Turning Technology into a Lifeline

David Condos: Hello and welcome to this episode of Recovery Unscripted. I’m David Condos and this podcast is powered by Foundations Recovery Network, today’s guest is Peter Loeb, co-founder of Lionrock Recovery which offers addiction treatment entirely through video conferencing and a mobile app. Peter joined me at the innovations in recovery conference to share the personal connection that inspired him to build a telehealth platform and discuss some of the skepticism challenges and pleasant surprises he’s seen along the way.

Also, stay to the end for more trivia from This Week In Recovery History. Today’s question highlights Alcoholics Anonymous, founded by Bill W. and Dr. Bob on this very week in which year? 1930, 1935 or 1940? Find out after the interview.

I’m here with Peter Loeb. Thank you for being with us, Peter.

Peter Loeb: It’s a pleasure, thanks for having me.

David: I thought we’d start off by having you tell everyone a little bit about yourself and about your personal journey that motivated you to work in this field of addiction treatment.

Peter: Well, I grew up in New York City in the ’70s and I had a sister who was a year younger than I and we were very close, partied together through ’70s and my first exposure to addiction in treatment was in 1985 when her boyfriend gave me a call and said, “Your sister’s addicted to heroin, we’d better do something about it,” and we persuaded her to go to treatment. Years later, it turned out that my oldest daughter had inherited the struggle and I’m very grateful to report that she’s over 11 years clean and sober and married and a mom.

I spent a lot of time as a consumer of treatment services, as a family member helping decide and addiction really was a big part of my life over time. My sister passed away unfortunately in 2010 having been clean and sober for a while but then falling back and really not finding a path forward, unfortunately. I worked in technology in Silicon Valley. I was working on a new business idea with Ian Crabb who is one of the Co-founders of Lionrock and he lives an hour and a half away from me and we were using video conferencing. And I was driving an hour and a half to go to a family group with my sister and I just wondered why I’d never heard about anybody attempting to use video conferencing.

We just started down a path of seeing if anybody was interested in working with us in video legal regulatory, it’s quite a complicated thing, unfortunately. The rules are still being written so when we started out over five years ago, there were no rules. We’ve been feeling our way along carefully, we’re joint commission accredited which was an important piece of who we wanted to be and then as time has gone on we found that there are things that we can do online which you can’t do in a facility.

David: For people who aren’t familiar with Lionrock, can you tell us a little bit more about your current role and the team you have there and where you go?

Peter: Sure, Lionrock is a joint commission accredited telehealth provider of addiction treatment, we provide outpatient care at the intensive outpatient level, the outpatient level and then we have lower levels which include peer recovery support. We host 12 step meetings, which are coordinated by people outside Lionrock but we host them in a video conference. Lionrock started with a team of three, my daughter who’s in recovery and Ian Crabb and I. We’re so dispersed we have can license counselors in over 30 states now.

David: The counselors are anywhere and they’re videoing in just like the patients.

Peter: We manage the whole company in video conference. If it’s good enough for our clients it’s got to be good enough for us.

David: Yes and so you told us a little bit about your journey to starting Lionrock, what was it you saw that motivated you to do something new in the industry and why did you want to provide care over the Internet?

Peter: Well, Lionrock is my revenge. I don’t mean it to be so harsh sounding but addiction really disturbed my life and stumbling into the reality that video conferencing which is a newly available technology was not being used, seems to present an opportunity for me to do something to fight addiction. Really, it’s that for me. Addiction took my sister, almost took one of my daughters. I’m kind of coming for addiction there.

David: Since you guys were one of the first ones to offer this all telehealth type of treatment path, how did you go about practically setting up the program?

Peter: There were really two questions, does anybody want to work with us online in terms of clients? Would counselors be willing to work with us? Then a third question was, is the technology up to it? In the first year, we punched around in the dark a bit. Some of the technology that we thought was going to be great really wasn’t. We needed slightly different people involved and it all came together towards the end of that first year and we were able to put a good team together and had the right technology.

Security is super important, quality is super important and these are all things we learned in Silicon Valley. I worked in the video game business 20 plus years ago for Sega and Electronic Arts and a big piece of that was learning what people expect. How do people interact with machines? Where do production values need to be?

