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Technology enhanced substance use disorder treatment

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Technology enhanced substance use disorder treatment

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Technology Enhanced Substance Use Disorder Treatment
by
Andrew Keys Krieger

MBA, University of Houston, 1999
MSW, University of Houston, 1999
BS, University of Houston, 1995

Project Submitted in Partial Fulfillment
of the Requirements for the Degree of
Doctor of Social Work

University of Southern California
May, 2020
Abstract
Technology Enhanced Substance Use Disorder Treatment
by
Andrew Keys Krieger

MBA, University of Houston, 1999
MSW, University of Houston, 1999
BS, University of Houston, 1995

Project Submitted in Partial Fulfillment
of the Requirements for the Degree of
Doctor of Social Work

University of Southern California
May, 2020
Abstract
Over 26 million Americans have a substance use disorder (National Institute on
Drug Abuse, 2015). Unfortunately, current approaches for treating addiction are
ineffective, especially when compared to treatments for other chronic mental health
conditions. This is evidenced by the fact that only 22% of people treated for a substance
use disorder remain in remission after one year (Miller, Walters & Bennett, 2001), while
people who have received treatment for clinical depression demonstrate sustained
remission rates of 77% (National Center for Biotechnology Information, 2017). Clinically
integrated technology could help close this treatment efficacy gap. Unfortunately, few
substance use disorder treatment programs use practices that are supported by research,
leverage technology to improve patient outcomes or utilize patient data to improve
clinical processes (Fletcher, 2013). Contemporary Recovery, a residential program for
treating adults with substance use disorders, will combine evidence-based clinical
protocols and modern technology to create an innovative and highly effective addiction
treatment approach. Initially, the proposed innovation will significantly improve
addiction patient remission rates. Ultimately, Contemporary Recovery’s treatment model
will leverage big data to dynamically improve clinical protocols for treating patients with
a substance use disorder. This revolutionary approach will help create a world where
highly effective treatment for substance use disorder patients is available to anyone who
struggles with addiction.

Dedication
This Capstone paper is dedicated to Paul E. Krieger. Dad, I miss you dearly, think
of you often and reflect on your legacy with gratitude.
Acknowledgments
I would like to acknowledge my family (wife Jenifer, children Catherine, Carly
and Andrew and my brother Tempe) for walking with me on this journey. Also, my
business partners and friends, Greg Mihaly and Dr. Bo Allaire, whose support in realizing
this dream has left me forever grateful. Finally, I would like to thank Professor Jim Wind,
Professor Stephanie Wander, Dr. Amanda Stylianou and Dr. Jennifer Lewis for their
mentorship and guidance.

Table of Contents
Section 1: Concepual Framework ........................................................................................1
Assessment of the Problem ............................................................................................1
Research Related to Technology’s Potential as a Game Changer .................................3
Research Related to Evidence-Based Addiction Treatment Models .............................4
Current Approaches in the Field ....................................................................................6
Innovation in Addiction Treatment ................................................................................7
Harmful Behaviors Associated with the Problem ..........................................................9
Social Significance Incidence and Prevalence .............................................................11
Social Significance Impact on Vulnerable Populations ..............................................11
How the Proposed Innovation Connects to the Current Environmental Context ........12
Theory of Change & Logic Model ..............................................................................13
Changing Harmful Behaviors Associated with the Problem ......................................14
Section 2: The Proposed Innovation ..................................................................................15
Section 3: Contributions to Improvements in the Social Work Grand Challenges ...........18
Section 4: Perspectives of Key Stakeholders Associated with the Problem ......................19
Providers ......................................................................................................................20
Payers .........................................................................................................................21
Patients .........................................................................................................................22
Section 5: How the Proposed Innovation Builds on Existing Evidence ............................22
History..........................................................................................................................22
Policy .........................................................................................................................23
Practice .........................................................................................................................23
Public Knowledge ........................................................................................................24
Discorse........................................................................................................................24
Local Contextual Environment ...................................................................................25
Section 6: Consideration of Existing Opportunities for Innovation ..................................26
Section 7: Innovation Alignment with the Logic Model and Theory of Change ..............27
Business Viability ........................................................................................................27
Medical and Behavioral Protocols ...............................................................................27
Technology Development and Configuration ..............................................................28
Section 8: Likelihood of Success .......................................................................................28
Section 9: Structure, Methodology and Action Components ............................................29
Section 10: Conclusion ......................................................................................................29
References ..........................................................................................................................31
Appendix A: Theory of Change Model .............................................................................38
Appendix B: Logic Model .................................................................................................39
Appendix C: Treatment Continuum Overview ..................................................................40
Appendix D: Patient, Clinician and Technology Workflow ..............................................41
Appendix E: Strategic Growth Plan ...................................................................................42

