Behaivior Recovery

The CDC’s National Center for Health Statistics has released provisional data indicating an overdose death rate of approximately 100,306 in the US in the 12 months ending April 2021, up 28.5% from the prior year. Of these deaths, approximately 75,673 were from opioids, and overdose deaths from synthetic opioids (mostly fentanyl) as well as semi-synthetic opioids (including prescription pain medication) increased in this period as well (Source).      

Current treatment models are reactive, inefficient, and expensive. Hospitalizations, overdoses, and repeated visits to the emergency room strain the healthcare system and the person in recovery (PiR). By allowing the PiR to have around-the-clock care and support on their wrist, and by allowing them to receive an alert when they are likely to experience a craving that may result in returning to substance use, they can take proactive steps to stay on their recovery journey.  

When people in recovery from substance use disorder are in a high-risk craving/obsession state (HRCOS), the propensity for relapse is high. By the time a traditional intervention occurs, they are often already reusing again. A tool that can be utilized continuously and remotely is critical, especially during the ongoing COVID-19 pandemic. The Behaivior system, Recovery, provides an opportunity to intervene in advance of relapse via a physiology-informed risk stratification and contact-initiation paradigm. Reducing addiction relapse and overdose not only saves lives but also saves significant amounts of money by reducing recidivism, re-hospitalization, and reliance on emergency services.  

Especially during the ongoing pandemic, care providers are struggling with staff and patient retention, being severely understaffed, and high levels of burnout and resignation (Source). The Behaivior Recovery system also offers a care provider and admin dashboard to help them provide improved care, and more efficiently allocate staff based on which patients need support and what type of support. There are lots of “recovery apps”, however, if they worked as intended and had the needed technology, overdose and relapse would not be such a continuously increasing problem. 

Behaivior offers an unparalleled proactive relapse prevention tool, bridging care gaps. Our vision is to expand our reach and get our accessible, affordable, never-before-seen augment to substance use treatment into the hands of those who need it most. It can detect cravings to provide opportunities to intervene with support prior to a person in recovery using again, and it also provides information to overworked and understaffed care providers about which patients are most in need of care and how they can best support them. We are using strategies from cognitive behavioral therapy, behavioral economics, and motivational interviewing to nudge people towards positive behavior change, and we provide proactive support to both the PiR and care providers. Long-term care is associated with greater success rates for substance misuse, but high treatment center costs often prevent those in recovery from getting the duration/amount of care needed. Behaivior’s tool acts as a guardian angel on your wrist, a recovery partner tailored to each individual.

Behaivior preventively refocuses monitoring onto the status of the individual before relapse occurs, observing both internal and external factors that affect opioid craving states in real-time. This positive change is accomplished via continuous data collection from sensors within wearable devices and smartphones, combined with reports issued by members of the patient’s social support network who know the patient best. 

A growing body of literature supports the impact of wellness interventions for people with chronic/disabling conditions (Source). Health and wellness coaching for lifestyle behavior is emerging as both a stand-alone profession and a health-augmenting practice in diverse health care, employee wellness, and community settings. Advances in the field have led to interventions such as digital therapeutics and motivational interviewing techniques that allow providers to give holistic support instead of merely combating opioid misuse in isolation. Using these evidence-based techniques and shifting focus toward the total picture of health, we hope to extend the duration of care and reduce gaps in care (which has been shown to lead to improved recovery outcomes), increase access to care regardless of income or location (with affordable costs, remote monitoring to provide access to information regardless of the ability to have transportation to a nearby care provider), and improve the overall health and wellbeing of Recovery users.

Until recently, the prevailing view was that harmful substance use was solely an act of willpower and judgment failures. As science has expanded, we now understand that rather than abuse, substance misuse and substance use disorders are complex medical issues, frequently instigated by an unwilling or unknowing participant due to injury, trauma, abuse, and lack of information and resources. Rather than being simply an individual choice, these disorders frequently require external clinical, behavioral, and community support to help resolve or mitigate symptoms. Most people don’t have the resources to address all of the factors affecting recovery successes on an ongoing basis, and most relapse and overdose occur during gaps in care. These barriers affect socially and economically disadvantaged individuals most severely. Most insurance doesn’t currently cover the full extent of the care needs that many people have, and longer durations of care lead to better outcomes. Health care providers are severely understaffed, and retention rates are frequently low. Without the personalization required to manage the different needs people in recovery have, and with time and other cost barriers, many people are being drastically underserved. 

Behaivior has created a solution to help stem the tide of the opioid epidemic and democratize addiction and mental health recovery. 

