The new wave of sobriety start-ups shaking up the 12-step model
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The circle of chairs has achieved a culturally iconic status. Alcoholics Anonymous and Narcotics Anonymous meetings are so prevalent in television dramas that you'd think the 12-step program was sponsoring the networks.
But in the past few years, a new recovery paradigm has risen fast. And it owes more to entrepreneurs and "lifestyle designers" such as Tim Ferriss than a higher power.
You might recognise Jack Nagle as the face beneath headlines such as '"I was bonkers — former junkie tells all". The founder of Real Drug Talk was once the poster boy for methamphetamine recovery. Now he's one of the people re-thinking how we do treatment.
"I was one of the first to tell my story about ice, and I did so much media," he says.
"I was conflicted about that. The amount of people that would get in contact to say 'this happened to me, too' was overwhelming, but I was also struggling morally with the private treatment centre model I was working within."
He was working at a Melbourne rehab aligned with the 12-step program and rose fast up the ranks. But it disturbed him that people were paying between $30,000 and $90,000 in this unregulated private sector, for treatment of wildly varying quality.
He decided to launch his own recovery coaching system for a fraction of the price.
Real Drug Talk is part of a wave of sobriety start-ups. The creators of these slick online courses, apps, e-books, workshops and retreats all have lived experience with addiction, and often a background in digital marketing or blogging.
Three of the forerunners are Australia's Hello Sunday Morning, with its behaviour-change app, Daybreak; She Recovers in North America; and Soberistas in the UK. They've spotted a gap in the market, whether it be young professionals who see sobriety as self-improvement, or suburban mums who have no hope of getting to 30 AA meetings in 30 days.
For Nagle, it's mainly "businesspeople or what you'd call high-functioning addicts or alcoholics".
"They wouldn't take time out to go to a treatment centre, partly because of the stigma," he says.
Nagle is an entrepreneur — before launching Real Drug Talk he ran a health bar, Wise Fools, with his girlfriend in Melbourne. But he doesn't want anyone to re-mortgage their house to get well.
He kicked off his services with one-on-one coaching by video conference. Now, he's launched the automated six-week Jekyll & Hyde Online Addiction Treatment Program, which ranges in price from $330 to $1,474.
"We don't have to pay rent, so really, the price shouldn't be too high," he says.
There are a lot of online sobriety courses out there, and usually the coach has no credentials, only an ethos of "this worked for me".
Nagle is different — he's a member of the Australian National Advisory Council on Alcohol and Drugs, and he's collaborated on this course with Nicole Lee, a respected researcher with her own 360Edge Drug & Alcohol Policy consultancy.
Yet he understands the line he walks as the face of his brand — of being relatable enough to clients and professional enough to satisfy the highly trained clinicians whose field he's stepped into.
"I do feel judged," he says.
"There are those in the industry who — without realising it, sometimes — discriminate against you for talking about your lived experience."
And yet, the treatment sector relies on the input of peer workers, who risk their own sobriety by being surrounded by triggers. Having a lapse or relapse while holding a position with a treatment service can bring a heightened sense of shame or failure.
Nagle himself has his days of feeling uncomfortable about going public.
"I think about what the people I used to use with would think, you know? We would definitely have had the attitude of, 'ugh, look at this banana'," he says.
Dawn Nickel doesn't feature as prominently in the branding of She Recovers. Her organisation leans towards the wholesome and affluent wellness imagery beloved by Goop or clean-eating Instagram influencers. Yet Nickel is pragmatic and well-versed in all models of addiction.
She and her yoga-instructor daughter Taryn Strong started She Recovers in 2011.
Nickel has a PhD in healthcare policy and had been leading research projects for the Government of British Columbia but felt burnt out. Building on the success of her recovery blog, she decided to hold luxury retreats in Mexico, then events in cities.
Now, the She Recovers Coach Designation program trains women to be recovery coaches and start local meetups. There's even a branch forming in Sydney.
Like most sobriety start-ups, She Recovers falls into the category of early intervention, largely attracting women who haven't reached the proverbial rock bottom. "Early exiters", as Nickel calls them.
Other women are drawn to She Recovers because they've been sober for a while but are disillusioned with their 12-step program.
"They often don't relate to the disempowering language of powerlessness and disease and defects, or the emphasis on 'service'," Nickel says.
"If you're a mum newly in recovery, you just want to start being of service to your family, not a bunch of strangers."
She Recovers will soon launch an online course and has a Facebook following of more than 273,000, but the emphasis is on real-life meetups and ongoing connection beyond what a rehab's fixed treatment period can offer. It complements rehab, rather than competing with it.
Researchers recognise that these start-ups are data goldmines, with membership groups ripe for surveys.
She Recovers has partnered with the University of Pennsylvania. Soberistas — a UK-based online community for those who want to stop drinking — partnered with the University of Southampton. Australia's Hello Sunday Morning — the largest such online community in the world — has contributed to several projects from the University of Queensland.
Hello Sunday Morning started as a blog by Sydney event promoter Chris Raine in 2010.
The company's runaway success story is Daybreak, a behaviour-change app for people wanting to moderate or quit drinking. It offers an initial assessment, habit tracking, an online community and chats with health coaches.
It's funded by the Australian Government's Department of Health, or available through an annual subscription for those outside Australia, and the data it collects builds deep-learning algorithms that can create tailored treatment programs for users.
Once upon a time, Raine had been concerned enough about his own drinking to quit his job and design a new career around sobriety. Now he's learnt enough to be able to drink moderately.
When we meet in a cafe around the corner from his Surry Hills HQ, he's fit, tanned, and psyching himself up to run a half-marathon the next day.
"I'm a personal development junkie," he says.
"I've done lots of courses like Real Education, Landmark … If you've got a couple of hundred bucks to spend and you spend it on someone showing you how to be a better person, can you fault that compared with Nike telling you you're a shit person and you need to buy these shoes?"
Raine thinks sobriety start-ups are threatening to the "old guard" in the sector.
"A lot of the ideas around stepped-care models and early intervention are ideas that they had 20 years ago, but there hasn't been the cultural support," he says.
"Now there are people that are new to the field who will take credit for it."
His team has partnered with huge corporate hitters like Vodaphone, Macquarie and NIB, and received grants from the likes of Google.
"There's a lot of work to be done in our field but in many ways it can be a winner-takes-all sort of thing," Raine says.
"There are a few people that are organised, and they get all the funding."
Increasingly, he's recruiting researchers, psychologists and defectors from pharmaceutical companies, to enhance Daybreak and future products.
Raine's next move is to investigate "digital therapeutics" — digital health technologies such as online cognitive behavioural therapy, behaviour-tracking and sending notifications as prompts, to treat alcohol-use disorder in a way that's scalable to the individual user. Once again it will rely on machine learning to enhance the clinical outcomes and reduce the necessity for seeing a clinician.
None of these start-ups can replace the crisis care of a detox, nor can they assist someone through withdrawal.
Instead, they play a different role.
"The legacy we want to leave is that behaviour change is priced well and there's a regulatory aspect around how that's done," Raine says.
"Ideally, that will remove some of the more nefarious practices where people are extorted for enormous amounts of money, for help that should be universally accessible."
Jenny Valentish is the author of Woman of Substances: A Journey into Addiction and Treatment.
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The new wave of sobriety start-ups shaking up the 12-step model