When we got started, we thought we’d be the perfect step-down program for residential care. People go home from wherever they went for residential care, and they are well-advised to continue their work at a lower intensity. We found that the residential treatment centers weren’t ready for telehealth, which was disappointing. But while we were unhappily discovering this dynamic, people started reaching out to us online who needed to get sober. In other words, they needed primary care, not step-down. And they told us that they would not seek help any other way than online.
As a part of my series about “Heroes Of The Addiction Crisis” I had the pleasure of interviewing Peter Loeb.
Peter is CEO and co-founder of Lionrock, the pioneer in the provision of telehealth substance use disorder recovery services. Over a nearly four-decade career, Peter has worked in interactive media and technology development, financial services, and energy. Peter’s interest in healthcare grew out of his long experience as a close family member of people struggling with substance use disorders.
Thank you so much for doing this with us! Can you tell us a bit of your backstory?
Substance use disorders (SUDs) have been part of my life’s story for nearly the last 50 years. Growing up in the 70’s in NYC, alcohol and drug culture was a significant presence, and I have many childhood friends who struggled with SUDs. My first real exposure to what we used to call addiction and rehab was my dear sister’s struggle. In 1985, I persuaded her to seek treatment for an opioid use disorder. Naive as I was at the time, when she came home from rehab, my thought was, hey, you’re fixed! I didn’t understand that almost all SUDs are driven by co-occurring disorders, and that recovery is, to varying degrees, a lifelong process. At Lionrock, lately we’ve come to call it “the art of recovery.” During the 15 years that followed, I didn’t think much about SUDs. I moved to Silicon Valley to work in technology with my young family, and we did what families do.
Is there a particular story or incident that inspired you to get involved in your work with opioid and drug addiction?
We know from the research on SUDs that just over half of people who struggle with substance use can trace it back to earlier generations. Apparently, that’s the half into which my oldest daughter fell. She struggled with alcohol and opioids in her young teens, culminating in a multi-year, multi-treatment center effort to help her find a way forward. We almost lost her several times, terrifying at a level that defies words, but we were lucky. At 19, she found enough reasons to dedicate herself to a life in recovery. Around the same time, my father died. He had been looking after my sister, whose life had continued to be difficult. At that point, I stepped in. Given my daughter’s then recent success (now nearly 15 years in recovery), my working assumption was that our family could surround my sister with love and help her find her own recovery. We gave it a shot. Sadly, four years later, my sister died from the accumulated damage to her body from decades of substance abuse. My sister’s death was the catalyst for founding Lionrock.
Can you explain what brought us to this place? Where did this epidemic come from?
Because overdose deaths from opioids have risen so quickly, it’s easy to perceive an epidemic that’s come from nowhere to become a scourge. But if we look more closely, the rise in opioid deaths is significantly a function of the increased use of a more lethal class of drug. Taken as a whole, substance use disorders in the U.S. increased by less than 1% in 2019 vs 2018. The 20.4 million people with an SUD represented 6.2% of the U.S. population. It’s true that 72,000 people died of drug overdoses last year, but only about 50,000 were opioid overdoses. Why is that important? Because there are about 88,000 alcohol-related deaths in the U.S. annually. The problem of substance use disorders is perennial, and its causes are not drugs and alcohol. Substance use disorders are a behavioral health problem.
What’s going on? Well, books have been written on this question, but here’s my best short answer: people with SUDs are self-medicating anxiety. The sources of that anxiety are very broad, including mood disorders, like bipolar disorder, obsessive compulsive disorders, and depression, and extending to environmentally-driven events, like trauma, which is the driver of a large percentage of SUDs. The critical point is that people with SUDs are not “partying”, no matter how it may appear. They use substances the way you or I use an analgesic, like Ibuprofen, for a headache. They want relief from the pain. In their case, the pain is anxiety.