In addition to pilot studies being conducted with the tool, results achieved from research and clinical studies funded by the National Science Foundation, National Institutes of Health, and Carnegie Mellon University, among others, validated the consumer application. Through machine learning algorithms, we can detect in advance that someone with opioid addiction is in a high-risk craving state, which allows for the provision of a life-saving, just-in-time intervention. Behaivior Recovery serves as an augment for treatment for substance misuse, a tool to help provide insights to both individuals and care providers into what an individual may be struggling with, what care is helping, and who is most in need of support. 

Many people in recovery end up relapsing repeatedly, despite their desperate best efforts. Historically, the tools used to help people in recovery have been reactive rather than proactive. They take action only after people return to using again or after they overdose. More tools are needed that provide high-quality, individualized care. Given that only 10-20% of people struggling with addiction receive treatment, a tool that can be used both alone as an adjunct to treatment, enhancing treatment protocols, is needed. That is where Behaivior’s Recovery tool comes in.

Behaivior is comprised of a diverse team of experts with professional backgrounds including business, UI/UX design, addiction science, consumer and behavioral technology, software development, and extensive human-computer interaction, artificial intelligence, and machine learning experience. They have successfully developed, deployed, and evaluated treatment support solutions for chronic disease management, medication reconciliation, and workflow management. 

Ellie Gordon, Founder and CEO of Behaivior, is a behavioral technologist, designer,  innovator, and entrepreneur. For over 14 years, her work has primarily focused on improving people’s lives through technology. She has successfully created, organized, led, and managed teams for everything from hackathons and codefests, to other science-based startups and initiatives, to community development and research projects. She did a TEDx Pittsburgh talk as a behavioral technologist speaking about the design elements of what Behaivior is developing.
 Through her research, she has developed subject matter expertise on behavior, opioids, addiction, wearables, and using technology for sensing. Having overcome challenges with substance misuse and PTSD, and having friends, family, and community suffering from substance misuse, addiction, and mental health issues, Ellie is passionate about and driven to help solve this epidemic. 

Behaivior's CTO, Arthur Sugden, Ph.D. has extensive experience in machine learning and the understanding of addiction and its underlying causes in the brain. He spent five years as a fellow at Harvard University's Beth Israel Deaconess Medical Center studying the addiction and reward regions of the brain and the mechanisms by which harmful associations with addictive events are strengthened. Trained in physics and computational neuroscience, Arthur is ideally suited to integrate an understanding of the physical capabilities of wearable devices with the effects of opioids on the brain in order to design effective interventions prior to relapse.

Behaivior prioritizes human-centered design and we have conducted over 200 customer discovery interviews with treatment providers, people in recovery, employers, and other stakeholders and have incorporated feedback gained from user testing in iterations. 

Financial barriers and how Solve could help us overcome them: With limited funding, our small team is limited in the speed and capabilities in which we can get our tool into the hands of those who need it most. Solve funding could support hiring new employees to expedite overcoming this barrier. With additional funding support, we can accelerate the pace of meeting our many goals, such as providing our tool to rural populations and other underserved communities. 

Technical barriers and how Solve could help us overcome them: With a small team, product expansion capabilities that increase health equity are limited by personpower. To increase accessibility, we plan on including Spanish language versions of our application but are currently limited by financial and personpower in our development. 

Market barriers and how Solve could help us overcome them: Our commercialization strategy focused on providing the tool to PiR through care providers. However, with healthcare staff leaving in higher numbers than ever before, limited funds due to covid challenges, and low insurance reimbursement rates in many states for mental health care, it has become even more time-consuming to provide access through providers, who are struggling to even provide basic services. While our tool can help solve some of these challenges providers face, and serves a population in higher need of our tool than ever before, deploying this tool more broadly will require more strong connections to providers, employers, and criminal justice groups to advocate for us and bring us in. We believe that Solve can help provide these connections.

Behaivior has the potential to improve the lives of countless people. With the use of a revolutionary approach to addiction and mental health recovery through our Recovery tool, we have the unique opportunity to proactively avert crises and increase health equity. 

