Rehab centers are cripplingly expensive, are often unscientific – most frightening – are “dangerously unregulated,” John Oliver said on Sunday’s Last Week Tonight. The comedian exposed a frequently obscured dark side of the $35 billion industry, which encompasses over 14,500 drug treatment facilities across the United States.

While many rehab centers boast impressive success rates hovering around 80 percent, Oliver argued that these statistics are based on self-reporting from former clients who often lie about their progress out of shame. Rehab, the host said, “should never be seen as a quick fix – it’s often just the first step in a lifetime of recovery.”

Some facilities utilize controversial treatments like equine therapy, for which there is “no empirical evidence” of its efficacy. And, in general, there are surprisingly few regulatory barriers to opening facilities in several states. “In California, as long as you take private pay clients, anyone can start an outpatient rehab center,” Oliver said. “And in Florida, if you want to open a sober home, a group home where people stay often while they receive outpatient treatment, there is nothing in state law to stop you.”

The host highlighted a system of recurring relapse called the “Florida Shuffle,” wherein centers milk the patient’s insurance until the patient dies. The cornerstone of the industry, Oliver noted, is conducting urine tests, which The New York Times dubbed “liquid gold” in a 2017 report.

For those battling addiction, the process of selecting a rehab facility can be intimidating. Last Week Tonight consulted with several experts who suggested starting instead with a doctor board-certified in addiction medicine. “It’s only recently become an official specialty, so there just aren’t many of them around,” Oliver noted, but those physicians are available to search online.

“This system clearly badly needs more expertise and oversight,” the host concluded. “And until then, it may be really important for all of us to understand that, at present, the word ‘rehab’ is so broadly defined as to be close to meaningless. It is honestly barely better defined than the word ‘building.’ And if someone were to tell you, ‘I have a drug problem, but don’t worry – I’m going to ‘building’ in Florida,’ you would naturally say, ‘Hold on, what’s ‘building’? Where did you find this building? What’s happening inside it? Is it a hospital or a Hooter’s? Or both – is it a Hootspital? What’s the proof that it works, and what’s the doctor-to-horse ratio like in there?’ Does Health Insurance Cover Rehab?

“And sadly, right now, it can be way too difficult to get answers to those questions, which is crazy because so much about battling addiction is really hard,” he continued. “Getting clean is hard; staying clean is hard. But getting good, evidence-based, trustworthy help should be the easy part. And right now, it is way too easy to literally wind up pissing money up a wall.”