Running Head: TECHNOLOGY ENHANCED SUD TREATMENT 1
Conceptual Framework
Assessment of the Problem
The wicked problem in addiction treatment is that patients with this brain disease are not
getting well proportionally to other medical disorders because the current treatment system is
failing. Miller, Walters & Bennett (2001) studied the outcomes of seven treatment programs and
found that approximately 78% of the addicts being treated had relapsed within one year. Fletcher
(2013) summarized multiple studies to conclude that most addiction treatment programs do not
implement practices that are validated by research or that are likely to lead to long-term patient
remission. While addiction treatment is failing, examples of the development of effective
treatments for other chronic medical and mental health conditions are not hard to find.
Diabetes, a chronic medical condition that often presents with significant behavioral
components related to eating habits and activity levels, has far more effective treatment options.
Mingrone et al. (2012) published a study in the New England Journal of Medicine on the
treatment of morbidly obese, type 2 diabetics that resulted in two-year remission rates on a range
of 75%-95% (outcomes varying by procedure). In mental health, the treatment of depression also
reports far better outcomes than are seen in addiction treatment. According to the National
Center for Biotechnology Information (2017), 77% of chronically depressed patients who
received antidepressants and/or psychotherapy remained in remission over a two-year period.
Ironically, scientifically validated medical, pharmacological and behavioral protocols
have been developed to effectively treat addictive disorders. The National Institute on Drug
Abuse; National Institutes of Health; U.S. Department of Health and Human Services (2018)
defined the key elements of addiction treatment best practices. There are also practice manuals
that explicitly detail how evidence-based approaches should be implemented. According to the
TECHNOLOGY ENHANCED SUD TREATMENT 2
National Center on Addiction and Substance Abuse at Columbia University (2012), none of the
defined best practices are in wide spread use in addiction treatment.
Also noteworthy, technologies that are readily available and in use by other professions
could be easily leveraged to implement, evaluate and scale evidence-based addiction treatment
approaches, but these capabilities are currently absent from much of the field of social work and
mental health treatment. The reason for this lies in the underlying motivations and inhibitions
related to technology adoption in social work practice (Flynn, 2017). Two major factors in the
lack of technology adoption for the treatment of addiction are managed care’s influence on the
economics of mental health treatment and the move from public sector to private sector
leadership in social and technological innovation.
The emergence of managed care in the early 1990’s and its current impact on the
economics of addiction treatment have created financial barriers to the development of outcome-
based approaches that data driven, technology adoption enables. Galambos, Rocha, McCarter, &
Chansuthus (2004) observed that the managed care related denial of services and the lack of
evaluation of treatment outcomes, among other factors, have created a very negative impact on
the quality of patient care. In managed care and private payer environments, addiction treatment
providers have a financial disincentive to spend the time, resources and capital required to adopt
technology-enabled clinical capabilities, as they receive no direct financial benefit for doing so.
The shift from the public sector to the private sector driving social innovation has also
impaired the adoption of technology by social workers. Flynn (2017) observed that historical
social innovation, based on a moral reaction to social trends like industrialization or tied to
leveraging government initiatives, is native to traditional social work roles. Modern social
innovation, brought on by computers, the internet and other technologies, is native to private
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sector businesses. This lack of native fluency often puts service-level treatment providers in the
role of a technology novice, where these innovations often feel alien, confusing and
overwhelming. In summary, sound research and theoretical bases for addiction treatment have
not been operationalized as evidence-based practices or technology-enabled approaches in the
treatment of addiction.
Research Related to Technology’s Potential as a Game Changer
A review of the literature, related to harnessing technology for social good in order to
improve addiction treatment, revealed both a promising technology path forward and a robust set
of existing, research validated addiction treatment protocols. Litvin, Abrantes & Brown (2012)
concluded that addiction treatment is ideally suited for technology-driven interventions as these
platforms allow for standardization and outcomes driven experimental control. They also
advocate for a blended human and technology approach, initially organized along existing theory
and protocols that would be evolved via analysis of the data generated by the technology
platform. Ramsey (2015) concluded that technology-based substance abuse interventions will
benefit the addiction treatment field by providing for greater access to services, higher quality of
care and lower treatment costs. Other researchers see the potential technology has to leverage big
data. “Technology permits a new vantage point from which to view the complex relations
between interventions, mechanisms, and outcomes.” (Dallery, Jarvis, Marsch & Xie, 2015, p.
20). Berzin and Coultron (2018) identified the modern innovations that are relevant to harnessing
technology for social good such as social media, the internet, mobile technology, wearable
technology, sensors, robotics, artificial intelligence, gaming, gamification, big data, integrated
data systems and advanced data analytics. Each of these technologies has clearly had a massive
impact on how many business sectors operate (e.g. banking, advertising, entertainment, etc.) and
TECHNOLOGY ENHANCED SUD TREATMENT 4
would likely have an equivalent effect on the social work field, when they are utilized in actual
practice.
Research shows that smart phone technology in particular holds great promise for mental
health and addiction treatment. Areán & Cuijpers (2017) reviewed nine studies assessing the
recent advances in mobile technology and the implications for mental health treatment. They
concluded that this technology universally made treatment more efficient and that there will be
many more future opportunities for mobile technology to improve direct services. Milward,
Wadsworth, Strang & Lynskey (2014) concluded that, “Mobile phones are widely available
among patients in treatment for substance use disorders and are considered an acceptable method
of contact” (Milward, Wadsworth, Strang & Lynskey, 2014, p. 114). In a literature review of
eight studies on mobile phone interventions for patients with alcohol use disorder, Fowler, Holt,
& Joshi (2016) concluded that in seven of the eight studies mobile technology-based
interventions delivered clinically significant increases in outcomes, regardless of treatment
methodology. Clearly there is strong research supporting the development and use of technology
to treat addictive disorders.
Research Related to Evidence-Based Addiction Treatment Models
While technology has the potential to dramatically change addiction treatment for the
better, it will need to integrate with sound clinical frameworks to be effective. Fortunately,
robust research exists on effective addiction treatment models. These models include an
abstinence based 12-step approach, an attachment focused model, and a cognitive behavioral
relapse prevention framework. Vaillant (2005), summarizing the results of a 60-year study on
addiction, concluded that traditional therapies and self-determination often failed with addiction
because they target the wrong part of the brain. He also endorsed 12-step recovery as an
TECHNOLOGY ENHANCED SUD TREATMENT 5
intervention that helps addicts create substitute behaviors, external accountability, new
supportive relationships and deepened spirituality, all of which were correlated with sustained
remission of the condition. Vaillant viewed remission in addiction cases as being similar to
remission in diabetes, where an individual needs to monitor the condition and change behaviors
in order to keep the pathology dormant. Nowinski & Baker’s (2017) evidence-based twelve step
facilitation model (TSF) was validated in a large government study in the 1990’s called Project
MATCH. TSF removes barriers to fully engaging in a 12-step program by focusing on
acceptance of the condition and surrender in a recovery process. While 12-step recovery models
are often considered to be the key component of addiction treatment, other modalities are often
integrated to help manage emotions and relapse prevention.
Flores (2004) viewed addiction as a neurobiological issue tied to emotional coping.
Compatible with a 12-step approach, attachment theory explains how an addicted individual’s
primary attachment to people is disrupted by an attachment to a drug. “…the vulnerable
individual’s attachment to chemicals serves both as an obstacle and as a substitute for
interpersonal relationships” (Flores, 2004, p. 4). Learning how to detach from chemicals and
reattach to people is an important part of early recovery from addiction.
Witkiewitz & Marlatt (2007) developed an evidence-based, cognitive behavioral therapy
