Triggr Health supports drug recovery using smartphones and AI
Phone app Triggr Health is supporting drug addicts through recovery, connecting patients to recovery coaches to help them reach their sobriety goals. If app users don’t contact their coaches for 24 hours, the team contacts them, ensuring they are safe and clean. The app could help former drug users avoid relapse by providing them with both a simple way to track progress and on-hand help when the road becomes difficult. Triggr's built-in machine learning systems can also predict with 92% accuracy when a user is likely to relapse in the next three days, according to the company. 

Triggr has been a different way to access support. In addition to tracking the number of days she has been in recovery, the app connects Hedstrom to a team of recovery coaches, who chat with her periodically throughout the day by text and app message. If she has not contacted Triggr for a full day, the team contacts her. Generally, they talk about how her day is going or goals she has set for herself, but recently they helped her through an unexpected challenge. A stranger followed her car into a lot and parked next to her, then offered her drugs. Not sure what to do, Hedstrom texted Triggr. “It’s not just about addiction,” she says. “It’s like we’re on a friend basis. You need to have backup supports.”

In 2015, 33,000 people in the United States died from opioid overdoses—the highest number ever recorded, and more than double the 2005 figure, according to the National Institute on Drug Abuse. More than half a million hospitalizations related to opioid dependence occur each year, at a cost of $15 billion, according to a recent study. Tens of billions more are spent on clinics and other treatment.

In total, 23 million Americans have a substance use disorder involving illicit drugs or alcohol, according to 2013 data collected by the Substance Abuse and Mental Health Services Administration, part of the U.S. Department of Health and Human Services. But fewer than 20 percent of those who need treatment will receive it. And while the most common form of treatment, Alcoholics Anonymous or Narcotics Anonymous, can be quite effective for some, according to one survey 75 percent of people in such programs relapse in their first year. Though a wide range of treatments are available, says James R. McKay, an expert in addiction and a professor of psychology at the University of Pennsylvania, “there are people for whom none of those things really work.”

New technologies are offering yet another option, making use of the computers we carry in our pockets. Of the 165,000 smartphone apps for health care, mental-health apps are the single largest category, including hundreds of addiction-related options offering inspirational quotes, directions to nearby AA meetings, hypnosis guides, and online peer support groups.

Art by Hedstrom’s sons Riley, four years old, and Jeremiah, 11 months, decorates the walls of her home.

Triggr is more ambitious. Using data collected from smartphones, the company aims not only to help people handle cravings and the stresses that trigger drug use but to actually predict when someone is going to relapse and intervene. Triggr collects clues from things like screen engagement, texting patterns, phone logs, sleep history, and location. Those are combined with information gathered from participants’ communications with the startup’s staff on its platform—such as drug preference, drug history, and the presence of dangerous words like “craving” or “stress”—and fed into a series of algorithms. The system has access to general information about other texting and e-mail activity but not to the content of private texts or calls. Using machine learning, it searches for patterns that point to an increased likelihood of relapse. When the likelihood rises to a dangerous level, a member of the recovery team steps in or alerts a customer’s outside care team.

Neither the company nor clients will say how much the platform costs to use, though in some pilot projects Triggr seems to be charging very little or nothing. Hedstrom downloaded the app for free but now pays a monthly fee for using the system, which she says is less than two dollars a day. The most promising way for Triggr to make money could be to share in the financial savings use of the app could offer the insurers and government agencies that pay the medical costs associated with addiction. An initial 30-day inpatient treatment can cost $17,000, and emergency room visits and other associated costs add up quickly.

Chris Olsen, a partner at the venture capital firm Drive Capital, one of Triggr’s investors, says it has been estimated that Ohio Medicaid is spending as much as $5 billion a year on hepatitis C infections, which are strongly correlated with injection drug use. “If we can reduce that,” says Olsen, “I just believe there will be a revenue model down the line.” Among those using the app today are patients who have been through rehab at Sprout Health Group, a chain of addiction treatment centers headquartered in New Jersey. Sprout CEO Arel Meister--Aldama says that before Triggr, a patient who had been in a full-time program for 45 days on average and then returned to the community would have been tracked with periodic phone calls and invited to alumni events, but it was hard to know how people were really doing. Now Sprout’s counselors get alerts from Triggr when a patient seems at risk. “There are false alarms, but often we’ll catch people on the way to their drug dealers. Or they’ll be sitting outside a bar thinking about going in,” says Meister-Aldama.

Having struggled with addiction for 15 years, Hedstrom has found that 12-step groups are not her thing. Triggr, though, has become a valued support.

Sprout’s readmission rates have actually gone up since the company started using Triggr, but overall cost per patient has declined. That’s because its counselors have been able to help patients earlier, avoiding expensive stays in treatment facilities and emergency treatment. With the data he is getting from Triggr, Meister-Aldama says, he has a better understanding of what it will cost to treat each patient. He expects that in the future he will be able to agree to flat payments per patient instead of charging fees based on services.