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Opioidsucht: rehab is broken. Can technology help?



My father's company had season tickets for the White Sox. On sultry summer days in the Midwest we went as a family – always on the same seats, 25 rows above the first base.

I told this to a counselor, I'll call Bill when he asked me to remind me of a childhood memory. It was part of the Confrontation Circle, a form of group therapy with a self-explanatory name. Half a dozen other clinicians watched as Bill put me in. "I bet you're not going to those games with your family anymore, are you?" Bill asked in a way that looked more like storytelling. I Shook My Head No

It was the summer of 201

2 and the start of my third round of opioid addiction treatment that I had tried to kick since I was seventeen. Now I was 22 and apologized For where did all my money go? I had confessed to my mother that the pills I used had escalated to heroin. At the behest of a consultant, I've logged into a housing program, the kind of rehab you probably know from television, the kind that's reserved for serious cases.

This confrontational circle felt more like gas lighting than therapy. Bill's voice filled with rage when he called me selfish, a liar, a junkie: all the words I called myself. I tried to tell the therapist that my whole body hurt and that I did not believe that my addiction was a "spiritual illness" as they had suggested. Bill kept an eye on me. He made fun of my withdrawal symptoms. He insisted that I was arrogant and intellectual; I had to feel the severity of my situation. Toward the end of the session, I looked up at the other therapists. Her eyes were on the floor.

My rehab visit took place in one of the oldest and most prestigious treatment facilities in America. But the various components of the program were designed to embarrass me – a brutal technique that provides little scientific evidence that it works. In the Handbook of Alcoholism Treatment Approaches William Miller, a clinical psychologist, classifies the confrontational approach that I have endured as the 45th of 48 treatments in terms of effectiveness. Hallucination on psychedelics ranks 32nd. Courses we held every day for an hour or two are the last.

In the US, the treatment community mythologizes "addicts" and "alcoholics" that I no longer use as developmental adolescents Most programs are based on these assumptions. We are considered tearful immigrants who stop ripening on the day we start using them. Since my depressing stay in rehab I've been trying to reckon with the sad state of addiction treatment in the United States. This has led me to become a journalist treating drugs and addiction: I wanted to understand why some mental disorders are treated with medication and effective therapy, while addiction gets stuck in the dim world of popular wisdom. I wanted to understand why so many of my friends were dying.

When I set out in search of the field's failures, I did not know that a group of researchers were trying to reinvent rehab, using technology I would never have heard of. "MHeath", short for mobile health, is a new kind of treatment delivered by smartphones, not unlike the spate of programs found on the App Store. But unlike mobile meditation apps or therapy-by-skype, these treatment apps are developed by clinical researchers and offer programs to curb addiction based on scientific evidence.

I wanted to understand why so many of my friends were dying. 19659009] Most importantly, these apps are one of the oldest stereotypes of treatment – that the only way to stem addiction is to separate a person from their lives. Admittedly, apps alone are not a panacea, which alone can reform the rehab industry. But by developing flexible programs that match the life nuances of their clients, this mini-movement of physicians, researchers, and developers seeks to make addiction treatment more modern-a welcome smoke signal in the midst of a massive crisis. [19659010IndenmeistenFällenhatdieSuchtbehandlungdieevidenzbasierteMedizinhintersichgelassendieaußerhalbdesMainstreamsfloriertSeitsichdasEvangeliumderAnonymenAlkoholikerindenfrühen1940erJahrenverbreitetehattedieAbstinenzgruppeeinenübergroßenEinflussaufdieRehaAAlehrtdassSuchtdurchdieabscheulichenEigenschaftendesCharaktersgeschaffenwirdMenschendieängstlichegoistischundvorsätzlichzuAlkohol(undDrogen)are;befreiesievonihrerbeklagenswertenPersönlichkeitundihreAbhängigkeitwirdfolgenDasErgebnisistwaswirheutehabeneineweitgehendunreguliertegewinnorientierteIndustriedieweiterhinAbstinenzundCharakterbildungalsAntwortaufdieSuchtpredigt

This is particularly true for the opioid dependence. A 2015 study found that patients who only received counseling die twice as likely to die from a fatal overdose than their counterparts on opioid medication, such as buprenorphine and methadone. But less than half of the 12,000 licensed addiction treatment facilities in the US offer drugs to treat opioid dependence. The reason for this lies in the popular wisdom of drug abuse treatment: To treat the addiction, the body must be free of chemicals. At the facility, where I was in Minnesota, for example, even the coffee was only half caffeinated.

