SeaSide [Photo: Behavioral Health of Palm Beaches]

In the world of addiction treatment in Florida, there are hundreds of places like the House of Hope in Fort Lauderdale, a 93-bed facility where patients with drug or alcohol addictions pay, on a sliding scale, up to $3,000 a month for a rehab stint. Patients at the non-profit get counseling, doctor visits, meals and a bedroom shared by four.

Then there's SeaSide. Run by for-profit Behavioral Health of the Palm Beaches, the 18-bed center on swanky Singer Island features designer-appointed condominiums, ocean views, massage therapists, a personal trainer, a fleet of cream-colored SUVs and even "equine therapy" — caring for horses. Recovering in that style costs $49,500 a month for a shared condominium — up to double that if you want a private stay.

"It was not an inexpensive proposition," says retired business owner Ron Dash of his stay at Hanley Center in West Palm Beach. "For me, it was worth every penny." [Photo: Scott Wiseman]

Florida's recovery industry is still dominated by House of Hope-type operations, but most of the growth is on the for-profit side. While two-thirds of the state's 1,360 addiction treatment centers are non-profits, the number of for-profit treatment centers seeking state licenses jumped 22% from 678 to 830 in the 2009-10 fiscal year, according to the state Department of Children and Families, which licenses treatment facilities. Meanwhile, another trend: Both for-profits and non-profits alike are opening upscale centers like SeaSide to serve wealthy clients.

Nowhere are the trends more evident than in Palm Beach County, which is home to the biggest concentration of high-end addiction treatment centers in the eastern United States and now rivals even Malibu, Calif., as a rehab center for the affluent. All but 11 of the 93 rehab centers in the county are run by for-profit companies. The operators include national chains targeting clients from across the U.S. and the world whose financial means are as significant as their substance abuse problems.

Ron Dash, a New Yorker who owned a successful button business in Manhattan, is a typical customer. For Dash, a husband and a father, one drink was never enough. He lived for cocktails at lunch, cocktails after work and a bottle or two of wine with dinner. He began to take pain pills for his hangovers, tranquilizers for the jitters, sleeping pills for insomnia.

Alcohol Still No. 1 • Rehab center directors say that alcohol is still the No. 1 drug abused by their patients. Prescription pain medication is the top addicting substance. At some centers, half of all patients are hooked on painkillers, anxiety drugs or other prescriptions. "We have an epidemic," says Mark Fontaine, executive director of the Florida Alcohol and Drug Abuse Association, which represents rehab centers. Success Rate • Is a $50,000-a-month treatment center better at keeping its clients drug- and alcohol-free than a cheaper facility? Addiction professionals say all addicts are likely to relapse, regardless of how much they've paid for rehab. Success rates are less a function of cost and more a function of length of treatment and how well a program fits an addict's particular needs. What the growth in upscale treatment centers and specialized programs reflects, they say, is patients' desire to rehab among people they view as more like themselves.

Only when his wife threatened to leave him and take their young son did he check into the 80-bed Hanley Center in West Palm Beach. The center, he says, got him sober and saved his life.

Insurance helped, but Dash still paid $20,000 out of his own pocket for a month of treatment. "It was not an inexpensive proposition," says Dash, 57, now retired and living in Palm Beach Gardens. "For me, it was worth every penny."

Hazelden Naples [Photo: Stormi Greener] Large Upscale Operators in Florida • Caron Treatment Centers (Wernersville, Pa.) — Subsidiaries: Caron Renaissance, Boca Raton, and Hanley Center, West Palm Beach • Hazelden (Center City, Minn.) — Subsidiary: Hazelden Naples • Watershed Addiction Treatment Programs: Boynton Beach, Boca Raton and Lake Worth • Behavioral Health of the Palm Beaches, Lake Worth — Subsidiary: SeaSide, Singer Island

Dash's refuge is one of the largest and oldest addiction treatment centers in Florida. Hanley, a non-profit, was founded 25 years ago by Mary Jane and Jack Hanley, a former CEO of Monsanto, after she was treated for alcoholism. Today, the first month of in-patient rehab costs $32,000 for a shared room. Hanley recommends patients get three months of treatment, with stepped-down fees for the second and third months.

Hanley's business development director, Michael Walsh, says Hanley's price includes housing and meals, a swimming pool and gym, doctor and nurse consultations, therapy and tests.

"It's really expensive to do really good treatment," says Walsh. These days, he says, Hanley's price is just "middle of the road."

Dr. Paul's at the Bay [Photo: Dr. Paul's at the Bay]

The intense competition for clients like Dash who can pay those "middle of the road" prices is evident in several ways, including the eagerness of national chains to expand. Caron Treatment Centers, a Pennsylvania-based non-profit that operates facilities in Wernersville, Pa., Dallas and Boca Raton, is merging with Hanley, which will add 20 beds for a new program for adolescents or young adults at its West Palm Beach campus.

"It's really expensive to do really good treatment," says Hanley business development director Michael Walsh. [Photo: Scott Wiseman]

The competition is also mirrored in the rehab centers' aggressive marketing. With some facilities relying on out-of-state patients for as much as 90% of their business, luxury centers maintain elaborate websites featuring slideshows of beaches, pools and luxury accommodations. They cultivate relationships with out-of-state hospitals, employers, counselors and labor unions. And they try to ensure they can be found on the internet by potential clients. SeaSide, for example, strives to make its website, luxuryalcoholdrugrehab.com, appear at or near the top of Google search results for "luxury alcohol drug rehab."

