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Help at Any Cost: How the Troubled-Teen Industry Cons Parents and Hurts Kids Hardcover – February 16, 2006

4.5 out of 5 stars 48 customer reviews

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Editorial Reviews

From Publishers Weekly

This important book takes the troubled-teens industry to task, exposing the "extremely harsh, perhaps even brutal tactics [companies use to] keep [kids] in line." For $2,000 a month and more, a program will take an oppositional teen to a lockdown facility or a wilderness boot camp for however long it takes to break him or her. Parents pay more than an Ivy League tuition for their children to undergo some "out-of-line" punishments (use of "stress positions," brainwashing, etc.), and, says Szalavitz, there's no evidence that these facilities cure anything. Indeed, many teens suffer post-traumatic stress disorders for years; some actually die in these facilities. Szalavitz, a freelance journalist and senior fellow at Stats.org, has written a courageous—if horrifying—study of the tough-love industry, focusing on four key players: Straight Incorporated, North Star Expeditions, the World Wide Association of Specialty Programs and the KIDS program. These hugely profitable businesses are largely unregulated by legal, medical or ethical codes, avoiding accountability for failure by blaming the victim. With a useful appendix discussing when and how to get responsible help for a troubled teen, this book, filled with first-person accounts, should be required reading in Parenting 101. (Feb.)
Copyright © Reed Business Information, a division of Reed Elsevier Inc. All rights reserved.

From Scientific American

In 1958 a residential treatment program for heroin addicts, called Synanon, initiated a radical methodology to break the addiction cycle. Using "attack therapy"in an environment of "tough love," counselors forced drug users to alter their self-destructive behaviors. Such methods became so popular that in 1982 counselors Phyllis and David York argued in their bestseller Toughlove that families should also embrace harsh measures. Hundreds of tough love–style residential programs have since emerged. Yet no scientifically supportable evidence has ever shown that these methods are effective. In fact, some data suggest they may do harm.

In Help at Any Cost, Maia Szalavitz, a senior fellow of the Statistical Assessment Service at George Mason University, shows how "abusive, dehumanizing practices that reformers of mental hospitals and prisons have attempted to stamp out for centuries" have been repackaged and sold to desperate parents. "Thousands of well-meaning, caring, and intelligent parents have been taken in by a business that uses exaggerated claims of risk to teens to sell its services." All of this has amounted to a multibilliondollar industry. This is a story, she says, "of splintered families; of parents convinced by program operators that extreme, even traumatically stressful treatments are their children’s only hope." Homing in on several leading programs, Szalavitz carefully documents cases of reckless punishment that physically and psychologically hurts youths. Military-style boot camps and wilderness programs that pursue extreme "rehabilitation" measures have left teens dead of illnesses and dehydration, spawnin numerous lawsuits. Such "professional" programs operate nationally and charge college-equivalent tuitions. Yet there is no regulatory oversight or medical or legal evaluation of the quality, competency or effectiveness of such programs, even though they assume responsibility for the lives of minors.

Citing a draft consensus report by the U.S. National Institutes of Health, among other studies, Szalavitz says such programs simply do not work. The evidence that exists "offers no reason to believe that group detention centers, boot camps, and other ‘get tough’ programs do anything more than provide an opportunity for delinquent youth to amplify negative effects on each other."

Szalavitz concludes her book gently with practical guidance for parents of troubled teens, including ways to get more sophisticated help. Ultimately, she urges parents not to yield to desperation and to recall the leading principle of medical ethics: "First, do no harm."

Richard Lipkin


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Product Details

  • Hardcover: 336 pages
  • Publisher: Riverhead Books; First Edition edition (February 16, 2006)
  • Language: English
  • ISBN-10: 1594489106
  • ISBN-13: 978-1594489105
  • Product Dimensions: 9.4 x 6.5 x 1.1 inches
  • Shipping Weight: 1 pounds
  • Average Customer Review: 4.5 out of 5 stars  See all reviews (48 customer reviews)
  • Amazon Best Sellers Rank: #404,487 in Books (See Top 100 in Books)

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More About the Author

Maia Szalavitz is an award-winning author and journalist who covers addiction and neuroscience. Her next book, Unbroken Brain (St. Martins, April, 2016), uses her own story of recovery from heroin and cocaine addiction to explore how reframing addiction as a developmental disorder could revolutionize prevention, treatment and policy.

She's the author or co-author of six previous books, including the bestselling The Boy Who Was Raised as a Dog (Basic, 2007) and Born for Love: Why Empathy Is Essential-- and Endangered (Morrow, 2010), both with leading child psychiatrist and trauma expert Bruce D. Perry, MD, PhD.

Her book, Help at Any Cost: How the Troubled-Teen Industry Cons Parents and Hurts Kids, is the first history of systemic abuse in "tough love" programs and rehabs and helped spur Congressional hearings, GAO investigations and proposed legislation to regulate these groups. She also co-wrote the first evidence-based consumer guide to addiction treatment, Recovery Options: The Complete Guide, with Joe Volpicelli, MD, PhD. (Wiley, 2000).

Currently, she writes a bi-weekly column for VICE on drugs and addiction. From 2010 to 2013, she wrote daily for TIME.com and she continues to freelance there and for other publications including the New York Times, Scientific American Mind, Nature, New York Magazine online, Pacific Standard, Matter, Nautilus, and The Verge.