The standard rehab is currently boasting only modest successes. On average, around 40 to 60 percent of people receiving treatment will become addicted again, according to the National Institute for Drug Abuse. This is just the rate for patients who have undergone quality programs that are staffed by professionals with advanced clinical degrees. The relapse rate for operations at night or in the old school is probably much higher. (They did not participate in the study of the Drug Abuse Institute.) Still, as the overdose crisis continues to demand more lives, politicians like Chris Christie and Bernie Sanders have made rude demands for more rehab beds to supply the approximately 20 million people that meet criteria for substance abuse

This is where apps come into play. They are created by clinical researchers who, with the help of developers and designers, transfer a program to their smartphone. However, unlike most inpatient facilities, these app-managed treatments begin with supervision. In September 2017, the Pean Therapeutics app, reSET, became the first of its kind to be approved by the Food and Drug Administration, a process that ensures that the treatment has been rigorously tested and proven to be effective. Conditions are so bad and there is so much demand that the FDA recently accelerated the approval process for Pears new app for opioid called reSET-O.

Of course, some cases require more support than others. When I was 17, my life was a series of six-hour cycles: get high, be sick, repeat. At a time when I was looking for new experiences, my world was limited to my opium bunker. I had few friends and many traders, many of whom spoke very little English: our common language was the metric system. Back in the days when there were apps, I was probably not the ideal candidate.

But as some national polls suggest, serious cases like mine are the exception, a stereotype reinforced by the harrowing stories of addiction memoirs. In real life, the addiction is as diverse as the people who experience it, and the majority of people recover from their addiction without formal treatment. Surveys show that many drug users manage to maintain a sense of normalcy: they go to school, hold jobs, and maintain reasonably healthy relationships. But in the universal rehab world, people who show any signs of problematic use are convinced to fly to expensive centers in Southern California or Florida to get the wake-up call they need.

The requirement for mobile treatment apps is that there is nothing magical to treat addiction. There is no moment when the clouds divide and a spiritual awakening begins. Curbing addiction is like stopping a bad habit or changing deep-rooted behavior; Like smoking or nail biting, it takes time, support and constant effort to change. You're on your phone all day, suggest the apps, why do not you slow down bad behavior without missing three months of work? They make time and space for the messy process of addiction slowly unravel: you do not have to wait for the problem to get worse, they suggest you can get help now.


Seek addiction treatment in Apple's App Store and you I'll get 10,000 results. At the moment, only a few apps offer evidence-based treatment, but that number is about to begin. President Trump's Opioid Commission highlighted the need to use telemedicine and technology-based mobile health apps to reach overpopulated rural communities. For less severe cases of addiction, such as people who are still able to keep a job, apps like Annum and Ria Health do not involve personal interaction and are designed to help reduce heavy drinking habits. Other apps fit into the room after rehab: outfits like WeConnect and Sober Grid work like social networks to keep people connected after treatment, while Triggr Health uses machine learning to predict when a patient is about to relapse.

Although many of these programs digitize common rehab practices, they present their methods with a modern spin. For example, Triggr Health uses uncharged phrases like "clean" to describe abstinence from drugs, but uses a more medically accurate (and less morally charged) word: "remission." Instead of proselytizing abstinence as the only way to recovery, many of these apps use expressions such as "wellness" and "quality of life" to describe the ultimate goal of the user.

And unlike most residential centers, including the ones I went to, none of these apps deter medications. For some apps, such as Annum and BioCorRx (which launched a beta version in September 2017), medication is central to their treatment approach. In addition to a digital therapy, an app like Annum connects the user to a psychiatric body that is certified in dependencies that can remotely prescribe prescription drugs that are delivered by post.

In Florida and California, in-patient treatment was called the Wild West Health Care. This lack of regulation has traditionally been a boon to bargain hunters who want to turn their beach houses into "treatment centers". But these lax standards have also left an opening. "We looked at the entire landscape and found that there was a lack of clinical evidence," says Corey McCann, CEO of Pear Therapeutics. "This is a gross failure of the field, patients deserve better."

Since apps are preprogrammed, they offer some protection against fraudulent advisers like Bill, who may offer a completely different experience than what is included in a treatment plan. And within those programs, the apps are designed so that users can set their own goals – unlike my rehab tour, where I was punished for failing to adopt the prepackaged abstinence-or-nothing approach.