(CBT) relapse prevention model that is often used in addiction treatment to help patients manage
thoughts and emotions without chemicals. CBT is useful in addiction relapse prevention, where
emotional triggers and high-risk situations are actively managed to intervene on a process before
it ultimately leads to a return to drug use. Self-awareness, cognitive reframing, behavioral
changes and the honest expression of thoughts and feelings are all meaningful parts of recovery
from addiction. TSF, attachment theory and CBT are fundamental theoretical frameworks that
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form the basis of the majority of addiction treatment in the United States. Though these
frameworks are all based on sound theory and backed by scientific research, they are often not
implemented as designed in actual treatment practices. Technology could help change this by
templating/standardizing interventions based on these frameworks, and validating both patient
and clinician compliance with these protocols.
Additionally, an extended period of clinical engagement, post primary treatment, is
correlated with better addiction treatment outcomes. Manuel, Yuan, Herman, Svikis, Nichols,
Palmer & Deren (2016) identified aftercare services, formal support networks, transition
assistance and expanded discharge planning services as key facilitators for recovery from a
substance use disorder, after long-term residential treatment. Blodgett, Maisel, Fuh, Wilbourne,
& Finney (2013) also determined that clinician facilitated continuing care (i.e. group therapy
following addiction treatment) should be integrated as part of a treatment process for patients
with substance use disorders. In conclusion, there are several evidence-based addiction treatment
models that, if integrated into a technology enabled/driven process, would significantly improve
the effectiveness of addiction treatment.
Current Approaches in the Field
While sound research supporting evidence-based clinical approaches and technology-
based interventions for addiction treatment are well established in academic circles, this has not
translated into actual industry practices. Most addiction treatment programs in the United States
have levels of care on a treatment continuum, in which patients are transitioned through an
industry standard 28 days of acute care. Typically, addiction treatment starts with physically
stabilizing a patient in a medically supervised detox phase, moves to a residential level or care,
followed by an outpatient phase and ends with a patient leaving the program to enter some form
TECHNOLOGY ENHANCED SUD TREATMENT 7
of aftercare and/or ongoing self-help program (i.e. AA, NA, Rational Recovery, etc.). This
approach was pioneered by Hazelden in the 1950’s, is referred to as the Minnesota Model and is
still the dominant treatment model in the industry (White, 2014). Via targeted reimbursement
practices, managed care-based insurance companies have effectively incentivized treatment
providers to only focus on short-term interventions for addiction, and will not typically pay for
treatment beyond the 28-day acute care program. The previously mentioned 78% relapse rate is a
strong indicator that this treatment model is an ineffective approach to treating addiction.
There is a massive misalignment between best practices and professional efforts to treat
addiction, resulting in the identified poor patient outcomes. As an example, the National Institute
on Drug Abuse; National Institutes of Health; U.S. Department of Health and Human Services
(2018) stated that a minimum of 90 days of active treatment is required for a program to be
effective, among other criteria. So far, social workers and other professional disciplines have
been satisfied to principally play roles within the current broken system, acting as program
directors in treatment programs, individual counselors or agency-based case managers. The
existing addiction treatment institutions do not effectively address the condition, ergo social
work and other professions have been coopted by the current system. Based on industry practices
and patient outcomes, current practices are failing to effectively treat addiction.
Innovation in Addiction Treatment
Despite the current broken system, there are some legitimate attempts in addiction
treatment to innovate. Examples of this include medication assisted therapy (MAT) and self-help
behavioral/social network phone apps. MAT treatments advocate that addicts, particularly opioid
abusers, get on a doctor prescribed maintenance medication as a substitute for illegal drugs. This
innovative approach holds that abstinence as the sole goal of treatment is limiting and even
TECHNOLOGY ENHANCED SUD TREATMENT 8
dangerous, particularly with opioid addicts. MAT therapies stabilize an addict with prescribed
medication in order to reduce the impact addiction has on a patient’s life. The American Society
of Addiction Medicine (ASAM) is a strong proponent of this approach. DuPont (2016)
summarized the group’s view by calling for the wide spread adoption of MAT based approaches
to medically manage the chronic nature of addiction, in order to reduce the harmful effects of
relapse on illegal drugs. While the proponents of MAT cite the low morbidity rates of addicts
directly related to overdose deaths on these medications, Lowfall and Walsh (2014) pointed out
the high potential the medications used in MAT approaches have for diversion (sharing or use in
unprescribed ways) and abuse. Another major issue with this approach is that MAT medications
are often prescribed without counseling or psychotherapy. Patient drinking or illegal drug use is
often not addressed by prescribing medical doctors in this scenario (i.e. patients often remain in
an active addiction).
Self-help apps, such as RTribe and Addicaid, are also emerging as an addiction treatment
innovation trend. These are phone apps that provide recovery support and a dedicated recovery
social network, often anonymously, for individuals struggling with addiction. RTribe reports
having over 30,000 active daily users, and averages active user engagements lasting six months.
Self-help apps are also relatively inexpensive, with costs ranging from a few dollars for purchase
to a monthly subscription rate of under $50. These applications tend to have a clinical basis (i.e.
were developed by or in consultation with a licensed clinician) or clinical philosophy associated
with them. However, a survey of these and other recovery apps by this writer revealed that none
that are widely used (>10,000 downloads) directly involve licensed professionals in treating
addicts or used evidence-based behavioral or medical protocols in their products. In other words,
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these would be considered paraprofessional treatment approaches, and while potentially useful,
would be unlikely to become the primary treatment for a chronic brain disease like addiction.
Harmful Behaviors Associated with the Problem
The key norms related to the identified problem are providers principally treating
addiction patients with acute interventions, providers using clinical protocols that are not
evidence-based and providers that do not track treatment or client outcomes. In a five-year study
that reviewed over 7,000 publications and five national data sets, the National Center on
Addiction and Substance Abuse at Columbia University (2012) defined addiction as a brain
disease, albeit with profound behavioral traits. The disease of addiction is also considered to be a
chronic condition, with the majority of medical and behavioral practitioners viewing sustained
abstinence as a primary clinical goal. Despite this fact, the vast majority of the addiction
treatment efforts ignore the chronic nature of the illness.
When medical doctors and behavioral health clinicians treat addiction, it is the norm that
they principally oversee the acute care of patients (i.e. attending to patients in a treatment
program). Very little emphasis is placed on the clinical oversite related to chronic condition
management or ongoing support for patients after discharge from a treatment program. It is not
difficult to connect the lack of medical and behavioral oversite of addiction patients after the
acute phase of treatment to addicts not getting better proportionally to patients with other chronic
medical and mental health disorders.
As previously mentioned, the National Institute on Drug Abuse; National Institutes of
Health and U.S. Department of Health and Human Services (2018) provided a comprehensive
list of evidence-based medications and treatment methodologies. There are also countless
practice manuals that detail how these and other evidence-based approaches should be
TECHNOLOGY ENHANCED SUD TREATMENT 10
implemented. Yet, White (2014) observed that the vast majority of addiction treatment programs
are still based on the unvalidated Minnesota model (i.e. 28 day, AA integrated program). The use
of this unvalidated approach by the majority of addiction treatment providers results in poor
patient outcomes.
The lack of outcomes monitoring and absence of related financial incentives significantly
contribute to the poor success rates of addiction treatment programs. Fletcher (2013) summarized
multiple studies to conclude that most addiction treatment programs are ineffective and do not
measure or accurately report outcomes. Further, medical and mental health professionals do not
have incentives, checks or certifications in place to ensure that they are using evidence-based
treatment modalities, or that they are even properly trained to do so. However, there is a strong
trend requiring other medical service providers to use best practices, outcomes tracking,
