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Exposing the Love Addiction and Codependency Fraud

Artwork by Jake Baddeley

Note: As I work toward an M.A. in Depth Psychology, I wanted to share an essay (modified for my blog) I wrote for a final that pushes outside the general oeuvre of Jungian language. However, I believe this post aligns with the spirit of the Jungian current.

Furthermore, this entry is inspired by events I witnessed, experienced and detail in my upcoming book, Love Letters To A Love Addict.

*If you or someone you know have been victimized by a predatory treatment center please follow this link for more information: National Association for Addiction Treatment Provider

"The addiction treatment industry is really suffering from a lack of standards." —Dr. Paul Earley, president of the American Society of Addiction Medicine.

The Ethical Imperative for Reforming Addiction Treatment: Love Addiction and Codependence

The addiction treatment industry is a cornerstone of the allopathic medical mental healthcare model, providing critical, though often debated, services to individuals struggling with substance and behavioral addictions.

However, ethical lapses and fraudulent practices have emerged as significant issues, particularly regarding non-official mental health disorders and advertising for treatments such as “love addiction” and “codependency.”

While these terms have become resonant in popular culture, they lack empirical validation. For example, Bacon, McKay, Reynolds, and McIntyre (2020) published the first interpretive phenomenological analysis (IPA) stating “researchers have attempted to identify the main problems associated with codependency; however, their evidence is still inconclusive.”

They are not recognized by the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), the official diagnostic standard and coding guide between treatment centers and the insurance companies treatment centers bill for their primary source of revenue.

This essay argues that addiction treatment centers must strictly adhere to DSM-5 standards, adopt ethical billing practices, and be subject to robust governmental oversight to ensure equitable, effective, and evidence-based care.

These measures are essential to protect patients, prevent exploitation, and restore public trust in the addiction treatment industry.

The Role of DSM-5 in Ensuring Diagnostic and Treatment Integrity

The DSM-5 is the standard for diagnostics for the medical mental health treatment model in the United States, providing clinicians with an evidence-based framework for identifying and categorizing psychiatric conditions. (American Psychiatric Association, 2013).

Its rigorous standards are essential for maintaining consistency, credibility, and accountability in the medical mental health model, including insurance providers and patients.

However, many addiction treatment centers undermine this foundation by offering treatments for diagnoses not included in the DSM-5, such as “codependence” and “love addiction.”

These practices not only dilute the integrity of the mental health care system but also risk harming patients through misdiagnosis, overdiagnosis, and inappropriate treatment.

Non-standard diagnoses often rest on theoretical constructs with minimal empirical support. Codependency as a mental health disorder requiring medical mental health treatment has been criticized for lacking a clear, scientifically validated definition (Diehl et al., 2017).

In some cases, treatment centers advertising services for “codependency” and “love addiction” employ highly controversial interventions, effectively functioning as high-priced break-up services or coaching that is not evidence based care.

Advertising “Codependency” Treatment: Integrative Life Center — Nashville, TN

Treatment providers often overstep ethical boundaries, intruding on patients’ personal relationships and blurring the lines of professional responsibility.

Dr. Eric Griffin-Shelley in his publication on Ethical Issues in Sex and Love Addiction Treatment states “Contrary to my uninformed view, more than 1 in 10 (12%) psychologists have an ethical, license, or malpractice complaint (Pope & Tabachnick, 1993). Of these, 70% of the complaints are deemed to have merit (Griffin-Shelley, E., 2009).

Under the authoritative influence of medical professionals and rigid treatment protocols, patients may be coerced into allowing home audits, assisted removal of their intimate partners’ belongings and sentimental items, and enforcing no-contact policies as conditions for achieving sobriety, even when there is little or no evidence to justify such drastic measures.

When unwarranted these isolation practices may generate severe disregulation in the patient exacerbating a patients negative affect toward self or other. Borrowing terminology from substance addiction the patient maybe told they are experiencing withdrawal without any evidence that separation trauma as a result is indeed in the best interest of the patient or couple.

The patient’s reactive emotional response from an institutional separation combined with a sense of powerlessness and medical persuasion may covertly coerce the patient into higher levels of treatment, psychiatric drugs, and longer in-patient or residential containment resulting in higher fees. Collaterally, the estranged partner may experience unsupported trauma from their partner’s medically advised disappearance.

This paid-to-care behavior commodification, maybe driven by an industry-wide savior complex. They (rescue) the paying patient (victim), often inflicting unjustified emotional harm on the estranged non-patient (persecutor). Such practices are antithetical to the core principles of mental healthcare and mirror the manipulative dynamics these programs claim to address and resolve.

The Karpman Drama Triangle commonly known as Triangulation.

Furthermore, recovery groups like SLAA and CODA, along with treatment programs, often employ broad, generalized language such as victim, toxic, bottom-line, normie, character defect, and disease conflating these terms with concepts like love addiction and codependency.

This approach may pathologize and sensationalize behaviors that may instead represent teachable opportunities within the normal spectrum of human relational development.