While SUDs are quite widespread, because so are mood disorders and traumatic experiences, the opioid crisis has been particularly pronounced in places struggling with economic blight. On September 29th, Cigna released a study citing “resilience” as a key driver of behavioral health and related physical health. The study found that unemployment is a significant destroyer of resilience. An SUD treatment program’s true product is hope, and hope is the basis of resilience. We help people find hope through a complex process and time practicing the art of recovery. In places where hope is in short supply because of external factors, we expect to see more SUDs than the average. Sadly, there’s no easy fix for that.
Can you describe how your work is making an impact battling this epidemic?
As with so many innovations, we stumbled into ours. When we got started, we thought we’d be the perfect step-down program for residential care. People go home from wherever they went for residential care, and they are well-advised to continue their work at a lower intensity. We found that the residential treatment centers weren’t ready for telehealth, which was disappointing. But while we were unhappily discovering this dynamic, people started reaching out to us online who needed to get sober. In other words, they needed primary care, not step-down. And they told us that they would not seek help any other way than online.
In general, a small minority of the people who need help with SUDs get it, while millions of people do not. Our field has long wondered how to attract those folks who don’t get help, and here they were, coming to us! It turns out that the privacy and convenience of getting help online is what’s missing from treatment in a traditional setting. Half of Lionrock’s clients tell us that they aren’t willing to get help in a traditional setting. So, our contribution to battling this epidemic is discovering a way to help the 80% or more of people who need help, but don’t get it. Online recovery really makes the difference.
Wow! Without sharing real names, can you tell us a story about a particular individual who was impacted by your initiative?
Yes. A former Lionrock client, Norman, is recently sober 1.5 years. He is a licensed pharmacist. It’s not hard to imagine that the access to pharmaceuticals, which healthcare workers have, can increase the severity of a substance use disorder, which they might develop. Certainly a pharmacist is in the most vulnerable position in this context, and in fact, Norman developed a pretty severe addiction to amphetamines supported by the access he had.
Like so many people, and contrary to popular belief systems which drive stigma, Norman did not “crash and burn,” he did not end up destitute, living under a bridge. Given the risks to his professional career, into which he had invested years of work and cash, he was very private about his substance use disorder. In addition, he is a young father of two kids, increasing the stakes beyond just professional risks. For those reasons, the only way Norman could see himself getting control of his substance problem was through the completely private and flexible options which online recovery offers.
Norman’s situation is a very common one for Lionrock clients. They are good people, often with families, who have a healthcare problem. 85% of Lionrock clients are employed. All that said, they’re not well. Sadly, too often the stigma of substance use disorders stops people from getting the help they need until, in fact, their SUD progresses so far that they do end up living in destitution.
Luckily, Norman found Lionrock online and made the call to take the first step toward recovery. Being able to participate in therapy sessions and support groups on his own schedule and from the privacy of home were major factors that made him stick with the program.
Bravely, Norman is willing to share his story because he understands that many other healthcare professionals currently struggle with drug access-fueled SUDs. It’s true that very few healthcare professionals in recovery speak publicly about their experience with SUDs because the stigma, even among healthcare professionals who ought to know better, is strong enough to ruin their professional status. Rock on, Norman!
Can you share something about your work that makes you most proud? Is there a particular story or incident that you found most uplifting?
My answer above to how our work is making an impact is probably our best story. We figured out how to reach people struggling with SUDs among the 80% who perennially don’t get help and provide a care solution that meets their needs enough to get them into treatment. That’s a big innovation.
Can you share three things that the community and society can do to help you address the root of this problem? Can you give some examples?
When I attend AA meetings, typically with my daughter, I’m often struck by two things. First, that everyone’s story, no matter where they’re from, how well educated or wealthy they are, is so similar to everyone else’s story. The way the stories are told varies quite a bit, but the essence does not. Second, that so many of their stories include problems that we all encounter and must confront. They tell stories about common problems, but their own reactions to those problems is what sets them apart.
What society can do is continue to learn about substance use disorders. They can learn that the people struggling with them are struggling with a mental health problem, not a morality problem. Their mental health problem, however minor or severe, has brought them so low that they can’t overcome their fear of almost everything. They can also learn that substance use disorders are in effect symptoms of these underlying mental health problems, and that these problems don’t go away just because a person is abstinent. We’re dealing with chronic mental health problems that require ongoing personal growth and vigilance to overcome. A quick stint in treatment isn’t likely to cure anyone.
