[00:00:06] Dr. Wilson: I think in this population where people are often expressing traumas that they’ve been through, for them to be able to talk about that completely freely, uninhibited, for people to be able to ask questions. When you have anonymity, you can ask anything. You’re not embarrassed to share what happened to you, or what you used to think, or how you use to approach this, what happened in your relationship, and the ability to be so free, it’s a level of freedom that we just didn’t even realize how powerful that would be in how we are providing care to a group of people who are so isolated right now. It’s a place of freedom on a physical level, and emotional level, spiritual level, every level. It’s really incredible.  

[00:00:52] Monica (Recorded): Hi and welcome to Technically Sick – This podcast explores how technology can increase access to education, employment, and improved socialization for the disabled and chronic illness community. 

[00:01:06] I’m your host, Monica Michelle.  

[00:01:11] [Music Ends]  

 

[00:01:11] Today I’m going to be speaking with Chief Executive Officer, Dr. Amanda Wilson and Chief Science Officer, Dr. Lisa Chiodo of North-Star Care, a personalized at-home Alcohol Use Disorder rehabilitation taking place in virtual reality.   

 

[00:01:29] Dr. Wilson is Board Certified as an Addiction Medicine Physician, having worked in development of Harm-Reduction focused programs for Opioid Use Disorder (or OUD). She has recognized the significant barriers of in-person treatment and has developed multiple tech-solutions for addiction intervention.   

 

[00:01:49] Dr. Chiodo is a developmental psychologist and statistician with more than 30 years of experience. In addition to being the Chief Science Officer for North-Star Care, she’s also the CEO of the Addiction Research and Education Foundation (or the AREF), a not-for-profit organization whose whole mission is to improve the understanding of care outcomes in patients with addictive disorders.   

 

[00:02:15] Together, with the help of their team, North-Star Care uses virtual reality technology to create a fully anonymous and immersive experience for Alcohol Use disorder Rehabilitation. This allows patients to stay at home with their families and to continue their professional careers, all while receiving world-class medical treatment remotely.  

 

[00:02:38] Before we begin, a quick clarification regarding the terms used in this episode. VR or virtual reality – this refers to 3D goggles that you put over your eyes which then immerses you in an entirely virtual world.  

 

[00:02:52] AR or augmented reality – this refers to a mix of the real and virtual worlds, where virtual overlays are superimposed on top of real objects that you would see through something like a smart phone or smart glasses and other smart technologies. In today’s conversation we are going to be focusing on the fully immersive, virtual reality experience.   

[00:03:13] [Music Plays]  

[00:03:15] Welcome to Dr. Amanda Wilson and Dr. Lisa Chiodo!  

[00:03:21] [Music Ends]  

[00:03:21] Monica: I’ve been really excited to talk to you guys about the applications of virtual reality and therapy. I would love to hear from you. When did you first realize that virtual reality would be an incredible tool for therapy?  

[00:03:34] Dr. Wilson: So, background wise, we both have extensive experience in treating in the addiction space, and we learned from that experience how imperative it was for people’s dignity and for their safety to be able to have an experience supporting one another, but truly know that that’s a private experience. 

[00:03:55] That was the initial driver for us exploring virtual reality. Even as we were creating the foundation of the company, understanding that there are numerable benefits from peer support and that there’s great data showing that peer support does impact clinical outcomes. We are creating a comprehensive medical program, but we knew that this would be an important aspect. So, as we began exploring, well, what methods might we use?   

 

[00:04:21] We were launching the company at the beginning of COVID. We were aware that many people were seeking peer support at that time, using Zoom, and connecting with people that we were bringing on into the company at that time. We learned a number of things, but one was that Zoom was really not working well for many. There were many aspects about that that were frustrating, and we found that anonymity being a prime driver, it would be really helpful to offer it in a way that really enabled people to have a much different experience than they were having in zoom.   

[00:04:53] Monica: That’s really interesting. Can you explain a little bit more about the dignity and the privacy aspect when it comes to addiction, and therapy, and getting help? 

[00:05:03] Dr. Chiodo: Sure. I’ll let Amanda kind of add on that in a minute, but I wanted to first add on a little bit. One of the reasons why we really started looking into VR is we were talking with patients and we had a patient that said to us, “I really need to find someplace to talk to people where they don’t know who I am”. 

