The liability of drug companies that pushed highly addictive opioid painkillers has been an ongoing story for years. But today, we’ll focus on another facet of the economy around addiction.

A new book explores the dark side of the drug rehabilitation industry. It’s called “Rehab: An American Scandal,” and it’s written by Shoshana Walter, an investigative reporter with The Marshall Project. Walter joined “Marketplace Morning Report” host David Brancaccio for a conversation about the failures and expenses of drug rehab. The following is an edited transcript of their conversation.

David Brancaccio: Give us a sense at least of the lay of the land in the world of rehab: Generally for-profit? A mixture of big players and small outfits? How does it work?

Shoshana Walter: The rehab industry as a whole is a $53 billion industry. You have insurance-funded programs, you have totally unregulated recovery homes, and then you have the world of medication-assisted treatment.

Brancaccio: Now, I know you have "scandal" in the title of this, but what do the data tell you about the success or failure of the overall system?

Walter: On average, people go to rehab multiple times before they enter recovery. Someone who attends a 30-day program and finishes that program is actually much more likely to overdose and die in the year following that treatment program than someone who failed to complete that program at all.

Brancaccio: You follow a number of people on their journeys through rehab, and there's a particularly stark contrast. You have a person who's Black, a person who's white, and their experiences are quite different.

Walter: That's right, one of those people, April Lee is a mother of three from Philadelphia who herself grew up with a mother who was addicted to crack cocaine. You know, when April was struggling with her own addiction, she could not find treatment, despite how much our treatment system has grown. Her children were taken from her, she grew worse in her addiction, and the only way that she could find to get out of it was to get herself arrested. And then, on the other hand, you have Chris, a young, white, middle-class guy from Louisiana. He was court-ordered into a treatment program. When he got there, he realized that he would have to work up to 80 hours per week — manual labor jobs without pay — and he rarely received counseling or anything that might be considered treatment. And he was badly injured in the program. And ultimately, he left the program and assumed that he would get sentenced to prison, and ended up getting a break from the judge who gave him probation.

Brancaccio: You know, let's say there were some policy solutions that could fix bad and dangerous management and abusive programs. There's still the problem of cost, right? Rehab can be very expensive, and insurance companies often don't pay the bills at all, or don't pay all the bills.

Walter: The system that we have now is actually fueling these high costs, because people are going into rehab, they're completing the program, they're leaving, they're relapsing, and then they're just going back in again. You know, I spoke with a number of treatment company owners who actually referred to this as "a cycler," like a washing machine cycle. You go in, you go out, you repeat. And a lot of the treatment industry now views this as part of the business model.