make sure its members are ethical. It’s up to the accreditation agencies — the Joint Commission and CARF — to make sure quality care is being provided. “But at the end of the day, the things we value — quality of staff, longevity of program, description of services, membership in NAATP — if you did a mathematical analysis, I believe you would find a strong correlation between those things and quality. But yes, you could, in theory, have shoddy business practices and good care.”

Greg Williams’ discoveries

Greg Williams, co-founder of Facing Addiction, contacted Google about its policy last fall, when he was working with then-Surgeon General Vivek Murthy, M.D., on the release of the Surgeon General’s Report on Alcohol, Drugs, and Health. “We originally started talking to Google not about ads, but about searches,” he said. “We thought that if you are doing a search for addiction, you should be able to get a sidebar, the way you do for cancer or diabetes, that included a reference to the Surgeon General’s report,” he said.

“That discussion fizzled, but we were concerned enough to hire a contractor who looked at our website,” he said. “Our not-for-profit name — Facing Addiction — was being purchased by many marketers,” he said. “When you typed in Facing Addiction, you had to scroll three pages down to get us,” he said. “There were 20 different treatment centers first.”

The SEO consultant told Williams that Google offers $10,000 grants to nonprofits. “They give you $10,000 a month in a Google grant for free, but it comes with one catch — you can’t bid higher than a two-dollar cost per click,” he said. “Our consultant literally could not spend more than $4,000 a month.” The reason was that the bid for Facing Addiction — the name of Williams’ organization (and of the Surgeon General’s report) — was $80 per click. “We couldn’t bid on it because we were limited to the $2,” he said.

After some research, Williams found out that the top-four highest-cost clickable words are in the addiction field. “Why is this? Partly because nobody knows how to find a good treatment center,” he said, adding that another problem is that good credible information on the disease isn’t easily available with quick Google searches.

So Williams met with Google again this spring. “The core question is, how do we know what is good versus what is bad? How do we participate in this market in an ethical way?" Williams said. “Google asked, ‘Aren’t there some good rehabs?’ And we said, ‘Of course there are.’”

Williams had talked to Ventrell and others before he brought this issue to Google. “We said, ‘We don’t know what’s good and bad, but we know that the evidence is that people should get care as close to their natural living environment as possible.'” The Google marketing was fostering the searches for treatment, even when combined with a geographical preference, because in fact a Florida-based treatment provider could make it look as if it was in New York City — and then send the patient a plane ticket to Florida. “That really started to help Google frame this pay-per-click movement,” said Williams.

Williams said this won’t be a panacea. “Programs will find other ways,” he said. “But what I’ve heard is for ethical providers and ethical marketers, this will level the playing field. They can’t buy each other’s names.”

Finding patients via the internet

Jim Peake, a marketing consultant who specializes in websites and SEO in the treatment field, said that nonprofit, education and government sites carry the most weight with Google. “Inbound links matter to them,” he said. “If I have an inbound link to NAATP, to SAMHSA, to Alcoholism & Drug Abuse Weekly, that will have more credibility and make for a higher rating,” he said. “Those links are pure gold.”

The Google policy is going to adversely affect treatment programs who have spent millions on AdWords, said Peake. “Now you see the guys who have bet the farm on paid advertising, and they’re going to feel the sting,” he said. But he thinks Google will suffer too. “I think AdWords revenue just for the addiction space is between $50 and $100 million a month,” he said. “This is just my guess. But that’s why I don’t think this will last more than two to four weeks.”

American Addiction Centers, which this month spent $85 million to buy AdCare (see ADAW, Sept. 18), is one of the companies that has deep investments in internet advertising. After Google announced its AdWords policy change restricting addiction ads, American Addiction Centers adjusted one website to include more government and organization links to enhance credibility, making it look as if the entire website was about publicly funded treatment and NASADAD and SAMHSA.

“We don’t fully know what this means yet,” said Ventrell of the Google change. “We’ll see how this develops. Marketers and firms who are very sophisticated about playing the online game are already ahead of the game in terms of avoiding the restrictions in the new rule,” he said. “For example, even though ads may disappear, they can still use SEO to get on top of searches, to the disadvantage of small- to medium-budget centers, which represent most of the field.”

For more information about Jim Peake, go to www.addiction-rep.com.

For more information about NAATP’s ethics code, go to https://www.naatp.org/resources/addiction-treatment-provider-ethics/code-ethics.

For NAATP’s press release on the Google changes, go to https://www.naatp.org/resources/news/google-restricts-addiction-ads/sep-15-2017.

Bottom Line…

The internet marketing for patients that has characterized so much of the dark side of addiction treatment has been put to a stop — at least temporarily — by Google.