It doesn’t get that much attention, but the methamphetamine epidemic in the U.S. is startlingly widespread and lethal. The number of overdose deaths involving meth increased 7.5 times from 2007 to 2017, according to the U.S. National Institute on Drug Abuse. And, while there were 1.6 million users in 2017, according to the National Survey on Drug Use and Health, more current estimates peg the number at 3 million.
At the same time, effective treatment often relies on behavioral therapy programs that aren’t tailored to the needs of meth addicts, according to Kristin Muhlner, CEO and co-founder of addiction treatment startup Affect Therapeutics. There is no FDA-approved medical therapy for methamphetamine user disorder.
That’s why in 2020, Muhlner joined forces with Dr. Jeff De Flavio, a founder of opioid addiction treatment programs, among other ventures aimed at broadening access to healthcare, to launch Affect, a New York City startup with an app-based treatment program for meth addicts that combines reward systems—paying cash for achieving certain tasks—with group therapy.
De Flavio got the idea as an entrepreneur in residence at AlleyCorp, a New York City incubator which he joined in 2019. He devoted much of his time looking for interventions that would make the most sense for meth addicts. The best approach needed to address a big problem: With a large population of addicts in rural regions, it was difficult for them to get to in-person facilities. At the same time, those in urban areas faced childcare and work obligations that also got in the way of attending sessions consistently. The answer: treatment delivered digitally, specifically through a mobile app.
Last year, he enlisted Muhlner to help launch and run the company. With a background in building and running digital businesses, she also had also previously lost a close friend to a drug overdose. With $1 million in seed funding from AlleyCorp, they founded Affect last June.
The program centers around what’s known as contingency management, meaning, providing rewards consistently for positive behavior. It’s something any parent learns to do with a toddler, but isn’t used that much in addiction treatment, according to Muhlner.
The approach stimulates the brain’s rewards system, much the same way drugs do, creating a high. “We’re taking away those massive dopamine hits from drug use, and seeking other ways to activate the reward centers in the brain,” says Muhlner. The approach also takes a cue from the video game design, which seeks to create a “compulsion loop”, a chain of repeated activities that also create a neurochemical reward, thereby motivating players to keep on playing.
To that end, patients receive cash when they complete daily and weekly tasks aimed at helping them build the skills necessary to stop taking meth, learn impulse control and start to develop plans and goals. That includes mindfulness and meditation exercises, as well as sessions in which patients develop a deeper understanding of the reasons for their addiction, analyzing such matters as when they first started using or triggers that spark their cravings. The app also collects data on behavior—sleep or exercise patterns, for example—with which Affect can better understand patients’ day-to-day status and how they’re progressing.
Patients are paid directly via the app; they don’t need a bank account. Contrary to the opinion of naysayers who oppose the rewards approach, patients don’t use the cash to buy drugs, according to Muhlner. “Research indicates they use it to improve their lives,” she says. Paying through the app also provides an auditable and trackable way to disburse the money.
It’s all part of a broader care program, which includes twice-weekly group therapy conducted over video, plus regular check-ins with what Muhlner calls a “care advocate”. The goal is to introduce patients to others in the same situation, to help them develop a social network and support system. There’s also psychiatric help.
In December, according to Muhlner, the company started a trial program with about 50 patients so far in California, where it’s overseen by an Institutional Review Board, an administrative committee that provides ethical and regulatory oversight of research involving human subjects. According to Muhlner, there has been a “demonstrable reduction in drug use.”
The company is now talking to health insurance payers about covering the treatment and providing Affect with reimbursement for providing those services. Ultimately, the plan is to begin a pilot in the third quarter in Nevada, expand to Kentucky and Arizona fourth quarter and roll out nationally in 2022.