The goal justifies the consequence: how to deal with violence in black rehabs
Cases of violations of patients' rights in rehabilitation centers for people with addictions are appearing in the information field more and more often. At the end of last year, it became known about several high-profile incidents related to the so-called black rehabs. To combat this phenomenon, deputies, public figures and market players have created a special code of ethics for the work of such institutions. However, according to experts interviewed by Izvestia, it will not help solve the problem completely — this requires clear government regulation. For more information, see the editorial staff.
Do no harm
A special code has appeared in Russia that sets ethical and professional standards for the work of rehabilitation organizations for people with addiction. Deputies of the State Duma, a charitable foundation and rehabilitation clinics took part in the development of the document. The Code has already been signed by more than 20 medical centers specializing in helping dependent citizens.
The main purpose of the new standards is to ensure the safety of patients in such institutions. Rehabilitation, according to the document, should be based on evidence-based medicine. Violence and coercion are unacceptable.
The Code obliges rehabilitation centers to keep personal information confidential and to ensure that the patient is in contact with his family, preventing his isolation. At the same time, the medical organization must have a clear rehabilitation program, which must be explained in advance to the person who seeks help. In this program, you need to prescribe a patient support plan after leaving the institution.
The presentation of the code was attended by rapper Guf (Alexey Dolmatov), who has visited more than 10 rehabilitation organizations over the past 25 years. He pointed out the importance of adopting standards for helping people with addictions.
"I ended up in a black rehab, in such a scary place that after I got out, I started using again due to stress. I lost a lot of friends because of drugs and such centers. I've seen broken destinies: how they mock people, tie them to the bed with duct tape, make them stare at the wall all day or be silent for a whole day," the artist said.
The reason for the creation of the code really lies largely in the high-profile incidents related to the so-called black rehabs that have been observed recently. One of the recent cases concerned the situation in the Yegoryevsky and Leninsky urban districts near Moscow. There, law enforcement officers revealed the facts of illegal imprisonment of guests of rehabilitation centers, who were systematically subjected to violence. This was reported in December last year in the GSU of the Investigative Committee of Russia for the Moscow region. Investigators have opened two criminal cases, detaining eight employees of the institutions.
We are talking about a network of rehabilitation centers headed by blogger Maxim Antonov. It became known about what was happening within the walls of these institutions after several of their guests contacted the police. By court order, Antonov was arrested. He did not admit his guilt.
A month earlier, a criminal case was opened against another rehabilitation center in the Moscow region. The institution located in Dedovsk was engaged in the treatment of adolescent addictions. The investigation found that it was operating illegally. The children in the organization were beaten and tortured, as a result of which one of the teenagers ended up in intensive care with numerous injuries and traces of binding on his hands and feet. Law enforcement officers detained the administrator and the organizer of the illegal rehab, charging them with several articles of the Criminal Code at once.
Later it turned out that this center was not the only one in the network of organizations, another one was located in the Urals. The Ministry of Internal Affairs of the Sverdlovsk Region announced the initiation of a criminal case on the illegal detention of children from several regions. Law enforcement officers did not find any traces of beatings on the body of the guests, but they decided to place the teenagers in the nearest children's centers until all the circumstances were clarified.
Request for transparency
The desire of a number of rehabilitation centers to unite and work within the framework of uniform professional standards is connected not only with lawsuits against clinics providing substandard services, but also with the reputation that "gray" organizations create for the entire field, psychologist Ekaterina Vashukova, addiction therapy specialist, is convinced.
— When news regularly appears that people were tortured in another center or a teenager was brought to a coma, it hits all market participants. Recent incidents in the Moscow region are perceived not as special cases, but as a symptom of a systemic problem," she believes.
Bona fide market players are tired of being in the same plane with scammers and violence and are trying to draw a line and declare that they work according to different principles, advocating security and evidence-based approaches, the Izvestia interlocutor believes. Their association reflects the growing demand to increase the transparency of the industry and protect its reputation, agrees Ruslan Isaev, head of the Dr. Isaev Clinic and president of the Independent Narcological Guild.
Potentially, the new code of ethics could become a serious argument in judicial practice in the case of claims of improper treatment of patients, admits Vashukova.
"If the center voluntarily assumed obligations to follow professional standards, but in fact violated them, isolated the patient, limited communication with loved ones, and used coercive practices, then this will be weighty evidence in favor of the plaintiff," the expert suggests.
However, it is important here that standards are based on modern and evidence-based models of care, the psychologist clarifies. And the clearer the acceptable and unacceptable practices are described, the easier it will be to distinguish violations of a patient's rights from controversial but professionally sound clinical decisions.
In turn, Isaev does not exclude that in judicial practice the existence of the code can be used as an additional guideline. But in the absence of a regulatory status, its provisions will not always allow unambiguous qualification of violations, since the court needs clear criteria set out in legal acts, the narcologist warns. The current document, by its legal nature, is declarative and does not create mandatory filters for admission to work.
Under one comb
Black rehabs exist largely because relatives of addicted people in a panic pay attention to the first beautiful link to the clinic's website and cannot always distinguish a good institution from a bad one, explains Ekaterina Vashukova.
— If the code forms the basis of a public registry of verified rehabilitation centers, people may have a reference point. When there is a list of organizations that have officially confirmed their standards and are ready for verification, it becomes more difficult to justify the fact that "we did not know where we were taking our son," the psychologist clarifies.
