It Can't Work

“It can’t work.” In entrepreneur-speak, this means “I won’t be coming to compete with you anytime soon.” Music to our ears, it means we’ve got time to figure everything out. But let me start at the beginning. 

My sister died seven years ago this August 6th. She was an opioid addict. Anyone who reads the news knows it’s an ever more common story. But it’s numbing. It feels too big to fix. Losing someone you love, however, is quite a different experience.

People react differently to loss. My reaction was to fight. I co-founded Lionrock Recovery, a Joint Commission-accredited telehealth company focused on helping people beat substance use disorders, aka addiction. We provide care worldwide by secure video conference and mobile app.

And a fight it’s been. Five years and nearly 1,000 clients later, “it can’t work” and its cousin, “you can’t do that”, are phrases I still hear frequently.

About a year ago, I was presenting Lionrock to leaders of a large addiction treatment organization. On screen, I had a slide displaying the Joint Commission Gold Seal, and I was discussing Lionrock’s accreditation by this famously demanding quality assurance organization. Literally interrupting me mid-sentence, a senior executive of this organization blurted out, “What part of Lionrock could the Joint Commission possibly accredit?” I took a breath to avoid saying out loud what was passing through my mind. I smiled and replied, “Well, all of it.”

The naysayers are right about one thing though: it’s a lot harder than it looks. Some parts of what we do couldn’t be more by the book. Our counseling practices, for example, conform to the American Society of Addiction Medicine’s (ASAM) best practices, also adopted by the Substance Abuse and Mental Health Services Administration (SAMHSA) of the federal government. The health insurance companies and state regulators also have a big say in what we do. But there are many aspects of how Lionrock provides best practices telehealth that don’t translate directly from brick and mortar to online. Here are a couple examples.

Testing clients for drug and alcohol use. Objectively holding clients accountable for their drug or alcohol use is very important. Brick and mortar treatment centers do it by collecting urine samples from clients and testing for the presence of substances. Online, the challenge is greater. By social convention, we can’t watch you pee. But it occurred to us that we can watch you put something in your mouth. So, we use oral swab tests. We ensure that the testing process is tamper-proof, and that the tests are administered correctly.

Emergencies. Sadly, we work with a killer disease. Its psychological and physical complications can be fatal to people who struggle with it. In brick and mortar settings, you know where people are. They’re there with you. Yes, you do need emergency contacts in case of trouble. Online though, there’s an added wrinkle: we’re not in the same place, and clients can attend therapy sessions from multiple places. We’ve created processes that ensure we know where clients are at all times. Because we’re “mandatory reporters”, we work closely with local police when we believe a client is in danger. When necessary, we do not hesitate to send officers to clients on “wellness checks.” It happens a few times a year.

There are many small obstacles like these to providing robust telehealth care. They all require creativity to overcome. Once we’ve figured them out, we automate them. We’ve built an end-to-end information system over the years into which we embed all of these telehealth-specific techniques.

Yeah but, can it work?

We survey all of our clients each week to understand how they’re doing. Some of the questions we ask also relate to how we’re doing. From our weekly surveys gathered over the last 12 weeks, 40% of our clients report being “extremely” satisfied with their recovery progress, and another 40% “considerably” satisfied. 15% were “moderately” satisfied. We’re hard at work trying to help the 15% "moderates" and the remaining 5% make better progress.

If you’ve got time, listen to what some of our clients say about us (it’s audio) here: https://www.lionrockrecovery.com/about/client-testimonials

We don’t have any big longitudinal studies yet, but we will soon. In the meantime, it may interest you to know that the Veterans Administration did a four-year study of 100,000 veterans from which they found they had better mental health treatment outcomes using telehealth than facility-based visits.

“Well, that can’t be right!” Another cousin.