addiction - intnsa

AddictionA Futurists Perspective

It was the best of times, it was the worst of times, it was the age of

wisdom, it was the age of foolishness, it was the epoch of belief, it was the

epoch of incredulity, it was the season of Light, it was the season of Darkness,

it was the spring of hope, it was the winter of despair, we had everything before us, we had nothing before us,

we were all going direct to heaven, we were all going direct the other way

Addiction: A Futurists Perspective 2015

Forces that will shape the future

▪ Transparency

▪ Technology

▪ User demands / User sophistication

▪ Data and Analytics

▪ Payer demands /Payer sophistication

▪ Advances in Pharma

The fundamental barrier will be ethics and morals, not science.

Privacy will be the key challenge.

“Go away for 30 days and come back better with a prescription for AA”


Disrupting the black box

▪ Unscrupulous referral capture tactics

▪ Panicked relatives in crisis directed to treatment without visibility into process and outcomes

▪ Widespread manipulation of outcome data

▪ Pocketbook determines setting but outcomes are not necessarily superior

▪ Need to “Uber” this.


TAXI: Hoping one will stop for youNo real idea what the fare will be, especially if you don’t know the directionsCrapshoot on driver qualityStuck with one pricing model (per ride etc)

Uber/Lyft etc:

Can select your driver based on user ratings

Can select car class

Can buy in bulk

More transparency / accountability

CHEAPER

Transparency- The Future State

▪ User and Family have high visibility into comparable outcomes

▪ Outcomes are longitudinal and standardized

▪ Process and outcome variables are reported and compared across systems

▪ “Rate your driver” / crowdsourcing ratings

Addiction – A Futurists Perspective

Leveraging Technology

▪ Mobile access to care 24/7

▪ Internet of Things

▪ Biometrics

▪ Behavioral Analytics / Predictive Modelling

▪ Hard to envision the future but might look something like this…


My GPS takes me around known open air drug markets or liquor stores tailored to my unique risk factors

My efforts to dial old-using friends texts my sponsor

Poor sleep tracked through wearables and suggestions offered

My wearable tells me what meetings are nearby

My healthy, recovery oriented choices are supported through gamification (I’m rewarded for healthy choices)

My access to care providers is immediate and mobile

Recovery materials, interactives, coach and peer support are always accessible

My addiction recovery and other health goals are integrated

Biometrics anticipate problems before they occur (stress etc)

And so on…

Data that informs interventions

FOOTER

Pharmacologic and Genetic Advances

▪ Advances in Functional Imaging

▪ Genetics / Epigenetics / Pharmacogenetics

▪ Vaccine-based interventions

▪ Targeted brain interventions (More refined than ECT/TMS/Psychosurgery)


Vaccines

▪ Anti-drug antibodies will bind to drugs and prevent them from crossing the blood brain barrier

▪ Natural use of drugs does not produce antibodies

▪ Active vaccines are made by chemically linking drugs to toxins like cholera toxin.

▪ Passive immunotherapy uses monoclonal antibodies generated in a lab

▪ Will eventually be used to manage overdoses, prevent relapse, and even to prevent addiction in high risk populations

▪ Social acceptance will be the principle challenge


Genetics

▪ Our study will extend beyond diagnoses to related symptoms (e.g. cocaine paranoia) and even personality characteristics (impulsivity etc)

▪ Will understand and intervene on rare variants at superhigh risk

▪ Will better understand how genes affect the gene-environment interaction

▪ Interventions (not just Rx) will be targeted to genetic factors


Some of the genes implicated so far


Demers et al Curr Behav Neurosci Rep (2014) 1:33–44

Ethical, Social and Other Considerations


Photo credit: Kevin Dooley 2009

▪ What are the limits of our privacy and how are they flexible?

▪ How will we trust algorithms?

▪ Future interventions may be even more expensive…how will we handle income disparity in access?

▪ How will intoxicants and intoxicating behaviors themselves evolve to beat our interventions? (porn, gaming, etc)

Innovation: How We Will Get There


▪What is innovation?

▪How can you innovate?

You don’t need to define innovation to innovate

▪ Agreement on a definition doesn’t seem to exist

▪ Knowing what it isn’t is more important than knowing what it is

▪ Somewhat akin to Supreme Court Justice Potter Stewart’s “I know it when I see it”

Change is not innovation

▪ Neither is improvement, enhancement or growth.

▪ Even if a development passes the “order-of-magnitude test” and the “of course”test, it may still not be innovation

▪ Innovators themselves don’t appear to be bogged down by definitions…

▪ “Definition” itself seems unattractive or unnecessary to innovators, and is perhaps a task best suited to the work of analysts who trail them and attempt to characterize their successes.

Innovations often seem outrageously simple

▪ A Rubik’s cube effect…so simple, yet so successful.

▪ “Why hasn’t someone thought of it sooner?”

▪ “Why haven’t we been doing this all along”

▪ The “Of course…” test

Innovations are outrageously simple

▪ When systems become complex, improvements seem to require aligning multiple domains and second and third order effects….order-of-magnitude changes can seem daunting or out of reach

▪ “Going back to square one” often seems to be a key feature

▪ Perhaps innovations seem simple because they are simple…they thrive on simplicity

Mismanaging innovation is the norm

▪ Innovation requires tremendous emotional effort

▪ Individuals must overcome deeply embedded homeostatic psychological tendencies which result from thousands of generations of evolutionary advantage to change-aversion.

▪ Continuous re-invention is exhausting

▪ Innovation at an systems and organizational level involves trust, which is at a premium.

Innovation is a new way of seeing things

▪ Not just a new way of doing things.

▪ Product innovations are important, but not sustainable

▪ Process innovations are elusive, because processes naturally kill innovation

▪ Observational innovations… changes in the way we see, understand, analyze, and view problems and opportunities are the most difficult to achieve and sustain

Passion fuels innovation

▪ Innovation requires an unfettered fantasy or vision that things can be better than anyone ever imagined

▪ Fears (of resource constraints, failure, the impracticality of transformation) crush passion, and thus innovation

▪ Innovators must be unflappable

▪ Innovators “Dream through” roadblocks, they “Dream past” naysayers and “Dream over” obstacles.

How will you innovate?

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