PEOPLE battling drug and alcohol addiction in Philadelphia are watching Hollywood movies in outpatient group therapy - on your dime.
The tab can exceed $50 a person for each movie, paid by Medicaid.
Clients said that some of the movies they saw - like "Caddyshack" and "Teenage Mutant Ninja Turtles" - had nothing to do with recovery.
The films that did depict addiction, including "The Basketball Diaries," starring Leonardo DiCaprio as a heroin addict, and "28 Days," with Sandra Bullock in the throes of alcoholism, made them crave the very substance they are trying to kick, they said.
More than two dozen clients at three of the city's largest treatment centers spoke with the Daily News about their therapy.
Although some city officials and treatment providers contend that watching movies can be helpful, national experts on substance abuse said there is no scientific research to support it as an effective treatment method.
In fact, some movie scenes could actually trigger setbacks for people in recovery, the experts said.
"[A movie] might stimulate a conversation, but it could also stimulate a relapse, especially movies that are graphic and realistic," said Howard Shaffer, director of the Division on Addiction at Cambridge Health Alliance and an associate professor of psychiatry at Harvard Medical School.
Several clients said that the drug scenes on screen did just that.
"It makes you want to use because it reminds you how good you feel when you're high - how it numbs everything and you don't have no worries," said Tiffany Anderson, 25, who receives treatment at the Goldman Methadone Maintenance Clinic, which is part of North Philadelphia Health System at 8th Street and Girard Avenue.
"The movies don't help; it's just something else to keep you there," Anderson said. "[The clinic] makes money from us going to group [therapy].
"It's all about the money."
Outpatient treatment is big business in Philadelphia. Each year, Medicaid pays more than $70 million to help people with drug and alcohol addiction through various treatments, including group and individual therapy.
The money is administered through Community Behavioral Health, which manages about $800 million a year in substance-abuse and mental-health services for more than 100,000 Medicaid recipients in Philadelphia.
CBH is a nonprofit contractor under the city's Department of Behavioral Health and Intellectual disAbility Services. In turn, CBH contracts with a network of more than 290 health-care providers, some for-profit and some nonprofit, including the Goldman Clinic.
How much in Medicaid dollars is spent on people watching movies is unknown.
But Medicaid pays between $5.70 and $8.95 per person for every 15 minutes of outpatient group therapy, depending on the client's treatment plan, according to rates negotiated between CBH and its providers.
So, using the $8.95 rate, Medicaid would pay $53.70 per person to watch a 90-minute film.
Most clients said they watched a movie about once a month on average in a group of about 15 people.
CBH officials who oversee treatment providers said they support the use of movies in group therapy as long as there is a "clinical rationale."
"I would suggest that there are times in which a video is appropriate, but a video is not supposed to substitute for the active engagement in terms of nonmedication treatment intervention," said Roland Lamb, director of both CBH and the city's Office of Addiction Services.
For a provider to bill Medicaid, a movie should only be used as a "psycho-educational" tool to foster recovery, said Lamb and Matthew Hurford, a psychiatrist and CBH's chief medical officer.
"So if [a movie] is used as part of a group therapy, we still need to see every element that we would expect for a therapeutic group therapy," Hurford said. "[The elements] include: what the therapist's interventions were, what the individual's responses to those interventions were, how it advanced or did not advance that individual's progress toward their recovery goals."
Other experts on substance abuse expressed skepticism.
John Cacciola, a senior scientist at the Treatment Research Institute and an adjunct associate professor of psychology in psychiatry at the Perelman School of Medicine at the University of Pennsylvania, said he would not recommend movie watching as "an ongoing regular component of treatment."
"You just don't throw the cues at someone without teaching them how to deal with them," Cacciola said.
"If it occurred once a month, would I say it's terrible? No. Would I say it's optimal? Probably not that either," he said.
William Stauffer, executive director of the Pennsylvania Recovery Organizations Alliance, or PRO-A, a nonprofit advocacy group, said that he is not an expert in Medicaid rules, but expressed concern about the practice of showing films in group therapy.
"I would worry that watching movies in therapy could run afoul of Medicaid rules," Stauffer said. "I've done therapy and treatment for 25 years and that doesn't sound to me like what you would do in a therapeutic group. Therapy is about working with people and having them examine issues about their own substance use and recovery process. If you are sitting there for two hours and just watching a movie, you are not involved in that kind of dialogue."
Anderson said that "The Basketball Diaries," in particular, made her want to use heroin.
"Part of group therapy is supposed to stop you from craving. Why would they show a movie that makes you crave?" she asked.
In the film, a young DiCaprio is drawn into a grimy basement, where a drug dealer persuades him to inject heroin and hands him a needle.
DiCaprio, who plays high school basketball star Jim Carroll, is then seen bounding through poppy fields, shirtless, under a crisp sun.
The character narrates, "It was like a long heat wave through my body - any ache or pain or sadness or guilty feeling was completely flushed out."
Other scenes show him snorting cocaine and washing down prescription pills with cough medicine.
Anderson, who has been receiving treatment at Goldman Clinic for three years, goes to two 90-minute group-therapy sessions a week. She said she has to attend the therapy in order to get her daily dose of methadone, an addictive synthetic opioid primarily used to treat heroin addiction.
"I can't get medicated if I don't go," Anderson said. "They should have a program to wean us off [methadone] but they don't."
Another 38-year-old Goldman client said she knows of two women who, after watching "The Basketball Diaries" in group therapy with her, left to shoot up heroin.
"They told me it was because of the movie," the woman said. She requested anonymity, fearing she would be booted from the program and denied methadone.
"I don't want to get thrown out," she said.
Other movies that stirred cravings included "Drugstore Cowboy" with Matt Dillon and "Clean and Sober" with Michael Keaton, clients said.
