Before the opioid crisis became a daily headline, Robin McIntosh noticed that many of her fellow comrades in the battle against addiction were disappearing from the East Bay rooms of Alcoholics Anonymous (AA). Meanwhile, McIntosh was struggling with her own recovery. The longer she remained sober from alcohol, the more the symptoms of her illness would manifest in other areas of her life, such as her eating habits and relationships. It was like playing a game of Whac-A-Mole.
AA helped McIntosh—who first went to rehab at age 17 and found lasting sobriety at 24—build a community of women on similar journeys of well-being, and introduced her to the possibilities of life without alcohol. But she was starting to believe the 12-step approach wasn’t enough for her—or for the millions of other Americans fighting to break free from addiction’s sinewy grasp.
"If you have success in AA, it’s attributed to the program. But if you don’t, it’s your fault," says the 34-year-old Oakland resident, sitting in a local coffee shop. "If you don’t jibe with [AA], though, what do you do?"
The Epidemic Hits Home
While the Bay Area is known for innovation and disruption, the field of addiction recovery is not. In 2018, addicts and alcoholics are often prescribed the same treatment plan they were 75 years ago: abstinence and God.
There are, however, signs of progress. Among them is Workit Health, the online addiction-recovery start-up McIntosh founded with partner Lisa McLaughlin, who has been sober for 16 years. As the company’s literature describes, Workit Health is "Made by addicts, for addicts, and backed by experts." Through Workit’s mobile treatment app—which recently expanded into brick-and-mortar clinics in Lafayette and Ann Arbor, Michigan—McIntosh and McLaughlin are attempting to bring 21st century scientific rigor and Silicon Valley novelty to this age-old ailment that, in the wake of the national opioid epidemic, has taken on new urgency.
The ferocity of the opioid crisis has brought to bear the inadequacies of the current one-size-fits-all treatment landscape. Every day, at least 115 people in the United States die from opioid overdoses, and more than 20 million Americans struggle with some form of substance abuse. Drug addiction has frayed the social and economic fabric of communities across the country, from rural towns in West Virginia to upscale enclaves like San Ramon and Danville. Families who’ve lost children and loved ones to opioids—including painkillers such as prescription OxyContin and codeine, as well as more notorious drugs like heroin—are scrambling to find answers.
Statistics are hard to come by, but according to estimates, roughly 20 percent of people battling addiction have access to medical or mental health resources to aid their recovery, and among those who do get help, less than half are able to stay sober long-term. "Addiction treatment has been a black market," McIntosh says, pointing out that AA has never been subjected to clinical trials yet is prescribed as the gold standard in clinical rehab settings. The White House opioid commission has also emphasized telemedicine and digital technologies as being integral to creating widespread accessibility to effective care.
A New Way Forward
McIntosh met McLaughlin, who is based out of Workit’s Michigan headquarters, in AA almost a decade ago. Around that time, McIntosh, a graphic designer by trade, was working on a yoga app, immersed in the advancements and possibilities of the medical tech industry. The two women began collaborating on a recovery-oriented prototype, and in 2016, Workit went to market. In early iterations, the platform was structured as an enterprise service that employers could offer employees. The following year, the company expanded to target underserved communities, making affordability core to its business model. Plans range from $40 to $75 a week.
Workit is a hybrid form of "mHealth," which refers to science-driven medical care administered via technology and apps. This virtual treatment approach keeps costs low and allows users to maintain stability in their lives, rather than having to disappear to rehab for weeks. And with the FDA now regulating apps, digital addiction medicine boasts more oversight than in-patient therapeutic programs.
For those overcoming opioid addiction, there is an additional component to recovery: medication-assisted treatment. Research shows that drugs that alleviate withdrawal symptoms and mitigate cravings, such as buprenorphine (known as Suboxone), are the most effective means of curbing opioid use. To get an opioid-antagonist prescription, though, patients must meet in person with a doctor and submit to drug tests to prove they are taking the medication as directed. So, Workit recently launched two clinics to support clients with opioid dependencies. (McIntosh and McLaughlin have plans to open a handful of additional locations across the country in the near future.) Lafayette was selected because it’s easily accessible to Bay Area residents, and to those traveling from the central corridor and from up north.
How It Works
While the clinics specifically treat people battling opioid abuse, Workit’s other programs serve all kinds of addicts. Clients start by identifying their problematic relationships—whether with gambling, sex, porn, food, alcohol, or drugs—which allows for personally tailored treatment plans that are built using a combination of therapies, including cognitive behavioral, motivational interviewing, and relapse prevention. Then, they begin weekly sessions with a coach or licensed counselor, and daily online exercises. The interactive curriculum continually adapts to each member’s evolving needs and gives real-time feedback. For instance, if someone has a wedding on the calendar, he or she might be assigned an exercise to create a plan for being in a social setting where most people are drinking.
Workit doesn’t quantify recovery by total abstinence or a "spiritual awakening," as it’s called in AA. Instead, it uses a Thrive Meter to measure quality-of-life markers, including sleep, physical health, and overall wellness. "AA is built on a linear model of recovery," McIntosh says. "But addiction isn’t linear." Sure enough, addiction relapse rates are similar to those of other chronic medical illnesses like asthma or hypertension.
The Workit app also teaches users to break destructive patterns by offering lessons on various topics, such as mindfulness. The slides are colorful, with minimal text and small graphics. The mindfulness session, for example, provides specific steps for cultivating self-awareness, staying present, and learning not to judge experiences. Users are asked to identify what they see, smell, taste, and feel, and are then shown how cultivating mindfulness can help them overcome cravings and override automatic thoughts.
When asked what recovery looks like for her, McIntosh doesn’t even mention sobriety. She talks about her relationships and the ways she’s able to give back to her community. She lists her daily musts: supplements, SSRI medication, 10,000 steps, nine hours of sleep, closing the computer at 6 p.m., and spending time with her fiancé and pup.
The name Workit comes from a maxim often chanted at the close of 12-step meetings: "It works if you work it." But the start-up’s philosophy expands that idea to something more communal: It works if we work it. "We always talk from the ‘we’ perspective," McIntosh says. "We’ve been there, too. We’ve got you.
"It’s on each individual to do the work," she adds. "But we will work as hard as they will." workithealth.com.