If you had the power to influence legislation, which three laws would you like to see introduced that might help you in your work?
There are already laws in place that mandate reimbursement for behavioral health at the same coverage and rates as physical health illnesses. Though the commercial health plans have found ways around this, acceptance of behavioral health care continues to grow and the problem gets smaller.
In the age of telehealth, the lack of broad reciprocity of licensure for mental health therapists is hugely counter-productive. For the moment, under emergency pandemic regulations, many of these barriers have been temporarily lifted. But the truth is that they serve no clear purpose other than preserving the power of the boards of behavioral health through state-level protectionism. We employ counselors licensed in many states and there is no material difference from one another in their training or skills.
I know that this is not easy work. What keeps you going?
It’s a bit coarse to say it, but Lionrock is my revenge. I’ve anthropomorphized Addiction; in my imagination, it’s a living thing, an enemy that took my sister and almost took one of my daughters. It’s an evil that created terror in my life, and I’m coming for Addiction, to put it down. Of course, I can’t really do that, but knowing that we contribute to people freeing themselves from its pull makes pushing through the difficult times worthwhile. We like to say that we are addiction’s worst enemy.
Do you have hope that one day this leading cause of death can be defeated?
The answer has to be yes, of course. How to get there, when the causes of SUDs lurk beneath the surface-level symptoms, is harder to envision. Getting people help sooner, through earlier intervention, holds the most promise for better outcomes. The online video tools of telehealth go a long way to enabling that shift.
How do you define “Leadership”? Can you explain what you mean or give an example?
Trust. At the end of the day, people follow someone they trust. People often confuse leadership with the authority to command, but leadership is a different thing. The output of strong leadership is influence.
Trust is built on a number of factors: knowledge, judgment, and relationship. They’re all bundled up. Does this person know what they’re talking about? Have I seen this person make good decisions in the past? Does this person care about me/us? When the answers all come back “yes”, a leader has earned enough trust to be followed, even without the authority to command. So, leadership is the amalgam of these things, each of which must be developed separately.
What are your “5 things I wish someone told me when I first started” and why. Please share a story or example for each.
There was really only one thing: that healthcare is a dirty business. I’ve worked in the financial and real estate markets and in entertainment businesses. Going into healthcare, where our goal is to help people, to save lives, I was shocked by the myriad restrictions on what would be considered normal practices in any other business. Inter-entity agreements like distribution and joint ventures have broad restrictions at both the federal and state levels under anti-kickback laws. In effect, there’s almost no way to ally legally with another company at any level beyond referral at the individual practitioner level. Along with a need to gain scale in negotiations with the health plans, it appears to me that these regulatory distortions are also a driver of the hyper-consolidation we’re seeing among providers. All that said, I subscribe to a healthcare law newsletter, which to my surprise, frequently brings me news of a 60-year-old doctor convicted of felony Medicare or Medicaid billing fraud who is going to prison. Apparently, I’m wrong about the need for the protections that have been put in place. That’s sad.
You are a person of enormous influence. If you could inspire a movement that would bring the most amount of good to the most amount of people, what would that be? You never know what your idea can trigger. 🙂
Not sure about the “enormous influence”, but I do have ideas about a movement. At Lionrock, we’ve already started a movement, or at least, we are passionate participants. We believe that we can use the Internet to dissipate the shame people in recovery often feel about their struggles. Achieving recovery is a more difficult thing than most people have ever done. We’re moving towards being a long-term ally in people’s recovery, serving their needs and helping honor their achievement.
Can you please give us your favorite “Life Lesson Quote”? Can you share how that was relevant to you in your life?
Many people have said it in many ways: never give up. There is no substitute for resilience and determination.
Is there a person in the world, or in the US whom you would love to have a private breakfast or lunch with, and why? He or she might just see this, especially if we tag them. 🙂
George Washington, but I doubt I can get on his calendar.
How can our readers follow you on social media?
This was very meaningful, thank you so mu