electronic medical records and evidence-based protocols in order to receive reimbursement
(termed value-based reimbursement, or VBR, by the industry). In a white paper discussing IT
initiatives to support VBR, Optum, a large insurance company, stated, “New reimbursement
models, changing regulatory dynamics and broad quality initiatives pressure providers and health
plans to increase their focus on the value of health care services being delivered…” (Optum,
2014, p. 1).
The United States Department of Health and Human Services (2017) reported that by
2016 30% of Medicare beneficiaries’ care was financed through value-based payments. Further,
they are targeting a goal of over 85% of reimbursements to be made based on VBR. Managed
care companies, as illustrated by the Optum example above, are also using this data to adjust
payment rates, based on the statistical outcomes of patients. Addiction treatment programs and
providers are currently exempted from these requirements.
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The behaviors of treating addiction patients with acute interventions, using clinical
protocols that are not evidence-based and not tracking treatment or client outcomes all serve to
perpetuate the failure of addiction treatment providers to effectively treat the condition.
Social Significance Incidence and Prevalence
Addiction patients demonstrating poor treatment outcomes relative to other chronic
medical conditions has profound social and financial consequences. Alcoholism and drug
addiction are major public health issues in the United States. According to National Institute on
Drug Abuse (2015), 17.3 million Americans either met criteria for alcohol use disorder or had
problems related to their alcohol use, with an additional 8.9 million Americans meeting clinical
criteria for a substance use disorder involving prescribed or illegal drugs. Further, the Center for
Disease Control (2016) reported that over 175 people per day die from a drug overdose in the
United States. Addiction also has a huge economic impact, “Abuse of tobacco, alcohol, and illicit
drugs is costly to our Nation, exacting more than $740 billion annually in costs related to crime,
lost work productivity and health care” (National Institute on Drug Abuse, 2018). Lipari & Van
Horn (2017) conducted a study commissioned by the Substance Abuse and Mental Health
Services Administration estimated that over 20 million Americans, or 8.4% of the adult
population, were diagnosable with a substance use disorder.
Social Significance Impact on Vulnerable Populations
Family members and vulnerable populations are particularly affected by untreated
addiction. Substance abusers often have a very negative impact on their loved ones, many of
whom are elderly, children or financially dependent on the addict. The Center for Substance
Abuse Treatment (2004), reported that multiple studies concluded that family members of
substance abusers often present with profound psychological and even physical issues, related to
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a loved one’s substance abuse. The same report stated that family members of substance abusers
were at increased risk of domestic violence, child abuse, neglect and sexual abuse.
Addiction also disproportionately impacts vulnerable populations. Wallace (1999)
concluded that although differences in the racial and ethnic epidemiology of substance use
disorders were relatively minor, substance-related problems disproportionately impact
minorities, particularly African American, Native Americans and Hispanic adults, resulting in
heightened mental, physical and social consequences. Compounding the issue, Arndt, Acion and
White (2013) found in a study of outpatient addiction treatment programs in the U.S., that
Caucasian clients had a 34% greater chance of successfully completing treatment than African
American clients and a 15% greater chance than Hispanic clients. Kulesza, Matsuda, Ramirez,
Werntz, Teachman, & Lindgrean (2016) found that stigma related to race, gender and addiction
was correlated with a bias towards punishment versus treatment in vulnerable populations
suffering from addiction. The majority of inmates in the United States were found to have
addiction issues (Bronson, Stroop, Zimmer & Berzofsky, 2017), populations that are
disproportionately made up of people of color.
It is staggering how widespread addiction is and how much damage it does to our society,
individuals with the disorder, their families and vulnerable populations. Clearly, the failure to
effectively treat addiction is of profound social significance.
How the Proposed Innovation Connects to the Current Environmental Context
In order to address the wicked problem of addiction patients not getting well, relative to
other chronic conditions, a new treatment approach was developed. The proposed innovation,
named Contemporary Recovery, combines existing evidence-based medical and behavioral
addiction treatment protocols and modern technology. An integrated patient and clinician facing
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technology platform will be utilized along a continuum of care. Within the proposed model,
doctors, counselors and other staff will use evidence-based interventions to actively engage,
guide and monitor patients throughout the treatment and early recovery process. The integrated
technology platform will leverage big data, which will provide predictive and prescriptive
knowledge which the clinical team can use to inform treatment. What makes the proposed
innovation highly disruptive is that it will radically improve addiction treatment by unlocking
current technology and big data capabilities. The adoption of this kind of technology for
addiction treatment would certainly enable providers to implement evidence-based, more
effective, scalable and more accessible programs.
Theory of Change & Logic Model
The Align theory of change model was used to as a framework to move from the
limitations of current addiction treatment programs (i.e. the wicked problem) to stated vision of
utilizing technology to empower providers to more effectively treat people with substance use
disorders (see Appendix A). This starts with the fundamental strategies of leveraging existing
evidence-based medical/behavioral protocols, developing chronically focused intervention
approaches and creating a technology platform within a business model that is market viable in
the current payer conditions (i.e. will be profitable within expected industry standards). The
efforts of this writer will align along these three key strategic focus areas, and will begin with the
launch of a production prototype.
The prototype will consist of a 50 bed, for-profit residential treatment program
(anchoring a full continuum of care), a technology platform for case management, evidence-
based clinical programing, and an outcomes tracking/predictive analytics capability. Once the
program is established, refined and demonstrates improved patient outcomes (i.e. >25%
TECHNOLOGY ENHANCED SUD TREATMENT 14
remission rates at one-year post treatment), it will be replicated and scaled via a licensing model.
The impact of demonstrated market viability and improved patient outcomes will drive the field
to adopt the proposed innovation or develop other approaches that have equivalent, or even
improved, key clinical metrics. A logic model for the proposed innovation appears below,
detailing specific inputs, activities, outputs outcomes and the anticipated impact of the proposed
innovation (see Appendix B).
Development of the logic model revealed that activities associated with the proposed
innovation will cluster around the three categories of business viability, integration of evidence-
based medical and behavioral protocols and technology development/configuration. Outputs are
specific to the current operational phase of the innovation, and outcomes are principally direct
disruptions of the identified norms associated with the wicked problem. Additionally, the long-
term outcomes of lowering the cost in order to increase access to treatment, more addiction
patients staying in recovery and an evolutionary big data component were also identified. By
building, implementing and scaling an effective addiction treatment model, addiction patient
remission rates will be radically improved. The impact will include billions in cost savings, a
significant reduction in incarceration rates, increased societal health and longevity and
ultimately, a world where all suffers of addiction are treatable.
Changing Harmful Behaviors Associated with the Problem
As previously stated, the wicked problem in addiction treatment is that patients with this
brain disease are not getting well proportionally to other medical disorders because the current
treatment system is failing. As discussed above, key behaviors (norms) associated with the
broken treatment system that are directly contributing to addiction patients not getting well
include providers principally treating addiction patients with acute interventions, providers using
TECHNOLOGY ENHANCED SUD TREATMENT 15
clinical protocols that are not evidence-based and programs not tracking outcomes or improving
care delivery. All three of these behaviors directly contribute to the identified wicked problem
and would be altered by the proposed innovation.
The proposed innovation is fundamentally a chronic condition case management
platform, designed to incorporate acute care interventions on the front end of a continuum of
care, targeting sustained long-term remission of the disease of addiction. Therefore, by design
the innovation shifts the treatment focus from strictly acute interventions to principally a chronic,