David: That was a big piece of it, you mentioned your background in technology and Sega. I imagine that was a big asset as you were starting this?

Peter: Certainly and we’re not necessarily a software company but we’ve actually developed some pretty cool software.

David: Yes, and so as you started in, you were having to introduce people to this new concept. Were people skeptical about it?

Peter: Yes. [laughs] That would be an understatement. What we discovered was that the people who were interested in working with us online found us online. So, we were trying all things and having modest success. Then we noticed that certain groups of people were finding us so two-thirds of Lionrock’s clients have had no mental health counseling whatsoever when they come to us.

Part of that 20 million that we always talk about that we’re not reaching, more than half of Lionrock’s clients are women, average age early 40s, usually working moms in small towns or suburbs. They come to us for privacy so that was something we didn’t necessarily expect. We knew that privacy was going to be important but it’s turned out to be the most important thing.

David: You’re allowing the market, as it were, to tell you why people are interested in your product?

Peter: Doing startups, that’s what we expect so that’s actually the fun part, to be honest time. I learned that in the video game business where we quite often thought we knew where each game was going to be the hit for a given season and were surprised to find it was a different one.

David: That’s been very rewarding. We have had clients all over the world. We have clients certainly in rural areas of the US, it’s not urban centers and it’s not necessarily the first ring of suburbs but it’s the second ring and the third ring and then smaller towns where the things are a little bit far away and they’re certainly not going to drive and park their cars somewhere where their friends or their friends’ friends’ friend is going to see them, “What are you doing here? Why are you at the hospital? What are you going to?” and over 80% of Lionrock’s clients, for example, are employed which is different than the broader population of people who seek the treatment. Again, it’s very private.

David: You mentioned the distance and the privacy. What are some other reasons that you see people drawn to Lionrock’s treatment?

Peter: One of them would certainly be the flexibility of schedule. We’re able to start at different times of the day, for example. We’re able to provide a way for somebody who needs to miss a session because they’re traveling for business to connect from wherever they are so long as there’s enough privacy. One of the interesting things, you have to learn to do a whole bunch of different things. For example, how do you drug test? People ask us this all the time so we had to figure that out.

Whereby social convention we can’t watch you pee, but we can watch you put something in your mouth so we send drug tests in sealed packages to our clients and then randomly they’re chosen to go get the test and perform it in video live. Our alcohol test is a clear way of testing so it’s an instant outcome. You put it in your mouth, you wait a minute, you hold it up and we can see yay or nay. And then we have a quantitative test for multiple drugs.

Clients collect the sample saliva and then seal and send out and we know what serial number their test is and typically the people who choose us, because that’s what it really comes down to, are very comfortable with the choice in the sense that they’re in their house, they’re comfortable there. Our counselors early on told us that one of the key skills for group facilitation which would be getting people to open up is actually not the problem that they face most often but rather the opposite. That a lot of times people are finally, especially because it’s their first time in any counseling, able to unburden because they want to just let it all out. Managing that is a new skill, for example, of online.

I think that residential treatment has a use and a place. I don’t think that online is going to replace residential treatment. We’re very specific about what we can and can’t do. When we come up against names that are beyond our capabilities, we always refer to other folks. It’s crazy for us to think that we can do detox, it’s crazy for us to think that we can take care of every problem that there may be. We try very hard to know our limitations. We’re thrilled to collaborate with other folks in the field to the extent that that’s desirable. I know that there has been resistance to accepting that a video based modality could create the kind of therapeutical alliance that we look for in a facility.

I invite anybody who wants to join us for a session to experience what it’s like because I think that people picture it as a grainy stop action video. In fact, it’s a lot more like being on night line with three other guests. It’s like TV. It’s high depth and sounds and looks great and so much of communication is non-verbal. We don’t realize how much of a skill speaking on the telephone is. I see you now nodding at me so I know that you’re going along with me but if we’re on the phone together, you’d have to make a sound. We actually are so used to video that we find speaking on the phone like black and white TV from the early ’60s.

