So this is an interesting story, of a city – Prescott, Arizona – that found itself becoming a capital of the “Florida Model” of addiction treatment – daytime group therapy on a social work basis plus residence in sober living homes, as compared to more “traditional” and expensive medicalized inpatient programs with onsite 24-hour programs at site of residence. Thoughts:

1. This sounds culty.

The ’60s-‘70s cults (and “human potential” groups), in drawing seekers who wanted to radically change their lives through intense group therapy, were not all that far off. (Remember, the medical inpatient model of addiction treatment only really broke through with the publicity surrounding First Lady Betty Ford).

Synanon started as drug treatment program. Narconon is an onramp to Scientology. I’m reading a history of the Rajneesh cult and detox programs, and also “deprogramming” from other cults, were a big part of their outreach. (Alcoholics Anonymous itself is something of a socially approved Nazirite cult)

The lost-in-life and desperate are prime conversion material. With this many small rehabs operating in one location, in a community of mutual influence and feedback, I would expect at least 3 or 4 full-fledged personality cults to emerge.

2. This sounds like a pyramid scheme.

I mean, the addiction treatment industry has always drawn on ex-addicts as workers. While in college heroin took off in my hometown, I noticed how many of the high school classmates who went through it seemed to come out being ex-addicts for a living, working as counselors or program directors. But I mean, there’s got to be a limit to this, right? Not everyone can follow the patient-worker-petit bougie service provider path, right? Set aside what happens when the opiate crisis ends, and these addiction waves do always end, one way or another.

(Off the top of my head, 1910s laudanum – opiate tincture – patent medicines; 1920s cocaine; 1940s heroin; 1960s-70s amphetamines and sedatives; 1970s heroin; 1980s PCP and luxury cocaine; 80s-90s crack; grunge-era heroin; 2000s methamphetamine)

Also, this is congruent with 1), consider the culty aspects of multi-level-marketing programs.

3. This sounds like a spa town.

The idea of a bucolic town people make retreat to in hopes of treating ailments and generally improving health through structured decompression is nowhere near new. That’s any number of mineral springs. Or countryside sanitariums/asylums/health resorts. Or pilgrimage sites with relevant divine patrons.

Or combinations, say Southwestern Desert outposts like Taos that made their name first on dry air for TB and other pulmonary patients and later the mystic power of intersecting ley lines.

(Arguably, that’s a big part of the dynamic with “secular” beach/lake/resort towns, too.)

4. This sounds like the eds/meds economy

A big problem with the American economy is most of the infrastructure and people are located in places that have no productive function today. Small towns grew up around river landings and railroad stops to serve a day’s ride or so worth of family farms; as the country industrialized they already had the transportation infrastructure and available labor population to support factories; now in the post-industrial, agribusiness world based on airports and interstate highways, they, uh…

This extends up to major cities, which performed similar roles further layers of abstraction up. So in trying to rig something together to justify and support their existence, a contemporary theme is focusing on “eds and meds” – universities and hospitals, and the support structures around them.

A lot of this is framed in terms of knock-on effects – that a dense network of technology-heavy institutions will spawn another Silicon Valley or Massachusetts Route 128, or at least make the area more appealing for businesses to locate or recruit employees to. (The difficulty of maintaining hospital service is a serious vicious cycle favoring rural depopulation.)

But more than that, this strategy serves to directly suck in capital from outside the region. A lot of university and medical costs are ultimately borne by the federal government in the form of grants, loan guarantees, Medicare, Medicaid, etc. What’s not still might come from out-of-town parents, patients, insurance companies. Students spend $X/yr into the local economy without requiring an $X/yr job. Once your medical industry is humming you can community college your middling HS grads into nurses, X-Ray Technicians, physical therapists – reasonable LMC paraprofessional jobs, with federal and state programs underwriting their training AND wages.

So by that standard, Prescott’s a success story. The treatment facilities and sober living homes bring $$$ to the city. They inspire secondary industries - the medical billing specialists mentioned, I’m sure also pharmacists, property managers, masters’ programs in social work. Property values are not only shored up after the 2008 crash but booming. Prescott has a reason to exist now, and the means to support itself.

And as typical, much of the benefits accrue to local propertyholders, local residents not tied in to the favored sector see few gains as the newcomers remake the city in their image while the cost of housing rises dramatically.