remission-based approach. As mentioned, evidence-based medical and behavioral protocols
would be programed into the app, assuring providers operate with fidelity to addiction treatment
best practices. Outcomes will be measured real-time, and then used to dynamically inform better
treatment approaches. In other words, best practices and research validated clinical models will
be programed into the treatment process, assuring provider and patent adherence to them. Once
established, this capability could be leveraged by payers to align reimbursement practices with
other medical conditions that use outcome incentives. If providers track addiction treatment
outcomes and correlate improvements to specific practices, they can leverage this information to
radically improve interventions for addicts. In summary, all three of the identified key behaviors
associated with the wicked problem would be directly addressed by the proposed innovation.
The Proposed Innovation
Anything that can be measured and observed can be digitized. Mental health treatment
plans and interventions are, by design, observable and measurable. Therefore, an entire clinical
framework for addiction treatment can be migrated to a technology platform. Once data driven
mental health technologies are developed and implemented, a computer algorithm can validate
provider adherence to evidence-based approaches and patent compliance with clinical
TECHNOLOGY ENHANCED SUD TREATMENT 16
programing. By combining evidence-based medical and addiction treatment protocols with
technological innovations, the proposed innovation will create a new addiction treatment
approach that delivers research validated clinical techniques via a powerful technology portal.
Ultimately, advanced data analytics will be able to dynamically adapt treatment, based on a
patient’s demographic information and behavior patterns, to target/optimize the treatment
process for any given individual and to predict patient outcomes. All of this equates to a unique
approach to addiction treatment that will be optimized for deliverability and social impact. If
successful, the proposed innovation will become a disruptive force creating radical
improvements in the addiction treatment field.
The proposed innovation will be utilized over a 12 to 18-month period, along a
continuum of care and on an integrated patient and clinician facing technology platform. Within
the proposed model, technology will work in tandem with doctors, counselors and other staff to
actively engage, guide and monitor patients throughout the treatment and early recovery process.
It is worth noting that the proposed clinical engagement would be over a significantly longer
period of time than most current treatment programs (see Appendix C). The technology platform
will also be capable of leveraging big data to dynamically evolve an outcome-based treatment
approach.
Patients checking into treatment will be given an iPad during orientation. The iPad will
contain all of the didactic material (e.g. education lectures), clinical assignments, a recovery task
list organized on a calendar, a HIPPA compliant telemedicine capability, a sober network portal
and many other features. Behavioral and medication protocols will be templated on the system as
a treatment framework, allowing clinicians to customize treatment plans within the evidence-
based model and dynamically push clinical interventions and tasks to patients throughout the
TECHNOLOGY ENHANCED SUD TREATMENT 17
treatment process. This will also reduce the time required for charting and documenting,
allowing clinicians to spend more time directly working with patients. Medical doctors and
psychiatrists will also use the platform monitor and manage patient symptoms. All members of
the multidisciplinary treatment team will have visibility to patient metrics that will help inform
treatment planning and care coordination. Data dashboards that are principally monitored by
clinical case managers will continually inform program and staff enhancement.
After completing primary treatment (i.e. detox, residential, PHP and IOP levels of care), a
patient enters aftercare with the same software app on their smart phone and case manager
guiding them beyond the acute care phase of treatment. The patient’s recovery related actions,
moods, drug cravings, drug use and other key recovery indicators will be monitored daily by the
case manager, via the technology platform. Potential relapse behaviors will also be monitored
and brought to the attention of both the patient and clinical staff. Medication assisted treatment
will monitored and coordinated on the platform as well. Existing addiction treatment models and
theoretical frameworks (i.e. Vaillant’s remission model, TSF, CBT and attachment theory that
were elaborated on in the literature review section of this paper) will be integrated as a unified
clinical model for use throughout the entire 18-month process (see Appendix D). This approach
combines scientifically validated clinical techniques with powerful technology capabilities to
advance addition treatment far beyond any current approach.
What makes the proposed innovation revolutionary is that it radically improves addiction
treatment by unlocking current technology and big data capabilities. Outcomes could be
correlated to clinical interventions and the efficacy of any given treatment approach determined.
This data will be used by the clinical team to dynamically evolve treatment protocols for greater
effectiveness, based on an ongoing computer analysis of clinical practices, patient behaviors and
TECHNOLOGY ENHANCED SUD TREATMENT 18
outcomes. Predictive analytics could even evolve the program to a model that individually
targets patients with treatment approaches, optimized by client profiles, detailed demographic
information and behaviors. Ahn & Vassileva (2016) utilized machine-learning (i.e. AI based
computer data analysis) to identify distinctly different behavioral markers associated with drug
addicts primarily abusing different substances (e.g. opiates vs. stimulants). It is logical to
conclude that this type of data analysis could be used to tailor behavioral interventions to patients
based on computer generated models, correlated to drug use patterns. Other key variables, such
as race, age, gender, etc., could also be integrated into the treatment approach, over time. The
result would be treatment targeted to each individual for a much greater chance of engaging
patients and helping them keep their brain disease in sustained remission.
Contributions to Improvements in the Social Work Grand Challenges
As previously mentioned, the selected Grand Challenge is to harness technology for
social good in order to promote the advancement of data driven, mental health technology. This
will be realized in the form of a less expensive, more accessible and higher efficacy addiction
treatment model. As many advanced technological capabilities already exist or are rapidly
evolving in other sectors, how to adopt current and near-term technological advancements for
use in research, education and practice is the principal issue for the social work field in this
Grand Challenge. As previously cited, Berzin and Coultron (2018) identified the modern
innovations that are relevant to harnessing technology for social good as social media, the
internet, mobile technology, wearable technology, sensors, robotics, artificial intelligence,
gaming, gamification, big data, integrated data systems and advanced data analytics. While each
of these technologies has clearly had a massive impact on how many business sectors operate
(e.g. banking, advertising, entertainment, etc.) social work as a field has been hesitant to utilize
TECHNOLOGY ENHANCED SUD TREATMENT 19
these advancements. The proposed innovation will utilize all of the identified modern
innovations, with the exception of robotics, creating a significant contribution to this social work
Grand Challenge.
Clinical social work, focusing on the diagnosis and treatment of mental health conditions,
has been particularly slow to adopt technology. None of the technological advances identified by
Berzin and Coulton are in widespread use in addiction treatment or direct mental health services
in the United States. Flynn (2017) saw the current disconnection between social work and the
business and technology sectors, the modern architects of social innovation, originating in the
rapid shift in the 1980’s from public to private sector leadership in the economics of social
change. She also called for the profession to start engaging with private sector companies, like
Google and Apple, to leverage their technology, innovation strategies and market power. The
great appeal of leveraging technology for addiction treatment is the potential it has to rapidly
improve patient engagement, access and outcomes. “It is evident that if, by using technology,
more patients can be treated over a set period of time with better clinical outcomes, everyone
gains…” (Yellowless & Shore, 2018, p.17). The widespread adoption of data driven, mental
health technology has the potential to radically improve access to addiction treatment and
improve the efficacy of addiction treatment programs. An effective production platform treating
a serious mental health condition would significantly advance social work, within the selected
Grand Challenge.
Perspectives of Key Stakeholders Associated with the Problem
The main stakeholders associated with addiction treatment failing are providers and
payers. Each group has different perspectives on addiction treatment, and both contribute to the
problem in very specific ways
TECHNOLOGY ENHANCED SUD TREATMENT 20