Behaivior’s system, Recovery, is a first-of-its-kind proactive approach to substance misuse, using wearable technology and a machine learning system to democratize addiction recovery. It can serve as an adjunct to current treatment protocols such as Medication-Assisted Treatment (MAT) or as a stand-alone to prevent gaps in care that can greatly set back a person’s recovery journey. Our innovation as currently adapted for opioid misuse can help lower relapse and overdose rates by intervening proactively. By providing a remote monitoring and alerting tool and digital onboarding (COVID-19 adaptations), care providers benefit from a safer and more effective staff allocation, being able to attract and retain new clients through the provision of high-quality, customized care, and reduction of care gaps. Relapse and overdose often result in PIRs leaving treatment early or shifting to different providers. Studies show that longer durations of care are associated with greater treatment success. Behaivior’s Recovery tool supports individuals with opioid misuse, other substance use disorders, and has recently expanded to provide generalized mental health support as well. Furthermore, Behaivior is working on incorporating additional, specialized components into the system tailored to conditions such as PTSD, eating disorders, and depression/anxiety, all of which become more pervasive and harder to address during a disease outbreak. Even if physical closeness is not possible during a disease outbreak, Behaivior’s system allows for 24/7 access to care, support, and potential intervention if needed - functioning as a guardian angel on your wrist.

Our impact goals within the next year include: 

-Making a positive impact in the lives of at least 100,000 individuals, with a reach goal of 1,000,000

-Solidifying 3 significant partnerships to help get our tool into more hands, especially those who need it most and are historically underserved.

Within the next five years, our impact goals are to:

-Broaden to a global scale by serving the 16 million citizens worldwide who have opioid use disorder, and 30 million people globally who suffer from substance use disorders.

-Solidifying 20 significant partnerships to help get our tool into more hands, especially those who need it most and are historically underserved.

Behaivior is measuring our progress towards our impact goals in numerous ways. Broadly, these are:

1. The number of patients and people in recovery who have used our tool, or will be soon

2. The number of partnerships we have, and those in relationships in the development

3. The amount of funding we have

Behaivior’s ultimate goal is to help people live better lives. With the Behaivior system, Recovery, there is now an opportunity to be proactive and intervene in advance risk events by providing a physiologically and behaviorally-informed risk stratification and contact-initiation paradigm. People in recovery and care providers using our system will have a valuable tool in their toolbelt to help them start and/or stay on their recovery journey in a more positive and proactive way, and provide better care, ultimately saving time, money, and lives. Outcomes include reduced gaps in care, increased duration of care, habit and behavior change, increased levels of mindfulness/emotional awareness, round-the-clock presence of support and resource access, and a more stable recovery journey. Research has shown that longer stays in rehabilitative care are correlated with better outcomes due to more sustained substance-free periods.

Behaivior’s application provides essential information for People in Recovery and Care Providers. Behaivior provides predictive information about the recovery of individuals to care providers via its app, Recovery, coupled with off-the-shelf wearable devices. Substantial clinical research has found that drug cravings, and particularly opioid cravings, are associated with physiological changes. A 2014 study tracking people with opioid use disorder delivered random self-assessments and found that moods and stress could be used as predictors for opioid cravings (Epstein et al., 2014). A 2016 study on 30 emergency department patients who were prescribed intravenous opioid medication found an association between opioid use, increased skin temperature, and decreased motion (Carreiro et al., 2016). Physiological data from wearables and behavior patterns collected by smartphones have also been used by Carnegie Mellon University and University of Washington researchers (with whom we have collaborated) to create machine learning-based algorithms which predict, through detection of craving states, excessive alcohol usage prior to use (Bae et al., 2017). Intuitively, the literature shows that cravings for opioids are strongly associated with patients returning to opioid misuse (Kakko et al., 2019).

From this extensive scientific background, Behaivior has created a multimodal system to measure predictors of opioid cravings. We combine data from smartwatches such as estimates of sleep, stress, motion, and more, with an application that requests regular self-assessments from patients. The design of the application is patient-focused and is accessible on nearly all smartphones equipped with Bluetooth. The selected smartwatches are elegant, robust, and affordable. Behaivior is currently conducting commercial trials with providers and the Recovery system has been validated through National Institutes of Health-funded clinical studies, and National Science Foundation-supported development pilots. 

Behaivior has a patent-pending platform, Recovery, for physiological and activity monitoring of individuals in recovery from substance misuse and other addictions and mental health struggles, using artificial intelligence (AI)- driven prediction of and response to physiologically underpinned substance-use cravings as well as impending risk events.

We believe that this novel solution which provides real-time intervention is especially critical to deploy during the current COVID-19 pandemic when access to both medical care and social support is diminished.