 

[00:05:20] And she said, “I just tried last week to go” – she went three towns over to ensure that nobody would know who she was, and she walked into the door and there was a family member and a friend there who also had done the same thing, had gone three towns over to make sure nobody knew who she was. We realized just how important the concept of anonymity is, to be able to go someplace to talk about these issues and these problems in a way that was freeing, that would allow them to say what they wanted to say, and allow them to be comfortable to receive the help that they wanted to receive. And that’s the point at which we knew we needed to really think about technology like VR to maybe do this.   

[00:06:08] Dr. Wilson: Realizing the limitations of zoom – some of them were that people would participate in group meetings, but they would shut their video off, and it was very difficult to feel the person, to feel connected to the people that you were on that engagement with. People were distracted, they’re doing other things, playing video games while they’re on, their cell phones while they’re on. So, there was a lot of distraction that was pulling people away. 

[00:06:30] So, there were a variety of things that were just difficult about it. I’ve personally always had the vision that with technology in time, that the possibility of doing in-home treatment could really just be profoundly changed by technology. The innovations that are coming, including AR, and the ability to anticipate what it might be like to meet really in, what feels like, a true in-person engagement, but do that from home, has always been really appealing.   

[00:06:58] And, in the addiction treatment space in particular, there are no avenues for private treatment. If you go to a support group, you are there in person, even if you don’t say your whole name, you’re usually saying your first name and you might run into people. Going to rehab, if someone chose that avenue for treatment, they are there in person. People know their faces, or see their faces, and get to know them over that time. Our vision was: let’s make use of technology so that no one has to leave their home at all, so that no one even needs to know that they’re in treatment unless they want them to. It gives them back that control.   

 

[00:07:30] This is a world sadly still filled with a lot of stigma around addiction, a lot of blame, a lot of misunderstanding about the disease of addiction, frankly. That piece of it is so unappreciated, honestly, by most. There are 28 million people with alcohol use disorder, 10 times the number of people who have opioid use disorder, and yet we talk about the opioid use crisis all the time. And alcohol use is just never spoken about it, yet 2 million people are only getting any kind of intervention at all, including AA, including rehab, including detox, including counseling, any intervention. So, a very small percentage. Why is it that 26 million aren’t getting any support? A huge part is this anonymity piece. Our vision with VR has just expanded dramatically as we’ve learned about other aspects besides anonymity that make VR really appealing, and really interesting, as we implement this therapeutic modality that we can talk about too.  

[00:08:32] Monica: I would love to hear about that. What you talked about with the privacy, it sounds like the way that you’re using virtual reality, if I’m understanding correctly, is the way that people can have a connection with other people, while still maintaining their privacy and their focus. Am I understanding that correctly? 

 

[00:08:45] Dr. Wilson: Yes exactly. We’re a comprehensive medical group providing care, but one aspect of our program is peer support. We hire support guides, who are themselves people with lived experience, who are trained recovery coaches. They are moderators of groups of up to 10 people in a virtual space. Every patient starting our program receives a kit that contains an Oculus headset. They then participate in this 3D space. Our room is already built – a three-dimensional virtual room where they’re going to meet up with other patients that have the same issue – only they can show up as an avatar. They can be any gender, they can be any color, they can voice mask so that no one would know that it’s them, and they can change that any day that they wish. They can be anyone they want, as they show up to that meeting.  

[00:09:33] We’ll be having meetings, not just for patients, but also for family so that we can provide support to them. They have an avenue and a place to receive support as well. We’ll be using VR for educational groups to help patients learn about their disease and families learn about the disease of addiction. So, there’s a variety of different tools that we’ll be availing patients of through VR. We’ll be doing yoga, mindfulness, breathing exercises for stress. There’s a variety of different things that can be done in virtual reality that are wonderful adjuncts to our medical group program.   

[00:10:05] Monica: I was reading about a modality with this in allowing people to experience immersion so that they can experience what it’d be like to be at party. If there’s alcohol around, they’re able to see the triggers and have guides and guided voices to help them. Is that something that you’ve seen or something you’ve been experimenting with? 