Providers
On the provider side, the main groups associated with the identified problem are the
American Society of Addiction Medicine (ASAM), behavioral health professionals and
treatment center owners. ASAM is a medical society for doctors specializing in addiction. They
are influential in how the medical profession views and treats the disease. Medical doctors are
principally trained to diagnose and medicate, as a response to medical disorders. ASAM’s view
on the identified problem is that a lack of adoption and adherence to medication assisted
therapies (MAT) is the main reason addiction treatment is ineffective. This group would likely
view the proposed innovation positively, in regards to the use of evidence-based medical
protocols, but they would also be likely to resist technology adoption, as a fully tech driven
clinical process would be a radical departure from current practices.
Behavioral health professionals include clinical social workers, psychologists, drug
counselors and other licensed psychotherapists. These groups are all licensed at the state level,
and many members participate in state and national professional groups. They are connected to
the problem as principally frontline service providers, and many who specialize in addiction are
bought into the ineffective and outdated treatment system. Often behavioral health clinicians
blame the patient’s lack of following treatment recommendations for treatment failures, and they
are resistant to the adoption of new treatment modalities (Fletcher, 2013). It is likely that this
group would be highly resistant to the proposed innovation, at least initially.
The executives and owners of treatment centers are connected to the problem principally
through their involvement with an ineffective product that does not standardize care along
patient outcomes or industry best practices. Their view on the problem is principally that
TECHNOLOGY ENHANCED SUD TREATMENT 21
managed care insurance companies have ruined the field, and that payers will not support
effective treatment approaches due to cost. Frankly, most of the individuals involved in addiction
treatment at the ownership and executive level are managing programs that operate on very thin
margins. Their financial interests dictate that they focus on maintaining a high census and short-
term profitability rather than improving their product. These actors would view the proposed
innovation as extraneous, as they are not compensated based on improving patient outcomes.
Payers
Payers consist principally of private sector insurance companies and the public sector,
Medicare/Medicaid programs. Both of these groups are connected to the problem by the fact that
addiction is treated differently than any other chronic medical condition, in terms of standards of
care and reimbursement policy. Insurance providers care more about reducing their overall costs
for addiction treatment than truly treating people with the condition. The emergence of managed
care in the early 1990’s and its impact on the economics of addiction treatment have created
financial barriers to the development of effective treatment approaches, as previously mentioned.
Put another way, managed care companies institutionally deny funding for mental health
services, and they do not financially support effective treatment approaches for addiction. This is
evident in the lack of requirements by managed care companies for addiction and other mental
health treatment providers to measure or demonstrate outcomes and in the lack of financial
incentives provided by payers for outcome-based results.
In managed care, Medicaid/Medicare and private payer environments addiction treatment
providers actually have a financial disincentive to spend the time, manpower and capital required
to develop and adopt effective treatment approaches, as they receive no direct financial benefit
for doing so. It is likely that payers would be initially resistant to incurring the additional costs
TECHNOLOGY ENHANCED SUD TREATMENT 22
associated with the proposed innovation. If the proposed innovation could demonstrate a cost
savings to payers, in the form of a reduction in secondary medical events related to active
addiction, treatment cost reductions and lower patient recidivism, it is likely that payers would
ultimately embrace the proposed innovation.
Patients
Patients with a substance use disorder are principally connected to the problem by being
uniformed consumers (i.e. not being able to discern the difference between effective vs.
ineffective treatment). Their health will be directly impacted by the proposed treatment model,
positively or negatively, depending on outcome. If the innovation is successful, potential patients
will support Contemporary Recovery by choosing the program for their treatment, and after
completing the program, will be likely to express positive opinions about the company in the
recovery community and online. Ultimately, the patient experience and patient outcomes will be
a huge driver of the program’s reputation and referrals. In other words, if patients with a
substance use disorder are given a viable treatment approach and understand the value of this,
they will select the proposed innovation over other options, and will influence others to do so.
How the Proposed Innovation Builds on Existing Evidence
The history of addiction treatment, current policies, practice realities, public
knowledge/discourse, and the local contextual environment in Houston, Tx. were all considered
in the development of Contemporary Recovery, the proposed innovation.
History
White (2014), in his book on the history of addiction treatment in the United States, notes
that the medical model (a doctor led, holistic approach) was the prominent treatment paradigm
until managed care insurance companies radically altered the economics of addiction treatment
TECHNOLOGY ENHANCED SUD TREATMENT 23
in the early 1990’s. White also sees the period from the early 1990’s until the election of
President Barak Obama in 2009 as a period of anomie, where the criminalization of substance
abuse and the institutional decline of addiction treatment programs became the norm. From
White’s perspective, this history has resulted in the addiction treatment industry’s inability to
address the current opioid epidemic. It would appear that the historical timing is right for the
proposed innovation, the groundwork of which can be seen in the national policies related to
addiction treatment.
Policy
Current federal policy is favorable for addiction treatment. The Paul Wellstone and Pete
Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) mandated that
group health insurance plans provide benefits for substance use disorder treatment that are
equivalent to other medical or surgical benefits on any given plan (Centers for Medicare and
Medicaid Services, 2008). The 2010 Affordable Care Act extended this coverage to private
insurance programs, which was operationalized in 2013 (National Alliance on Mental Illness,
2019). According to the United States Census Bureau (2018), 91.2% of the U.S. population is
covered under a health insurance plan. This means that a large majority of Americans have
health insurance coverage for addiction treatment. The proposed innovation builds on this by
utilizing an insurance-based reimbursement model, within a treatment continuum of care. In
other words, the planned treatment program will be eligible for coverage by most insurance
plans, and will be viable in the current marketplace.
Practice
As previously stated, current addiction treatment practices are failing, as evidenced by
patients with a substance use disorders not getting better relative to other chronic medical and
TECHNOLOGY ENHANCED SUD TREATMENT 24
behavioral conditions. Current practices lack patient outcomes tracking, research validated
clinical protocols and technology/big data capabilities. Rather than continuing or building on
current addiction treatment practices, the proposed innovation aims to radically alter and disrupt
these ineffective approaches with an innovative new model. Licensed providers and programs
will be utilized, but in ways that are fundamentally outside of current practice paradigms.
Public Knowledge
The public perceives substance abuse as a major health issue, particularly the abuse of
opiates, and believes that there is not inadequate treatment available for people suffering from
addiction. According to a Kaiser Family Foundation survey (2016), approximately half of
Americans knew someone personally who was addicted to painkillers, and addiction was ranked
second overall in major health issues facing Americans. The same survey found that
approximately 75% of Americans thought that the lack of adequate treatment was a major
problem. These perceptions indicate that the American public wants an innovation in addiction
treatment that effectively treats the condition.
Discourse
Laura Hilgers (May 19, 2018) called for addiction to be treated like any other medical
condition. Drawing from her personal experiences of going through addiction treatment with one
of her children and supporting her stepbrother during a cancer treatment, Hilgers’ New York
Times opinion article drew a sharp contrast between how effective and professional cancer
treatment is versus how ineffective and uniformed addiction treatment appears to be. Addiction
is widely considered to be a chronic, pathological condition, with the majority of medical and
behavioral practitioners viewing sustained abstinence as a primary clinical goal. In a five-year
study that reviewed over 7,000 publications and five national data sets, the National Center on
TECHNOLOGY ENHANCED SUD TREATMENT 25
Addiction and Substance Abuse at Columbia University (2012) defined addiction as a brain
disease, albeit with profound behavioral traits. Hilgers’ perspective closely aligns with the
proposed innovation.
Pundits are also beginning to strongly advocate for technology-based solutions to address
addiction, a perspective that has anecdotally been historically absent from much of the public
discourse on this issue. Siegel (2018, April 1) viewed addiction treatment as a failing enterprise
and proposes that technology has the potential to fix it. Parkinson (2017, January 3) called for
technology to play a major role going forward in addiction recovery. In a Forbes interview, Sam
Frons, the CEO of a New York based technology startup company, promoted the use of AI based
software applications to guide a scientifically based treatment processes for addiction and other
mental health issues (Walravens, 2017, November 2). These articles are clear bellwethers
indicating that a technology-based innovation, like Contemporary Recovery, is on point with
