Considering Addiction Through the Eyes of Digital Health
Did you know that in 2015 the National Survey on Drug Use and Health (NSDUH) found that 20.8 million Americans struggled with a substance use disorder? Out of these individuals, 15.7 million of them specifically were dealing with an alcohol use disorder and 7.7 million had an illicit drug use disorder. This is a startling percentage of Americans who are dealing with issues of sobriety and societal integration.
Sometimes it can be easy to hear these statistics and simply focus on the overall numbers and percentages. We can discuss how drug abuse and addiction costs the U.S. close to $200 billion in healthcare, criminal justice, and legal costs or how the World Health Organization estimates that the global burden of disease related to addiction is 5.4% worldwide. But when the conversation solely revolves around these impersonal numbers and discussions of how to systematically reduce the cost and prevalence of addiction at a macro level it is easy to lose sight of the more micro picture. Each of these statistics represents real individuals with families and loved ones who are all being impacted by alcohol and drug usage. The Department of Health and Human Services has said that on the average day 3,900 people begin using opioids for nonmedical reasons and that 78 people die from opioid-related overdose. That is 3,978 families being impacted daily.
Addiction is a dark corner of healthcare.
It is a disorder that is easily sensationalized with claims of widespread epidemics that produce catchy headlines or stories that are used as scare tactics to keep young adults in line. In the United States, there is a long problematic history of attempting to deal with drug and alcohol use that extends all the way from even before events such as President Richard Nixon’s vilifying of addicts and policy of containment to today’s drugs laws which have resulted in significantly higher rates of incarceration for minorities. Just look at the fact that some states today allow recreational use of marijuana while others still view it as an illegal substance whose usage should be punished similar to heroin usage. Irrespective of one's view on marijuana, the fact that there is such a breadth of stances towards this substance is troubling in a developed country and demonstrates our lack of consistency of approach and knowledge when it comes to drugs.
Today in healthcare, we as a whole are still somewhat unsure of how to address issues of addiction in a substantial and productive manner. We have consistently struggled with the question of how to best support individuals dealing with substance use disorders in an affordable and equal opportunity way. With inpatient rehab centers costing anywhere between $12,000 to $60,000 for a 60- to 90-day program and the number of beds available at a lower cost for the uninsured being in extremely low numbers, the cost of recovering from a substance use disorders is as painfully high as the cost of sustaining such a disorder. The current available treatment methods, and also continued sobriety support, are vastly skewed towards catering to the wealthy despite the fact that addiction is not something that is limited to one socio-economical category of individuals, it traverses all economic boundaries.
The only way that we can begin to address the cost of addiction on society is by making the cost of recovery and sustained sobriety much less for the individual.
How can this possibly be done? It currently looks like the solution may potentially come from technology and the digital health sphere.
Free and low-cost digital platforms for addiction and sobriety management have been on the rise in the startup realm. With the ease of technology adoption and also the ability for widespread distribution these platforms have the capability to reach audiences of all socio-economic levels and geographic locations. Some traditional barriers of healthcare access are able to be circumnavigated by the digital realm which makes the potential for increasing access and individual level solutions much more widespread. While technology solutions alone cannot solve addiction, when such solutions are integrated into a comprehensive treatment plan they truly have the potential to improve recovery numbers.
Sam Frons, the founder of the addiction wellness platform Addicaid, highlighted the potential benefits that will occur on an environmental level if addiction is mitigated or eradicated when I spoke with her, highlighting the “$700 billion spent annually on addiction related problems from the productivity loss, student drop-out rates, welfare, and unemployment costs that all add up over time”. Her platform was not only designed with the desire to build a support group for those dealing with an addiction; she also wanted to focus on the “often overlooked aspects of behavioral health that factor into addiction”.
Addicaid was developed by Frons and a team of recovering addicts who were focused on offering spectrum-based treatment by incorporating cognitive behavioral therapy, dialectical behavioral therapy, compassion-focused therapy, community reinforcement approached, motivational interviewing, and acceptance and commitment therapy into a single platform. Unique to the platform is that users are matched together by within cohorts of 7 other members to give each other feedback in the recovery journey and function as a unit of support. For Frons, relapses and lapses are just part of the continued journey of addiction recovery and her platform stays away from sobriety day counts which she views to be “draconian”.
One of the most exciting parts of Addicaid is the potential expansion into settings where affordable addiction solutions and truly needed. Currently, Frons noted that she is working with a district attorney in Chicago in drug and family courts to work on getting Addicaid out to case managers. This would allow for managers to offer the Addicaid platform as a solution to individuals in the system who need assistance with substance abuse disorders.
Another addiction-focused startup that has been involved in this sphere is WEconnect, which was founded by Daniela Luzi Tudor when the idea came to her while in recovery in 2014. WEconnect focuses on the most crucial first-year of sobriety and takes a 24/7 approach with a focus on the “tracking of mind, body, and spiritual activities”.
Highlighting isolation as a major hinder to recovery, WEconnect allows users to add their loved ones into the app and encourages communication and progress tracking. “The invited contacts receive a text, and they can choose whether to onboard onto the app and then accept or decline the invite. Everyone can edit their support group as they see fit. The individual can include counselors, peers, parole officers, and loved ones; anyone they consider a supporter of their recovery. It was important to include the entire gamete of their support network and not just a counselor or a clinician as recovery is effective through community support.”
What is makes WEconnect a standout in the addiction platform market is the SOS feature that is part of the app. Tudor said this, “was developed to solve a common struggle we face in recovery: isolation. The SOS button is much easier to press than picking up the phone and asking for help. It sends a message gently asking for support from all of your contacts on the app.”. Asking for help can be at times on of the most difficult hurdles of addiction recovery, so the focus on interconnectivity and ease of network access with WEconnect seems invaluable.
Other applications are also taking note in the importance of fostering a support network that is established both in the digital realm and in real-life. The application Sober Grid founded by Beau Mann is currently the world’s largest sober community. When asked to describe his platform, Mann said “Sober Grid is a social network of people that are sober and in recovery from substance use disorder and utilize the application for both social purposes and to offer mutual support to one another. I thought of the idea while I was on vacation and wanted to meet other sober folks to hang out with in the city I was visiting. “.
His app allows uses to click a “Burning Desire” button that highlights their profile in red to let others in the vicinity know that they need help. Used by individuals in AA, NA, or those in no program at all, Sober Grid is an application that is completely cost-free thus providing an extremely affordable option for addiction recovery.
Maybe by continuing to invest in affordable digital health solutions such as these three above applications, solutions to sustaining addiction recovery can be efficiently scaled-up and disseminated to those who need these options the most.
Insurance companies should also begin to look at these platforms as shared saving models and valued-based care solutions that have the long-term potential to help ease some of the costs on society of substance abuse. By focusing our efforts on helping the individual we will be able to see societal impacts. Let’s not get overwhelmed by statistics of addiction and begin brainstorming and supporting current solutions to the micro level issue of recovery and relapse support.