By doing so, these programs attract individuals who either do not meet the diagnostic criteria for DSM-5-recognized conditions or who may require effective treatment for an underlying mood or personality disorder. This strategy not only broadens their client base but also expands program offerings, ultimately driving revenue growth.

Advertising “Love Addiction” Treatment: The Meadows — Nationwide, USA

This strategy, while lucrative for providers, trivializes legitimate mental health disorders and over-pathologizes normal human behavior, such as interpersonal difficulties or emotional dependency (Pearce, 2014).

The absence of DSM-5 compliance in these practices raises significant ethical concerns. Misdiagnoses based on unvalidated terms can lead to treatments that are not only ineffective but potentially harmful, undermining the ethical principle and Hippocratic Oath “to do no harm.”

Furthermore, these practices contribute to public mistrust in the mental health profession, eroding confidence in the ability of clinicians and institutions to provide reliable and evidence-based care. Adhering to DSM-5 criteria is, therefore, a critical ethical imperative for addiction treatment providers.

The Financial and Ethical Costs of Fraudulent Practices

The financial implications of fraudulent practices in addiction treatment are extensive, undermining the integrity of mental health care systems and misallocating critical resources. Among these practices, upcoding is one of the most egregious and prevalent forms of fraud.

Upcoding occurs when healthcare providers exaggerate the severity of a patient’s condition or report a higher-cost procedure than what was performed to secure greater insurance reimbursements.

For example, a patient presenting with mild anxiety might be intentionally misdiagnosed with a severe anxiety disorder or post-traumatic stress disorder (PTSD) to justify billing for more intensive and expensive treatments.

Similarly, a center may provide general therapy sessions while billing insurance companies as if the patient underwent specialized or advanced procedures.

In addiction treatment, upcoding often intertwines with the use of non-standard diagnoses such as “love addiction” or “codependence.” For instance, a treatment center might initially assign a legitimate DSM-5 diagnosis, such as major depressive disorder or generalized anxiety disorder, to a patient.

However, the center may then “upcode” the treatment plan by billing for interventions designed to treat more severe psychiatric conditions, such as borderline personality disorder. Once the insurance claim is approved and funds are disbursed, the center may treat the patient for “codependence” or “love addiction,” an unrecognized and unvalidated condition, using unscientific methods.

This practice not only defrauds insurers but also diverts funds away from evidence-based treatments for patients genuinely diagnosed with severe psychiatric disorders.

The ethical ramifications of upcoding are significant. Patients subjected to this type of fraud often receive inappropriate care, as the treatments administered are quasi-fabricated diagnoses rather than the patient’s needs.

For example, an individual who seeks help for relationship challenges may be misdiagnosed with a condition like PTSD to justify insurance billing. This misdiagnosis leads to treatment protocols that fail to address the patient’s real issues, potentially causing psychological harm and further complicating their development.

Additionally, misallocating healthcare funds exacerbates systemic inequities by reducing insurers’ capacity to cover evidence-based treatments for patients with DSM-5-recognized conditions (Center for Medicare Advocacy, 2021).

The ripple effects of fraudulent billing extend beyond individual patients, eroding trust in the healthcare system. Vulnerable individuals seeking addiction treatment are often misled into enrolling in programs under the guise of receiving specialized care, only to find themselves subjected to ineffective or unvalidated therapies.

This betrayal of trust not only undermines the therapeutic alliance between patients and providers but also contributes to public skepticism about the addiction/recovery treatment industry as a whole (Roberts, 2020). Over time, this erosion of trust can dissuade individuals from seeking necessary mental health care, perpetuating cycles of untreated addiction and related disorders.

The financial costs of upcoding are equally staggering. Fraudulent claims divert billions of dollars annually from insurers, damaging the entire healthcare system. These costs are ultimately borne by taxpayers, who fund public insurance programs, and individuals who face rising premiums as insurers attempt to recover lost revenue.

This misuse of resources diminishes the capacity of insurance providers to support legitimate, evidence-based diagnostics and treatments, creating barriers to care for those who need it most.

To combat the financial and ethical harms of upcoding, addiction treatment centers must adopt transparent billing practices that adhere to DSM-5 standards congruent with the treatments provided.

Regulatory frameworks should enforce stricter accountability measures, such as mandatory audits and penalties for non-compliance, to deter fraudulent practices. By aligning financial operations with ethical principles, the addiction treatment industry can rebuild trust with patients and insurers, ensuring that resources are directed toward effective, evidence-based care.

Need for Governmental Oversight

While voluntary adherence to ethical standards is ideal, more is needed to address the systemic issues plaguing the addiction treatment industry. Governmental oversight is indispensable in enforcing accountability and preventing malpractice.

Regulatory agencies should establish robust oversight mechanisms, including mandatory audits, random third-party secondary diagnostic evaluations, treatment center licensing requirements, and penalties for non-compliance.

These measures would ensure that addiction treatment centers adhere to DSM-5 criteria, treatments, coding, and transparent financial practices.

Critics of increased oversight argue that regulatory intervention could stifle innovation or impose financial burdens on smaller facilities (Peters, 2022). However, these concerns must be weighed against the risks of under-regulation.