public discourse trends.
Local Contextual Environment
The local contextual environment consists of addiction treatment programs, providers and
related services in the metro area of Houston, Texas. This writer owns the largest addiction
medicine and mental health medical services company in the city, and has an intimate
understanding of the local addiction treatment environment. This will be leveraged for all aspects
of the Contemporary Recovery production prototype, which will be launched and developed in
Houston, Texas. Staffing, referral sources, marketing, location, state licensing, business
development, etc. will all be enhanced by this expertise.
The addiction treatment market in Houston, Texas is currently served by a small number
of specialty providers, ranging from outpatient programs to a handful of 30-80 bed residential
TECHNOLOGY ENHANCED SUD TREATMENT 26
treatment centers. Though Houston is a large city, there is not a nationally prominent addiction
treatment program based in the area. Though more market research will need to be conducted,
the suburban north and west areas of Houston appear to be ideal locations to build the planned
addiction treatment program prototype.
Consideration of Existing Opportunities for Innovation
Innovating within current addiction treatment models, innovation exclusively with
technology and innovation principally utilizing a medication assisted treatment (MAT) approach
were considered. Elements of each of these existing opportunities will be utilized, however each
was ruled out as a primary path for innovation. The existing treatment approaches are failing so
dramatically, that it made sense to look for a different treatment paradigm as the basis for
innovation. However, a physical location for detox and residential treatment will be incorporated
into the proposed innovation (see Appendix C), albeit as an integrated part of a radically
different treatment model. As previously mentioned, addiction is considered a chronic brain
disease, so a stand-alone technology innovation did not seem appropriate at this time (i.e.
without human clinical oversight). However, the power of technology to monitor, analyze data,
communicate, scale and coordinate services will be extensively leveraged in the innovation. As
previously highlighted, MAT is a promising innovation trend in addiction treatment, but it has
significant limitations. This approach is also not designed for substance abusers using drugs
other than opiates or alcohol. Though not deployed as a stand-alone intervention, Evidence-based
medications and medical oversight by doctors will be an important component in the
Contemporary Recovery treatment model. Ultimately, the combination of sound medical and
behavioral practices, delivered by licensed clinicians and delivered on an integrated technology
TECHNOLOGY ENHANCED SUD TREATMENT 27
platform, was decided upon as the best innovation approach to address the identified wicked
problem.
Innovation Alignment with the Logic Model and Theory of Change
Business Viability
Business viability for the innovation will be determined by the commercial success of a
production prototype treatment program and the ability to replicate and scale the solution.
Commercial success of the prototype will require that the treatment program has an average
patient occupancy over 70% and that it is profitable within industry standard gross profit margins
(>18%, as observed by this writer over the past six years as an industry consultant), within 18
months of operation. A detailed business and financial plan will be created for the model to
theoretically demonstrate that these metrics are achievable. This plan will be based on input from
industry experts to validate the model’s key assumptions.
Scaling the solution will start by establishing an initial treatment facility in the Houston,
Texas area. After the technology, clinical and business components are validated, a second
program will be established in another major market in Texas (see Appendix E).
Ultimately, the lessons learned from launching, establishing and then replicating the
program/innovation will be used to develop a rapid scaling plan for national expansion, via a
technology licensing and brand franchising model.
Medical and Behavioral Protocols
As revealed by the literature review, validated medical and behavioral protocols exist to
effectively treat addiction patients. These will form the basis of the initial clinical program, and
they will be integrated into the planned technology platform in the production prototype. As
previously mentioned in the theoretical framework, the clinical focus timeframe will be 18-
TECHNOLOGY ENHANCED SUD TREATMENT 28
months (as opposed to the industry standard 28 days). Staff will be trained on both the clinical
models and the technology platform, and provider and patient compliance with of the medical
and behavioral protocols will be monitored. Patient outcomes will also be tracked. The
Contemporary Recovery treatment protocols will then be evolved for greater effectiveness via
data analysis within the technology platform. This writer is already an industry expert on
building medical and behavioral protocols for addiction treatment programs. This knowledge
will be heavily leveraged in the development of this component of the innovation.
Technology Development and Configuration
The technology platform has already been developed over the last five years in a
company founded by this writer called PsychTrac. This product is a cloud-based provider and
patient facing, case management software application. It is currently in production in both pilot
projects and with paying customers, and the current software has all of the core components
needed to support the proposed innovation. Specific content, branding, configuration and
patient/provider usability testing and refinement will all need to be developed in the production
prototype. A value-added reseller company (VAR) will be formed as the business entity to do
this in, and the VAR will also servs as the brand/technology licensing entity for Contemporary
Recovery, as it is rolled out and ultimately scaled. The initial production prototype will serve as
an incubator to deploy, configure and refine the technology solution.
Likelihood of Success
The proposed innovation, Contemporary Recovery, has a very high likelihood of success.
This writer has a strong business track record in raising capital, executive management, mental
health and technology that will greatly contribute to the strategic and operational aspects of the
business. Additionally, a diverse and highly talented executive team has already been established
TECHNOLOGY ENHANCED SUD TREATMENT 29
for the Contemporary Recovery project. Early feedback from experts and investors in the
addiction treatment and technology fields has been very positive. Additionally, this writer has
existing, leverageable businesses and business contacts that are highly synergistic with the
planned treatment model and prototype.
Structure, Methodology and Action Components
A Contemporary Recovery business plan, website and online product demonstration were
developed and presented for the project inquiry format (i.e. prototype). Included in this were a
meaningful analysis of the market, a project implementation plan, detailed financial plans, a
methodology for assessing the innovation’s impact, a stakeholder involvement plan, a marketing
and communications plan, and a summary of ethical considerations related to the treatment
program (see Contemporary Recovery business plan). All of these elements specify a structure,
methodology and action plan to address the identified wicked problem by clearly articulating an
investor ready business plan to launch a production prototype of the proposed innovation.
Conclusion
Addiction patients deserve effective treatment. With current treatment programs failing to
adequately treat the condition, it is time for a radical new intervention to address this chronic
brain disease. Combining evidence-based clinical protocols, sound business practices and an
innovative approach will radically improve addition patient outcomes. By using technology for
social good, the proposed innovation will have a significant impact on people suffering from a
substance use disorder and the associated costs of the condition. If Contemporary Recovery
increases the utilization of addiction treatment services nationally by 10% and can deliver 40%
remission rates, this would equate annually to 2.1 million people going into remission and a cost
savings to the United States of $30 billion dollars (Center for Disease Control, 2016). If the
TECHNOLOGY ENHANCED SUD TREATMENT 30
utilization rates for the treatment approach could reach 40% and treatment outcomes were
brought into parity with the efficacy of approaches for treating chronic depression (i.e. the
previously cited ~80% remission rates), this would equate to a staggering 8.4 million people with
a substance use disorder going into remission and a cost savings to the United States of $120
billion dollars, annually (Center for Disease Control, 2016).
In terms of implications for future work, a great deal still needs to be done in research
and in the operationalization of technology integrated substance use disorder treatment. Using
technology for substance use disorder treatment is still in its infancy, and though much of the
literature espouses the potential technology has to improve clinical processes, patent access and
treatment outcomes, there is still much that is unknown about the operational realities of this type
of innovation. How to better engage and keep patients on software applications, the optimal
length of time and frequency for technology-based treatment interventions and how to optimize
machine learning with artificial intelligence will all need to be better understood and refined in
production settings. Initially, the greatest limitation of Contemporary Recovery will be the
company’s limited reach, until the innovation can be validated, replicated and scaled.
To this end, the next steps for Contemporary Recovery will be to raise capital for the
launch of a single production prototype facility (see Contemporary Recovery business plan). An
18 to 24-month period is anticipated, after production launch, to refine the business, clinical and
technology processes. The planned approach will then be ready for replication and scaling (see
Appendix E). By using technology for social good, Contemporary Recovery will help create a
world where highly effective treatment for substance use disorder patients is readily available to
everyone who struggles with addiction.