David: Yes. I can imagine as video conferencing becomes a bigger part of everyone’s life, Facetime, Skype, all of that, it sets up well for being a natural transition to using this type of treatment.

Peter: Absolutely. No question about it. Yes. As video conferencing has become more popular, we appear much less exotic than we used to.

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David: Could you explain a little bit about what an average day or an average week might look like for a patient who is going through the Lionrock program?

Peter: Sure. If a client is in intensive outpatient, the client will know that he or she has three days of scheduled treatment for three hours which is again the ASAM protocol, also what the health insurers want. We communicate in a variety of ways with clients. Right now they have a secure email address which we use to give them information as well as links to video sessions that they will attend. We also have our mobile app which includes a social network. I’ll talk a little bit about that in a second, but we are integrating our mobile app into everything we do now. Soon it will be the total portal for clients.

We like clients to use a tablet or a laptop of a larger screen for a group therapy because otherwise, the images are a little small. People think of video conferencing if they’ve experienced it in any corporate settings as everyone sitting around the table with the camera at the end of the room. That’s not what we do. Our video conferencing is– The distance between two people’s faces is a foot and a half or so. It’s much closer than you would sit in real space because it would be uncomfortable. It’s very intimate actually.

A client knows when his or her sessions are and is prompted and will click the link and is immediately transferred into the video session. We try and take it slowly for a few minutes just to make sure our physical connections are right, the technology connections are right, everyone is settled in and then they dive into treatment. Our mobile application includes a structure and accountability tool. It’s a feature that allows a counselor to take goals from the treatment plan and create therapeutic exercises that the client would perform outside of sessions.

An example might be, I have trouble getting up in the morning and I keep forgetting to take my meds. One might be, get up at 7:30, eat a healthy breakfast, take your meds. An actual example is a guy told us that he would leave work and then go to the bar on the way home. We had him check in as he was leaving work and check in when he got home using our app which measures location as well as time and date and uses the photo image.

The photo image is really helpful because sometimes you want to know that the client has the phone with them so you ask them to shoot a selfie. Other times you want to know what they are doing. For example, there were three women in one of our groups a couple of years ago who were having trouble with their weight. Turned out that they were not planning meals, that their refrigerators were empty and they would just go to McDonald’s when they were hungry.

What we did was put a visit to the supermarket in their calendar is one of the check-ins. The check in would 5:00 pm at Trader Joe’s on Thursday, shoot a photo of your cart and check out with the healthy food you’ve just bought and tell us what meal plan for the evening is. It’s very flexible and then along the path we decided, “Oh gosh, wouldn’t it be nice for clients to be able to support each other?” We created a social network and integrated that into the structure machinability feature set. What you’ve got is sort of a Facebook-style forum where clients can support each other 24/7 and they actually can see– When it’s configured, then the clients are happy with it.

They can see the check-ins and say, “Hey, where to go?” We’ve stayed away from things like tracking their every movement. One of the interesting things we find, this is particularly when people are in early recovery, they really don’t want us to program their every move. We’ve come up with a way so that rather than, “4:00 pm, go to the gym,” it’s, “How many times do you want to go the gym this week?” “I don’t know I can program get there twice.” “Okay. How about you check in each time you go?”

We have a feature in the app that we call instant check-in which allows you to without a calendar schedule event just do a check in the same way you would otherwise and it still records the time and the place and the photo but it’s up to you when you do it. We found that’s good and we’ve just introduced a rewards program because one of the other observations was that while 12-step programs have chips and positive reinforcement, most of the time at least in our experience in addiction treatment, it’s a lot of negative reinforcement around consequences and things like that. We wanted to see what will happen–

David: Positive reinforcement for a positive action?

Peter: Exactly. For doing what they would have agreed to do anyway, they earn points and we send them in a very small Starbucks card, gift card and it’s highly motivating. That’s exciting.

David: That’s cool. Yes. Back to the– you were talking about the social networking aspect. I bet that’s helpful for them because a lot of these people already know each other from the group sessions so they already feel connected and they are on this journey together and they’re able to encourage along the way.