The unchecked use of non-standard diagnoses like “codependence” and “love addiction” highlights the dangers of self-regulation, as profit-driven motives often overshadow ethical considerations. Governmental accountability is, therefore, crucial in fostering a culture of integrity within the addiction treatment industry.

To mitigate potential financial burdens, policymakers could introduce targeted incentives for compliance with ethical standards. For instance, tax breaks, grants, or subsidized training programs could support smaller facilities in meeting heightened regulatory requirements.

These measures would enable treatment centers to maintain ethical practices without compromising their financial viability.

Balancing Innovation and Ethical Accountability

One of the most frequently cited counterarguments against increased oversight is that it could hinder innovation in addiction treatment. Critics argue that stringent regulations may limit the development of novel therapies or create barriers to entry for smaller providers.

However, this perspective overlooks that true innovation thrives within a framework of scientific rigor and ethical accountability. The DSM-5 provides a flexible diagnostic system that accommodates diverse therapeutic approaches while maintaining evidence-based standards (Pearce, 2014).

Innovation and oversight are not mutually exclusive; they can be mutually reinforcing. Regulatory frameworks that reward scientific rigor and ethical compliance can incentivize the development of treatments that genuinely benefit patients.

For example, new therapies that align with DSM-5 criteria are more likely to gain acceptance within the medical community, ensuring their sustainability and widespread adoption. Oversight can thus serve as a catalyst for evidence-based innovation rather than a barrier.

Proposed Solutions for Reform

A comprehensive reform strategy is necessary to address the ethical and financial challenges in addiction treatment. This strategy should encompass three key components:

1. Adherence to DSM-5 Standards:

Addiction treatment centers must commit to using only DSM-5-recognized diagnoses with evidence-based therapies and truth in advertising adherence. This commitment includes eliminating non-standardized terms like “codependence” and “love addiction” to ensure all treatments are scientifically validated.

2. Governmental Oversight and Incentives:

Regulatory agencies should implement stringent oversight mechanisms, such as regular audits, treatment center licensing standards, randomized third-party secondary diagnostic patient evaluations, and penalties for non-compliance. To support compliance, policymakers could offer incentives like tax breaks or grants to facilities that adhere to ethical standards.

3. Professional Education and Training:

Training programs for addiction treatment providers should emphasize the importance of ethical accountability and DSM-5 compliance. By equipping clinicians with the knowledge and skills needed to deliver evidence-based care, these programs can help foster a culture of integrity within the industry.

These reforms would address the root causes of malpractice and fraud in addiction treatment, ensuring that patient welfare takes precedence over financial gain. Moreover, they would promote equitable access to care by prioritizing evidence-based practices and deterring exploitative behaviors.

The Path Forward within the Medical Mental Healthcare Model

The addiction treatment industry faces a critical juncture. Without meaningful reform, unethical practices and fraudulent billing will continue to undermine the integrity of mental health care, harming patients and eroding public trust. Adherence to DSM-5 standards, robust governmental oversight, and professional education offer a clear path toward ethical accountability.

While critics of increased regulation raise valid concerns, these challenges can be addressed through targeted incentives and thoughtful policy design. Ultimately, the benefits of reform—enhanced patient care, reduced exploitation, and restored public confidence—far outweigh the potential drawbacks. By prioritizing ethical integrity, the addiction treatment industry can fulfill its obligation to the vulnerable populations it serves.

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). American Psychiatric Publishing.

Bacon, I., McKay, E., Reynolds, F., & McIntyre, A. (2020). The lived experience of codependency: An interpretative phenomenological analysis. International Journal of Mental Health and Addiction, 18(3), 18. https://doi.org/10.1007/s11469-018-9983-8

Griffin-Shelley, E. (2009). Ethical Issues in Sex and Love Addiction Treatment. Sexual Addiction & Compulsivity, 16(1), 32–54. https://doi.org/10.1080/10720160802710798

Center for Medicare Advocacy. (2021). Fraud and abuse in addiction treatment centers.

Diehl, A., Silva, D., & Bosso, A. (2017). Codependency in families of alcohol and other drug users: Is it in fact a disease? Journal of Health Psychology, 22(4), 34–42. https://doi.org/10.25118/2236-918X-7-1-4

Fried, E. I. (2022). Studying mental health problems as systems, not syndromes. Current Directions in Psychological Science, 31(6), 500–508. https://doi.org/10.1177/09637214221114089

Jones, R., & Taylor, S. (2020). Ethical concerns in addiction treatment practices.

Pearce, S. (2014). DSM-5 and the rise of the diagnostic checklist. Journal of Medical Ethics, 40(7), 515–516. https://doi.org/10.1136/medethics-2013-101933

Playle, J., & Keeley, P. (1998). Non-compliance and professional power. Journal of Advanced Nursing, 27(2), 304–311. https://doi.org/10.1046/j.1365-2648.1998.00530.x

Roberts, J. L. (2020). Modern-day witch hunts: How the mental health industry abuses patients and the judiciary while committing fraud. Conspectus Borealis, 5(1), Article 4.