Cassandra McIntosh, a psychologist specializing in counseling, believes that this all-or-nothing abstinence method leads to worse outcomes. Unlearning compulsive, almost automatic behaviors will inevitably bring numerous trials, but if you drink or use in a rehab, even once, you'll probably be thrown out. "If you send heroin addicts to the rehabilitation center, you may be overdose," she says. The reason: After weeks of abstinence, our tolerance to opioids is reduced and there is an astronomical risk of overdose in relapses.

Medications such as buprenorphine and methadone reduce this risk by half or more. McIntosh helped design an online platform for WorkIt, one of the first companies to offer web and app-based treatments. From the company's home base in Ann Arbor, Michigan, WorkIt provides remote access to apps, including online text and video chats with coaches and counselors for $ 75 per week. WorkIt also has a inpatient clinic for medication consultations and recovery support group meetings. (A minimal program that costs $ 25 per week includes access to an online addiction program and a weekly check-in with a coach.)

The WorkIts offerings feel a bit like a class: they write into a "Craving Log" "and do exercises in categories like" body "and" mind. "A WorkIt user, Lindsey, who fought opioids, told me she found the prompts easy to follow, and they were often so easy How did you give yourself 15 minutes to clear your mind today? But the exercises are based on Cognitive Behavioral Therapy and Motivational Interviewing, two research techniques that beat work better than the 12-step approach I was taught. (WorkIt's treatment for alcohol had a abstinence-based propensity to do so, a user tells me.)

Not everyone is gung-ho on treatment apps. Therapists and psychiatrists fear that insurance companies will never appealing costs of apps are tempting and leave behind patients who need other treatment options without appropriate options. (A low-end stint in rehab can cost $ 14,000 per month, compared to $ 300 for a monthly app subscription.) Some argue, as my own therapist, that the intimate relationship between client and therapist is not on one Screen can be simulated. And the personal treatment leaves less room for excuses. You are forced to appear as you are in every state of mind. (This may be true, although a 2014 meta-analysis found that "internet-based cognitive-behavioral therapy" was as effective as face-to-face sessions.) Although most apps take action to secure data, many still fear their data to transfer intimate medical information online.

But the strongest effect of a more informal approach to rehabilitation could be detoxification of addiction treatment. Brandon Bergman, associate director of the Recovery Research Institute at Harvard Medical School, told me that clinically validated apps might be of interest to users who are already familiar with technology. According to Bergman's research, 11 percent of the 22.4 million US adults who had solved their substance problem used "recovery-related online technology" such as Facebook groups, subreddits, or a phone app that wakes you up with a motivational slogan. Treatment that is similar to these more informal options provides access to other types of support.

"As long as the treatment is considered this great ordeal, you have a lot of people who do not want help," says Bergman. But if it is on your smartphone? "They will engage many more people in recovery processes," he says. In addition to being rigorously tested by some of the area's top psychiatrists, treatment apps can ultimately make it easier to overcome this first hurdle: finding help.


In the end, my recovery came about despite my stay there. With the financial support of my parents, I found a therapist and a psychiatrist who could help me overcome my depression and lead me to a fulfilling career. I have found friends who have convinced me that I am not damaged goods and taught me what compassion looks like. Many of these friends are people I found online – I am very pleased to be part of a tight addiction bubble on Twitter. Of course, online forums are not a treatment, but when I'm online and connecting with readers, it gives me the kind of solidarity and community I could only offer AA meetings.

And at least I sound like a success story. After rehab I finished college and then a masters degree in journalism. Now I write (precariously) for a living. But if we get past the molecules in my blood stream – THC and ethyl glucuronide – probably from an edible or gin tonic that tries to finish this story – then I did not pass the abstinence that defines traditional recovery.

At least that sounds like a success story on paper

I went to rehab at the age of 22. Now I'm 28, and I look back with dismay on my treatment experience. I know more than a dozen people-high school friends and treatment, some sources-who have died from an overdose of drugs. They were all "treated", abstinent and eventually died from an overdose. Traditional thinking would conclude that they did not pass their treatment. But I do not see it that way. They did not fail the treatment, they failed. When I was sitting through this confrontational circle five years ago, I experienced a field that clung to tradition. But this new generation of providers gives me hope that people who struggle with addiction will receive care that recognizes their dignity.


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