However, it is important to understand that the cases that occurred at the end of last year indicate poor-quality services in only a couple of centers out of about three thousand operating in Russia at the moment, Alina Rudakova, co-chairman of the board of the National Anti-Drug Union (NAS), draws attention. When a negative example appears, the shadow falls on the entire industry, despite the fact that there is a large percentage of organizations working with a different ideology and really trying to help people.
— There are a lot of situations with black rehabs now, but no one is talking about white rehabs. This is largely due to the fact that there are no criteria by which black can be distinguished from white," the Izvestia interlocutor points out.
At the same time, bona fide centers often work in difficult conditions, but they continue to help people, despite the low cost of services and the lack of a lawyer to help them protect themselves from defamation, she adds.
Discussing the appearance of an ethical code for rehabilitation centers in this context may have negative consequences, warns Rudakova. Due to the fact that only a small proportion of rehabilitation organizations have signed the document, it seems that only they are ready to work in the legal field. However, many centers were not invited to cooperate without receiving the developed document for review.
— And this is a problem, because we are working with a very disturbing category of citizens. When patients and codependent relatives hear the news, they may be afraid that their center has not signed the code. Although the organization that did not support the document is not necessarily a black rehab," the representative of US emphasizes.
The rehabilitation industry really needs to be regulated today, but this requires interdepartmental cooperation with the participation of various experts and centers with unique experience, the expert says.
At the same time, there is still no understanding on the basis of which the code will work, who will check its compliance and fix violations, Rudakova notes. This suggests that there are too many unanswered questions right now.
The document can help in the fight against black rehabs, but only if it becomes a real tool, and not just a declaration, admits Vashukova. By itself, the appearance of ethical standards becomes a signal to the market that the rules are changing, but not only the document is important, but also the mechanism for its compliance.
— Who will check the centers and how? Are there independent auditors, a procedure for revoking membership, and public sanctions for violations? — the interlocutor of Izvestia asks questions, emphasizing that without understanding this, any code risks remaining only a set of correct formulations.
The legal vacuum
To date, rehabilitation centers do not have mandatory standards of work, including in terms of the conditions in which patients should stay, Alina Rudakova notes. But the proposed code of ethics, in her opinion, will not solve this problem, since the sphere of psychosocial rehabilitation in Russia is now in an "interdepartmental pit."
— The work of the centers is supervised by several departments at once — the Ministry of Labor, the Ministry of Health, the Ministry of Internal Affairs, and the Federal Penitentiary Service. And the inspection authorities do not fully understand on the basis of which this inspection should be carried out, and the centers themselves are unclear what criteria they should meet," the expert points out the problem.
At the same time, back in 2015, Russian President Vladimir Putin instructed to develop uniform requirements for the activities of organizations involved in the rehabilitation of drug-addicted citizens, Ruslan Isaev recalls. The task was addressed to relevant agencies, including the Federal Drug Control Service. However, over the past years, the problem has not received a systematic regulatory solution — powers have been transferred from one body to another, and federal mandatory requirements have not been adopted.
— Currently, there are disparate documents in the legal field that are declarative in nature. In particular, GOST R 54990-2018 is in force, which establishes general provisions for the provision of social rehabilitation services to people with addiction. In addition, an order of the Russian Ministry of Health dated May 3, 2023 was adopted to approve the procedure for drug addiction patients to undergo medical and social rehabilitation," says the narcologist.
But these documents did not create rigid, working mechanisms for admission to activities and quality control of work, he clarifies. And none of them saved the industry from the events of the end of 2025 related to the activities of black rehabs.
To prevent such situations, it is necessary to adopt uniform professional requirements at the federal level and form regional registers of rehabilitation organizations, which should be supervised by the Ministry of Labor and Social Protection of the Russian Federation, Isaev is convinced.
And first of all, for effective regulation, clear, unambiguously formulated requirements for personnel are needed, according to the Izvestia interlocutor. Criteria for specialized education, additional training programs, proven work experience, and professional reputation requirements should be fixed, he lists, noting that today people without sufficient qualifications are often allowed to do psychological and rehabilitation work. And it is the lack of "filters" that is the root of the problem.
The real task of bona fide market participants and legislators in the current realities is to build regulations that will make it possible to block low—quality services without creating a critical price increase, the doctor is convinced. And this, according to him, can be achieved by systematizing the requirements for personnel and processes, rather than excessive bureaucratization.
The code of ethics rather affects the reputation of clinics, giving them a quality mark, Rudakova believes. But it does not set uniform standards for all institutions operating in Russia.
— This is definitely not a systematic solution to a problem that has been forming for several decades, — the expert emphasizes.
Notice something amiss
At the same time, prevention of violations is equally important, Ekaterina Vashukova is sure. We need clear recommendations for relatives telling us what questions to ask the center, what documents to require, and what conditions to alert them, she lists. And it is worth checking the organization according to these criteria before giving it to a loved one, and not after the fact.
— It is fundamentally important that the industry finally ceases to exist in the "gray" zone. The more transparency and clear standards there are, the less space there will be for violence covered up with words of help," the Izvestia interlocutor claims.
If the trouble has already happened and the patient is in a dangerous rehabilitation center, you need to act quickly, the psychologist emphasizes. If there are signs of unlawful imprisonment, extortion or violence, it is necessary to contact law enforcement agencies with a specific indication of possible violations.
— It makes sense to involve public organizations that collect such cases and help them to give a legal assessment, — the expert recommends.
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