Szalavitz has won major awards from organizations like the American Psychological Association, the Drug Policy Alliance and the American College of Neuropsychopharmacology in recognition of her work in these areas.

She lives in New York with her husband and a Siamese shelter cat.

Customer Reviews

Top Customer Reviews

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Maia Szalavitz' Help At Any Cost is a carefully researched and well-reasoned analysis of the development of "tough love" programs formerly and currently operating in what she calls the "troubled teen" industry, also known as the "behavioral health" industry. I believe the book is destined to become a landmark volume on this topic, and I applaud the author's efforts to bring the issue of institutional child abuse onto the national stage where attention to and debate about this topic is sorely needed.

My perspective as a reviewer is first, as a mother of a daughter who spent nine months in a residential treatment center in Utah in 2005 for treatment of profound depression and suicidality. Secondly, I am a practicing pediatrician and a former master's level social worker. I have personally read nearly every reference which Ms. Szalavitz has used for documentation. I found this book to be written in a very even-handed fashion, especially considering the incendiary nature of the topic and the damning evidence of continuing abuses which continue to be revealed on nearly a daily basis in small, regional publications throughout the country.

It was critically important that Ms. Szalavitz' present the natural evolution of the "teen help" programs as descended from The Straights, because although some of the programs she has thoughtfully dissected are no longer in existence, many of their basic tenets and operational principles have been passed down to new generations of programs. Beliefs such as that all kids are "manipulators" and are therefore not to be trusted, and that kids who arrive in treatment programs must have done something bad and therefore do not deserve respect, are rampant, including in the "good" program which my daughter attended.
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Having survived a facility in MT and heard from recent graduates describing the same type of mistreatment I endured at a facility that is touted as one of the best by Educational Consultants and parents alike, I have found that Ms. Szalavitz has hit the nail on the head with regard to the wide spread ignorance of educational consulants, of parents, and ultimately of those who run many facilities in this industry- all at the high cost of harming many youth in the process.(I suggest that at times this ignorance has been willful, as in my case)

While educational consultants may believe they know, parents may claim they know, few actually do until their children live it...by then it's too late. It simply is impossible to know what kind of program your getting given the wide spread approach of youth as manipulative, the involuntary institutionalization of many youth (some for minor offenses), and the lack of access to advocates and lack of unrestricted access to parents. Surely this type of approach is a breading ground for trouble, reasonably so- what ever happened to real care and empowerment?

Given these facilities are unregulated, often states have extremely stringent requierments when it comes to invesitgating child abuse. Call CPS at any state and ask their policy on unregualted facilities vs. regualted, you'd be suprised what you find out. With the exception of Michigan and Ohio to my knowledge, the way most states handle unregualted facilities in terms of child abuse differs a great deal. Enough so that I would not feel comfortable considering sending my child to an unregulated facility.

This list goes on and on with regards to problems within these facilites.
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Being a student at one of these "programs" for near the entire year of 1999, this book helped me heal more than anything else has. It described situations and feelings we all went through there, things I had blocked out. Maia is a hero for all of us survivors: telling our story, making people aware of the injustices that continue to go on against America's youth. Her detailed accounts of individual incidents and informative sections on related general areas, including POW's and brainwashing, brought the whole book together as an informative masterpiece about a great injustice of this day and age.
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I just finished reading this riviting book. Maia interviewed our family and many other families while doing research for this book. She has told our story accurately and has postulated questions that are important for our society to answer about what we will and won't allow to happen to our youth, even if they misbehave. Whether you agree with the books conclusions or not, the stories she tells are real. We know many of the people she talks about. These things are happening today, and we need to look at it, be aware and have a voice in the future of our youth. I would not say that this is an unbaised report, but it is well documented and the conclusions are valid and supportable. Maia takes a stand, without apologies. But, she arrived at that stand after much objective research.
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Besides a headline here and there about deaths or extreme abuse at "programs for troubled teens" the scope of the problem with these programs and exploitation of families, especially their vulnerable teenagers, has gone largely under the media radar. It is from under the radar this industry is growing like a cancer. One umbrella corporation operates about 30 programs and seems to plan to go public. The profits from this black scam are huge.

It is stunning to me that a minor who has commited no crime, (often the opposite - is suffering from some trauma or abuse) can be "escorted" (kidnapped) across state lines and locked up in a *licensed* (or unlicensed)troubled teen facility for an indeterminate length of time without *any due process* at all, no way to contact friends, extended family, get legal help or report abuse. All of this is supposed to be part of "milieu therapy" and at the heart of the treatment is a type of Primitive behavior modification that is nearly universal among these programs. The system aims to break a teen by stripping them of any BASIC comforts, like using sugar or wearing shoes and closing them off from the world. Teens will either succumb to the mind control or they will play the very twisted game despite their moral compunction. They are constantly put in a double bind, i.e. commonly they are forced to rat on each other at level 3 or 4. They are told that if they behave according to the bizarre standards set by these behavior modification system earn points to get privileges and move to another level, usually 4 levels, at which point they are considered "graduated." The system in its details is extremely Orwellian and staff don't need to get physically abusive when they have control over the souls of these kids.
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