Dana Klapiszewski, another Goldman client, said she does not see any benefit to watching movies as part of therapy.
"It's stupid. It's a joke . . . I think it's the easy way out. Who wants to watch a movie? You can do that at home," she said. "The movies are boring. And some people who come here are still getting high and they fall asleep."
Whether the clients are asleep or awake, the clinics get paid.
Jessica Thomas, 35, said she has been a client at Goldman since June and has watched five movies in group therapy, including "Anger Management" with Adam Sandler and the comedy "Tammy" with Melissa McCarthy.
Thomas said she recently watched "Anger Management" over two days. Her counselor put the film on during a 9 a.m.-to-noon "intensive" group-therapy session and then left the room, she said.
The movie had not yet finished, Thomas said, when the counselor returned and turned it off, asking the group something like, "Did anybody ever go through any of these situations in life and if so, how did you deal with it?"
Thomas recalled responding, "Why the hell are we watching this movie? What the hell does this movie have to do with recovery?" Her questions were greeted with murmurs of agreement from fellow group members, she said.
Still, the group watched the rest of the film the next day, she said.
Thomas is among more than 750 clients who go to the Goldman Clinic every day to receive methadone. The amount of required therapy hours is based on their treatment plan.
Goldman Clinic administrators did not return phone calls for comment.
CBH audits providers at least once every three years and the state inspects the licensed facilities annually.
Providers are not permitted to bill Medicaid, through CBH, for movies that include no therapeutic components or psycho-educational value, said CBH's Hurford.
"If we ever learned that there was a group where somebody came in and pressed play on a DVD, like on a movie . . . and then walked out and came back an hour later, hit stop and then sent us a bill . . . we would take the money back," Hurford said.
The provider would be cited and CBH would conduct an investigation, he said.
CBH has received only one complaint for showing a movie in a nontherapeutic way within the past two years, he said. The provider generated the complaint and the employee was suspended or fired.
One provider said that if a movie shown in group fuels a temptation, that is exactly the point: to address cravings in a controlled setting with professionals who can teach clients how to fight the pull of addiction.
"You can walk past a corner where you used to cop drugs and the very same thing can happen," said Lloyd Thomas Reid, founder and CEO of Southwest Nu-Stop, a for-profit outpatient treatment center.
"But now you have a platform to talk through it. Here's what you can talk about, 'I feel like using. How do I deal with the craving now?' " he said.
Movies can be used to hold a mirror up to people who don't want to see themselves realistically, he said.
"There's a lot of instances in movies that people can relate to - death, stealing, absence of family, dysfunction. Folks seldom associate with their own behavior. It helps them see themselves and understand," Reid said.
Even so, Reid said the center doesn't show movies all the time.
"This is not a movie theater," he said. "The purpose is to have some therapeutic value. We don't show them for leisure, entertainment or because there's nothing else to do."
Pat McGarvey, director of clinical services at Nu-Stop, with centers on Woodland Avenue and on Poplar Street in Francisville, said films are sometimes shown on Fridays, known as "socialization day."
"When members come here they are so beaten down with battered self-esteems," she said, "they have lost their leisure-planning skills."
Clinical supervisor Johnie Fennell said "28 Days" and "What Dreams May Come," starring Robin Williams about death and afterlife, were two recent movies shown in group at the Poplar Street location, which generally has about 250 clients a day.
On a recent Friday afternoon, Jesse Jamison, a client at Nu-Stop's Woodland Avenue location, said he had just finished watching "The Inevitable Defeat of Mister & Pete" featuring Jennifer Hudson.
Jamison, 33, said he got a lot out of the movie, which is about a Brooklyn boy who must fend for himself after his mother is locked up on drug charges.
Jamison, who attends two 90-minute group-therapy sessions a day, said Nu-Stop has helped him deal with alcoholism. Counselors don't only show Hollywood movies, he said. He recently watched a documentary about Sigmund Freud's love of cocaine.
Executives at the Northeast Treatment Centers, which serves more than 3,800 people as outpatients battling drug or alcohol addiction every year, said its policy is not to show commercial movies in entirety.
"We use a small number of educational videos and sections of commercial movies using psycho-educational goals to support the larger group goal," said Regan Kelly, president and CEO of NET.
The use of any movie has to be approved by a supervisor, she said. Staffers have to justify how it would help in treatment and recovery.
"We are not showing movies just to kill time," she said.
John Carroll, vice president of the NET Steps division, said showing a full Hollywood movie during group therapy is "a no-go here. It's against our policy. We're not into that."
Yet clients, both former and current, said they were shown full-length movies.
Joe L., 43, who went for treatment at NET for five years ending in 2012, said he saw more than 30 movies during group therapy there.
Since the center lacked a treatment program to help clients wean off methadone, Joe said he went through an insufferable withdrawal on his own in the woods near Holme Circle in the Northeast. He said he doesn't want his full name used, fearing it might jeopardize his current career as a successful commodities broker.
The claim that NET therapists don't show movies is "an out-and-out lie," he said.
"They say they have a policy against it. Well, why would you have a policy if it's not a problem?" he asked. "It's like you wouldn't have a policy saying, 'Don't wear swastikas' unless someone had worn something with a swastika on it."
"8 Mile," "Caddyshack," "The Edge," "City by the Sea," "Titanic," "Clean and Sober" and "The Boost" were just a few that he saw in group there, Joe L. said.
"These movies are a waste of time. It's a joke," he said. "We'd just sit around and taxpayers are paying for it."
Having a new counselor every three months or so made treatment even more difficult, he said.
"They would go through counselors like Olive Garden goes through dishwashers," he said.
"It was a ridiculous situation. There was no incentive [for them] to help me get better. They would [lose their clients and] all lose their jobs."