'It's Very, Very Complex': Navigating the Maze of Addiction Treatment De Novo Expansion
Behavioral Health Business
By Chris Larson
September 22, 2026
Addiction treatment providers cannot assume a de novo location will open without hiccups. Industry experts emphasize that leaders of new-growth projects must be prepared for unpredictable state policies and potential roadblocks.
"It’s very, very complex; it’s not very transparent," shares Doug Leech, CEO of Ascension Recovery Services, during a panel at the 2026 SUD Business Summit. He suggests states could improve by providing clearer guidance to attract quality operators.
Navigating Uncertainty
Ascension Recovery Services operates in 35 states across nine programs. Their experience highlights the challenges:
- Process Unreliability: Following procedures to the letter might not guarantee success due to varying state regulations.
- Impact on Patient Care: Time spent navigating bureaucratic processes can hinder patient care.
- Building Relationships: Leech emphasizes the importance of early engagement with key decision-makers and functionaries to foster relationships that can aid in overcoming challenges.
Leveraging Relationships for Success
Tony Kilgore, CEO of Behavioral Health Group, agrees on the value of relationship building, but acknowledges the added time commitment it requires. While it can lead to strategic partnerships, not all providers are willing to invest the effort.