There, a high-tech twist helped Kostigen break freed from his habit. And now, greater than 4 years later, he’s sober, repairing relationships with family and friends, and dealing half time for the developer of the app he says helped save his life.
It’s made by Boston startup DynamiCare Well being, and right here’s the way it works.
Researchers have known for years that providing individuals battling habit small rewards, like vouchers or present playing cards, for making optimistic adjustments might help break the cycle of drug or alcohol dependency. Often known as “contingency administration,” the therapy works by triggering the identical on the spot gratification response within the mind that somebody would possibly get from substance abuse. However contingency administration has been tough and costly to manage, whereas additionally being criticized for giving cash that is likely to be spent inappropriately.
“All of the medicine of abuse disrupt the mind reward heart, which is deeper within the mind,” mentioned David Gastfriend, DynamiCare’s cofounder and chief medical officer. “Once we simply put individuals in detox after which ship them to counseling, we’re saying, ‘Use your considering mind to attempt to overcome your chemical drive heart.’ The issue is, habits works in the other way.”
The aim of the app, in contrast, is to go proper to the reward heart.
DynamiCare is amongst a rising cohort of native software program firms utilizing every part from cell apps to video video games to deal with illness. Often known as digital therapeutics, the sector consists of Akili Interactive Labs, which is developing video games to deal with ADHD and cognitive issues, and Pear Therapeutics, which is engaged on digital treatments for insomnia and habit.
At first, Kostigen was skeptical that an iPhone app might assist him overcome his alcoholism.
“It appeared like a far attain that I had this piece of expertise that I held in my hand day by day that would assist,” he mentioned. However he made the hassle so as to add his appointments for AA and different conferences, meditation classes, and different necessities into the app.
As he stayed sober, the app doled out small financial rewards onto a debit card that might be simply tracked and restricted — not working at locations like bars, liquor shops, and casinos. The app additionally supplied uplifting messages, reminders, and monitoring of commitments met. DynamiCare pays out the rewards and runs the system in return for a charge that usually is about $350 per affected person monthly, charged to well being care suppliers, insurers, and different organizations that work with individuals battling habit.
Inside a couple of weeks, he was bought.
“When you’re in early restoration, not lots of people are supplying you with optimistic reinforcement,” Kostigen mentioned. “And so at first, simply that accolade of the $5 reward . . . was one thing that I might construct on.”
The app, which additionally permits individuals to fulfill with counselors through video conferencing, has been examined in 5 revealed research and dozens of pilot applications, enhancing outcomes for individuals recovering from abuse of opioids, stimulants, alcohol, tobacco, and nicotine.
In a single research final 12 months within the Journal of Substance Abuse Remedy, 61 sufferers recovering from alcohol abuse at Gosnold Remedy Facilities clinics in Massachusetts have been divided into two teams. These utilizing DynamiCare ended up about twice as prone to cross urine exams over 4 months of therapy.
DynamiCare is the brainchild of David Gastfriend and his son, Eric Gastfriend. David Gastfriend is an habit psychiatrist and the previous director of habit analysis at Mass. Basic. Eric Gastfriend labored at a gaming startup in Cambridge after which attended Harvard Enterprise Faculty.
About six years in the past, when a member of the family was battling habit, Eric Gastfriend had an concept about the right way to clear up the price and accountability issues of contingency administration. “Don’t you notice with fashionable expertise each a kind of obstacles might be overcome?” he informed his dad, considering of smartphone apps, linked testing gadgets, and telehealth classes.
“My jaw simply hit the ground,” David Gastfriend recalled. “I mentioned, ‘Eric, if you happen to might combine that stuff, you may revolutionize my discipline.’ ”
The pair integrated the corporate with Eric as chief govt and David as chief medical officer. They’ve raised about $6 million from buyers together with MEDA Angels, a gaggle of docs who again small well being care startups, and former US consultant Patrick J. Kennedy.
DynamiCare has pitched its program to researchers in addition to hospital networks, therapy amenities, and insurers. The app helps care suppliers by retaining them updated on a affected person’s progress. Which means a counselor shall be alerted when somebody misses an appointment or drug take a look at and might attain out and attempt to get the particular person again on observe.
The app additionally permits individuals in restoration to self-administer a breath or drug take a look at with a tool that connects to the app through Bluetooth, a less complicated requirement than having to go to a facility in particular person.
“I do know I can preserve going with that as an alternative of being lined up with 34 guys ready to get right into a males’s room with a 70-year-old man watching, after which handing him heat pee,” Kostigen mentioned. “It’s quite a bit totally different, and also you begin to really feel such as you’re regular. You’re not feeling that disgrace, that stigma.”
Although DynamiCare’s outcomes have been good, one hurdle to broader adoption had been a Nineteen Seventies-era federal regulation meant to forestall fraud in Medicare and Medicaid. The Anti-Kickback Statute prohibits well being care suppliers from paying or receiving bribes, rebates, or different funds to encourage remedies lined by the federal government.
Something over $75 was thought-about a possible bribe. DynamiCare began out utilizing lesser rewards, like a $1 McDonald’s coupon, however didn’t get the identical outcomes as with larger rewards, just like the $5 it presents now.
So the startup sought an exception to the rule. In March, the workplace of inspector common of the US Division of Well being and Human Companies issued a nine-page advisory opinion concluding that because of the effectiveness of applications like DynamiCare, an app that paid out as much as $200 monthly and $599 per 12 months wouldn’t violate the anti-kickback guidelines.
The transfer comes as deaths from drug and alcohol abuse have surged through the pandemic. Nearly 92,000 individuals died from opioid overdoses in 2020, up 30 p.c from 2019, based on the Facilities for Illness Management and Prevention. And the latest figures for alcohol-related deaths present a 25 p.c increase in 2020 to greater than 99,000.
“The opioid epidemic is simply off the charts,” mentioned John McGahan, president and chief govt of the Gavin Basis, which runs Gavin Home and different therapy amenities. “It’s been exacerbated by the pandemic, after all, as a result of it’s saved individuals out and made it tougher to obtain therapy.”
The muse has seen about 200 individuals use the DynamiCare app. “It’s been a godsend,” McGahan mentioned. “We have a look at this as a life-saving measure and that’s why we use it.”
Kostigen believed so strongly in it that he has signed on as a buyer help employee.
He mentioned he has patched up his relationships along with his ex-wife, three youngsters, and three grandchildren and is even beginning to consider actual property growth once more.
“I dwell a beautiful life and I couldn’t be happier,” he mentioned. “And I have to share that with others to the very best of my talents.”