Peter: Yes, and we can configure the application so that it’s just a client and a counselor or it’s a client, a counselor, and that councilor’s therapy group. It can just be the people you’re in a group with. Or we have a larger community that includes alumni, people who have come in who are in our lower level programs, and it’s nice to have them mix there. There have been some beautiful things that have happened where people have shown up and said, “I’m in trouble,” and three other people would come online and post, “Call me. Here’s my number.”

We’re experimenting with something we call video room which is basically a video conference room that anybody can enter into. They’re not private but if you maybe showed up at 2:00 in the morning and wanted to talk to somebody and maybe there’s somebody there and you can just connect that way. Because it’s within our app, it’s secure. You don’t have to reveal who you are more than you want.

David: That seems like a cool way to use the peer network there because even if–and maybe they could–even if they can’t get in touch with one of their official councilors if they get in and say, “Hey, I need help,” there’s all these other people who are happy to offer that.

Peter: Absolutely. Yes.

David: Then you mentioned your family’s history with addiction. How would you say that your personal experience that you have with that has helped to shape your perspective as you then turn and help others?

Peter: Right. A couple of things. One is that addiction touches people with different levels of intensity. Where my sister really struggled with it quite awfully, I have elements of it and I think that’s actually why I do startups because I need that stimulation. That intensity. Another thing that I’ve learned along the way going to many 12-Step meetings with my daughter the experience of going to AA meetings is very uplifting. There’s something for everybody. There’s the problems encountered and the solutions that have been developed are perfect for anybody.

David: Yes. I’ll just wrap up with this final question. You’ve devoted a lot of your time and effort over the last several years starting Lionrock and trying to help people find recovery. Why would you say helping people through this journey is important to you?

Peter: Commercializing products that are useful is fine but this is an opportunity for me to help the world in a way that is deeper and in the way that as I mentioned before fighting addiction. Addiction has touched my life very deeply and startups are very very hard. I often ask people who tell me, “You do startups? That’s so cool.” I’m like, “Hold on now.”

David: It’s cool after 10 years if it’s become really successful.

Peter: Exactly. Overnight success in 10 years. I often ask people, “Do you prefer boredom or fear?” They look at me and they say, “What?” I say, “No. Boredom or fear?” You had to choose one. Because if you chose boredom, you definitely don’t want to do startups.” In those dark moments where we’re afraid, and I’d like to say it doesn’t happen very often but that would be not true, knowing that we’re doing work that helps people directly. We have a web page of testimonials, audio testimonials. If you listen to them, they tell us one after another, “You saved my life.” The truth is we didn’t save their lives. They saved their lives but we were helpful. That’s gratifying and it helps me through those rough days.

David: Awesome. Well, thank you, Peter, for being with us today.

Peter: Thank you so much. Appreciate it.

David: Thanks again to Peter for joining us and thank you for staying for another installment of our trivia segment called This Week In Recovery History. Each time I share a question, it features a different pivotal event from this week in history that has helped shape our current world related to addiction and mental health recovery.

Today’s question highlights the origin of Alcoholics Anonymous. It was founded by Bill Wilson and Dr. Bob Smith on this very week in the year 1935. Bill W. and Dr. Bob, as they became known in the AA community, first met in Akron, Ohio through a spiritual fellowship called the Oxford Group. The spiritual element along with the concept of alcoholism as a disease provided the foundation for their own recovery and how they would start to help others. They quickly began working with alcoholics in Akron City Hospital but the AA movement didn’t really begin to multiply until they published their philosophy, methods, and early case studies in a seminal text now known simply as the Big Book.

By the time the first AA International Convention was held in 1950, their message had helped 100,000 recovering alcoholics worldwide. Today the Big Book has been translated into 67 languages and latest figures estimate that AA has nearly two million members in 170 countries across the globe. That’s Alcoholics Anonymous, founded this week in the year 1935. Stay tuned for more trivia from Recovery History in future episodes.

David: This has been Recovery Unscripted Podcast. Today we’ve heard from Peter Loeb. For more about the care they offer, visit lionrockrecovery.com. And thank you for listening today. If you’ve enjoyed this episode, please check out our list of previous episodes. There are a lot more great conversations in there so you just might find another one that you’re interested in. See you next time.