Several factors continue to drive the ritzy-rehab trend, most obviously, a supply of substance abusers willing and able to pay — in cash — for themselves or their children to detox in comfort. For the most part, the clients, not insurance companies, foot the bill. Many health insurers no longer automatically authorize a month of in-patient addiction rehab as they once did. Instead, insurers approve payments for treatment they determine to be appropriate, with policyholders picking up the rest of the tab.

In Treatment • In recent years, treatment centers have developed more programs targeting a specific clientele — for example, programs for lawyers, doctors and other professionals. Many treatment programs focus on younger patients: Twentysomethings, college students and even teenagers hooked on alcohol or marijuana or prescription drugs. • Once at a center, patients begin detoxification and undergo medical, psychological and social evaluation. Then a treatment plan is developed: The patient begins a daily schedule of lectures, individual counseling, group therapy and specialized therapy (for grief, chronic pain, early-life trauma, relapse prevention and other ailments). Patients also may receive physical therapy, massages, etc. Psychiatric problems are treated with medication and counseling.

Operation PAR [Photo: Mark Wemple]

Although many moderately priced rehab centers do well with insurance benefits, some pricey centers don't like working with insurers because they won't pay high fees, rehab executives say.

With a steady stream of customers, the centers can provide treatment at profit margins ranging from about 10% to as much as 25%, according to rehab center executives. Behavioral Health would not disclose its revenue but says SeaSide has experienced a gross revenue increase in excess of 20% year over year.

The market has been so lucrative that some middle-of-the-road providers have begun to offer upscale services as well. The main rehab program at for-profit Palm Partners Recovery Center of Delray Beach costs $19,500 a month. But CEO Peter Harrigan says the center found that its clients included "executives who needed an environment where they could still run a company and have some anonymity."

Three years ago, Palm Partners opened "Platinum Partners," a $30,000-a-month program that provides elegant private apartments with private pools, catered meals, internet access and limousines. Patients participate in intensive counseling, yoga and hypnotherapy as well as spa treatments. Palm Partners, which is privately held, targets executives, pro athletes, entertainers and other wealthy addicts. "People with money want a certain standard," Harrigan says. "There's a real need for this level of care."

State officials expect no letup in the trend toward swanky rehab centers. "We have several applications in the process for high-end facilities targeting the wealthy," says Cathy Claud, DCF's substance abuse service coordinator for Palm Beach County — including a 117-bed facility in Tequesta modeled after the Betty Ford Center in California. Monthly charges? About $38,000.

Says Claud: "It's a good investment."

Why Palm Beach? • The proliferation of high-end rehab facilities is no accident in a county that's among the wealthiest in Florida. Dennis Grady, president and CEO of the Chamber of Commerce of the Palm Beaches, notes that Palm Beach County has attracted other forms of high-end medical services, such as the Cleveland Clinic. And with so many rehab centers, Alcoholics Anonymous and Narcotics Anonymous groups and "sober" houses, the area projects a nurturing environment. It has the greatest concentration of recovering people in all of Florida, says Mark Fontaine, executive director of the Florida Alcohol and Drug Abuse Association.

PRICE POINTS: ULTRA-LUXE • SeaSide, opened two years ago on Singer Island by for-profit Behavioral Health of the Palm Beaches • Beds: 18 • Cost: $49,500 a month for a shared condominium — up to double that for a private stay • Insurance: Accepts some insurance • Market: SeaSide was designed to compete with celebrity rehab centers such as Promises in Malibu, Calif., for clients who otherwise might not consider Florida. SeaSide's treatment program includes "equine therapy." [Photos: Behavioral Health of Palm Beaches]

PRICE POINTS: High • Hazelden Naples, part of the Hazelden organization, the nation's largest chain of non-profit addiction treatment centers, based in Minnesota • Beds: 47 • Cost: $17,000 a month • Insurance: Accepts health insurance • Market: 50% of patients are from Florida and 50% come from out-of-state, including South America. [Photos: Stormi Greener]

PRICE POINTS: Mid-market • Dr. Paul's at the Bay, St. Pete Beach (for profit) • Beds: 28 in a small, converted waterfront motel • Cost: $7,700 for one month, $15,100 for three months • Insurance: Accepts health insurance and offers financing options • Market: Advertises affordable drug and alcohol addiction treatment, including faith-based treatment [Photos: Dr. Paul's at the Bay]

PRICE POINTS: Basic • Operation PAR, a Pinellas Park-based non-profit • Beds: 308 • Cost: A sliding scale based on income and circumstances, ranging from nothing (if the patient qualifies) to about $4,500 for a month of in-patient rehab • Insurance: Insurance and Medicaid accepted • Market: Provides intervention and treatment to more than 13,000 people a year. Also treats drug offenders referred by the courts. Eighteen locations in Lee, Manatee, Pinellas, Pasco and Hernando counties. [Photos: Dr. Mark Wemple]