Recovery is an application that processes data from wearable devices with custom artificial intelligence models to identify periods of relapse risk for people in recovery. These data are used to suggest wellness methods at low levels of risk and to provide alerts to caregivers at higher levels. As stratification of patient risk is currently a time-consuming and inefficient process - Recovery solves this problem by utilizing AI to rapidly and accurately identify high-risk PiRs. The core artificial intelligence/machine learning models are trained on data from rigorous pilot studies organized by Behaivior. These models, which include custom neural networks in addition to other prediction techniques, can be modulated on an individual basis with data from users to provide a unique prediction model per user. Recovery can also alert the PIR’s care team and family members/friends who function as their social support.

PiRs have the option of sharing location data with pre-approved support network members for in-person administration of overdose reversal medication or removal from a trigger area to a support group meeting. The software contains customized intervention options and alerts the subscriber that they may need to take positive action. 

Behaivior is currently conducting commercial trials with providers and the Recovery system has been validated through National Institutes of Health-funded clinical studies, and National Science Foundation-supported development pilots. The mobile app version of the software is available by download link for commercial trial partners and customers. The provider dashboard login is through recovery.behaivior.com. To request a demo, please request contact us through www.behaivior.com. 

Behaivior actively provides hiring and training opportunities for employees that may face work barriers, including mothers and family care providers, women of color, and those who are historically marginalized. Behaivior provides flexibility and compassion for balancing home/family management and caring for mental health and fosters open communication among team members about self-care needs, plus regular guidance and resources for accessing help. Behaivior Founder and CEO Ellie Gordon believes strongly in helping empower more women and minorities to not just get into the tech sector and STEAM fields, but to thrive there. She is breaking barriers while doing so and providing people from all walks of life, especially those with a non-traditional career path, learning and professional growth opportunities. She has worked with local universities and programs like the Center for Women and the Innovation Works Diversity Intern program to hire and train over 20 interns, over half of whom are women of color and/or marginalized community members. She provides opportunities for those who may face barriers in their career, such as employees who have left the workforce for several years and are looking to return and gain skills and experience at a tech startup. 

Team discussions include sharing of gratitudes and strategies for mindfulness and stress management, as well as a prioritization of gender/race equity and inclusion through sharing anti-racism resources and resources on how to use de-stigmatizing language for people in recovery. At Behaivior, everyone’s contributions are valued, and feedback is encouraged.

Behaivior uses a SaaS offering for care providers for mapping business and program-related outcomes to treatment paradigms, increasing revenue, saving time and money, and helping them provide better care to their clients. 

• The stakeholders involved with this SaaS offering for our beachhead market include:

  • The PIR wearing Behaivior-provided or care provider-provided hardware (i.e. devices) with our app installed

  • Behaivior technology stack that services cloud-based patient monitoring, physiological and behavioral data-driven learning, and presentation of insights relating to triggers that precede crisis events

  • The providers of services that will access the data from the PIR as well as the triggers identified by the Behaivior technology stack in order to:

    • Deliver better care at the right time

    • Improve outcomes in terms of sustained sobriety of residential and outpatient clientele       

    • Improve traceability and retention of outpatient clients after their 30-60 day residential rehabilitation programs     

The U.S addiction rehab industry was valued at $42Billion in 2020 and is expected to grow at a CAGR of 5.2%, up to $53B in 2025 (Research and Markets). The economic impact of substance misuse in the US is estimated at over $800 Billion annually (Statista). Given the extent of the opioid crisis and insufficient treatments and tools to tackle the epidemic we are facing, our initial target market is large and eager for solutions. Initial target customers are substance use disorder (SUD) treatment centers and recovery (transitional living or sober) homes.

Behaivior offers a subscription (SAAS- software as a service), payable monthly with an annual commitment, that can include the wearable, the smartphone application, and the dashboard. Providers will pay $30-50/month/subscriber. That amounts to $1-2/day to save lives. Behaivior plans to enlist the recovery homes and treatment centers as “partners.” Care providers will be able to tout their use of Behaivior’s leading-edge technology, lower relapse rates, increased care quality, and provision of personalized care as a differentiator to attract patients and extend billable service. They can use reimbursement or opt to pass along the subscription costs to the payer as a part of their service. In return, Behaivior can share 5-10% of the subscription fees collected. The costs of revenue-sharing to Behaivior are offset by having resources helping to sell and distribute its product. The end result is a win-win-win for the treatment center and recovery home market.

Funding to date in the total amount of $858,000 has been acquired through investment, grants, competitions, accelerators, and awards including, but not limited to, investment from the Richard King Mellon Foundation, investment from Innovation Works through Alphalab, grants from the National Institutes of Health, including the National Institute of Drug Abuse, the National Science Foundation, Carnegie Mellon University, University of California, and more.