TECHNOLOGY ENHANCED SUD TREATMENT 31
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TECHNOLOGY ENHANCED SUD TREATMENT 38
Appendix A
Theory of Change Model

TECHNOLOGY ENHANCED SUD TREATMENT 39
Appendix B
Logic Model

TECHNOLOGY ENHANCED SUD TREATMENT 40
Appendix C
Treatment Continuum Overview

TECHNOLOGY ENHANCED SUD TREATMENT 41
Appendix D
Patient, Clinician and Technology Workflow: Primary Treatment Through Aftercare

TECHNOLOGY ENHANCED SUD TREATMENT 42
Appendix E
Strategic Growth Plan

Abstract (if available)

Abstract Over 26 million Americans have a substance use disorder (National Institute on Drug Abuse, 2015). Unfortunately, current approaches for treating addiction are ineffective, especially when compared to treatments for other chronic mental health conditions. This is evidenced by the fact that only 22% of people treated for a substance use disorder remain in remission after one year (Miller, Walters & Bennett, 2001), while people who have received treatment for clinical depression demonstrate sustained remission rates of 77% (National Center for Biotechnology Information, 2017). Clinically integrated technology could help close this treatment efficacy gap. Unfortunately, few substance use disorder treatment programs use practices that are supported by research, leverage technology to improve patient outcomes or utilize patient data to improve clinical processes (Fletcher, 2013). Contemporary Recovery, a residential program for treating adults with substance use disorders, will combine evidence-based clinical protocols and modern technology to create an innovative and highly effective addiction treatment approach. Initially, the proposed innovation will significantly improve addiction patient remission rates. Ultimately, Contemporary Recovery’s treatment model will leverage big data to dynamically improve clinical protocols for treating patients with a substance use disorder. This revolutionary approach will help create a world where highly effective treatment for substance use disorder patients is available to anyone who struggles with addiction.

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Asset Metadata

Creator Krieger, Andrew Keys (author)

Core Title Technology enhanced substance use disorder treatment

School Suzanne Dworak-Peck School of Social Work

Degree Doctor of Social Work

Degree Program Social Work

Publication Date 04/30/2020

Defense Date 04/16/2020

Publisher University of Southern California (original), University of Southern California. Libraries (digital)

Tag Addiction,addiction recovery,addiction technology,addiction treatment,big data,evidence-based treatment,mental health technology,OAI-PMH Harvest,substance use disorders,technology for social good

Language English

Contributor Electronically uploaded by the author (provenance)

Advisor Lewis, Jennifer (committee chair), Feuerborn, William (committee member), Stylianou, Amanda (committee member)

Creator Email akkriege@usc.edu

Permanent Link (DOI) https://doi.org/10.25549/usctheses-c89-295526

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Legacy Identifier etd-KriegerAnd-8391.pdf

Dmrecord 295526

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Rights Krieger, Andrew Keys

Type texts

Source University of Southern California (contributing entity), University of Southern California Dissertations and Theses (collection)

Access Conditions The author retains rights to his/her dissertation, thesis or other graduate work according to U.S. copyright law. Electronic access is being provided by the USC Libraries in agreement with the a...

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