 

[00:10:22] Dr. Wilson: That’s a great question. Actually, when we met our virtual reality partner, Foretell Reality, they talked about that they had had that vision also. Interestingly, we’re not intending to use that as a part of our treatment. We are absolutely bringing patients together to support one another. We’re doing some other really innovative things. For example, every patient will have a peer to whom they are assigned so that they have a one-to-one partnership, and they’ll be able to do things like meet up in virtual reality, go for a walk on a beach, go explore Rome, literally play ping pong together, or a table game, or something, whatever they want. We’re going to use it in a variety of ways that enable both one-on-one and group interactions.  

[00:11:05] Our experience though with immersion therapy is, in full disclosure, patients every day are already exposed to triggers. Every day they’re facing it because the trigger could be as simple as they’re on their way home from work, and they usually had something at close of the day. They’re always dealing with triggers. Purposefully putting them in a position that’s back to a trigger in early treatment – I’m not convinced that that actually has the amount of benefit that people think.   

 

[00:11:33] We’re really approaching this from a medical standpoint. I’m a physician. Lisa can talk about her background too, but we’re approaching this as we have with our previous experience in addiction – treating this using nutrients, using medications, that help improve as well as these behavioral supports. The thought that just behavioral interventions, like immersion, are likely to be successful as a single intervention, in our opinion is less likely. We don’t see many patients actually benefiting from that as much.   

[00:12:02] Dr. Chiodo: As Amanda said, patients have triggers every single day and we don’t really find the need to put them in a triggered situation. We’re just not sure that’s really very beneficial. However, one of the things that we do think that we might use this for is having someone come into a situation where they say I’m really struggling talking with my partner about my treatment, and my planned path in my treatment, because we’re struggling around that. We could see putting them into the situation with them and maybe their peer where they’re role playing that out, and how that conversation might go, and what they might do, and what they might say. We kind of see the therapeutic value in that when it’s a patient driven, role playing activity.  

[00:12:47] Monica: Thank you so much. That really helped clear that up. What are some of the benefits of this virtual reality space, where you can be any avatar in something like family therapy, or being able to get people who are far away from the person who they may need to have a support or have a discussion with?  

 

[00:13:04] Dr. Wilson: A variety of different aspects about this are really helpful. For example, if you live in a small town in Alaska and you’re participating in a virtual group, the probability of being able to build a group of people together who have a shared common experience is less. We envision having groups that are specifically for veterans, we’ve envisioned having groups specifically for people who have PTSD. It turns out that the group that had the largest increase through COVID of alcohol consumption and problems were women with children under the age of five. So, we want to have a group for them. You can’t really form a group like that, unless you have a broad group, and you can go across the country, and offer groups at scale to thousands of people and be able to do that virtually, and now we’ll be able to offer that.  

[00:13:48] There are advantages for families, same idea. You could have families who have a person who is struggling with alcohol use disorder, and that person is a veteran or has PTSD, and they want to address certain aspects of what’s happening there. You can have a family group for people who their relationship was in big trouble because of the alcohol use disorder, and now they’re really working through that, and they want to talk with other people who’ve had that struggle. We can find commonalities and, at scale, we’ll be able to provide care across the country and really individualize the needs each patient has to be met in a group support setting, and then again, one-on-one as well. There are many other aspects about VR that are really interesting and helpful.   

 

[00:14:30] Dr. Chiodo: One of the things I want to make sure that we do say, during this conversation, when you are in our peer room, and you are with a group of people, it is actually an immersive experience. You are there, there is no ability for you to look at your phone. There’s no ability for you even to look at your watch. They actually have in our room, a clock that changes based on whatever time zone you’re in. So, you know what time it is, you don’t have to look at your watch, you don’t have to look at your phone.  

[00:14:42] You are. There is no ability for you to look at your phone. There’s no ability for you even to look at your watch. They actually have in our room, a clock that changes based on whatever time zone you’re in. So you know what time it is. You don’t have to look at your watch. You don’t have to look at your phone. 

[00:14:59] You are really there actually in the environment, you feel like you are with people. I would do a VR meeting over a zoom meeting any day of the week. You don’t have VR fatigue. You are comfortable. You’re open to so many more things than you would be if you were in zoom. You can high five somebody who’s next to you and you feel something, you actually feel that energy. It’s truly an amazing experience that really does make you feel like you’re talking with a group and you can talk so openly and freely.  

[00:15:35] Monica: I wanted to touch a little bit on the comfort aspect. I’m a wheelchair user, I’m disabled. And, the attendance issue is something I also wanted to talk about – the ability if you’re living in a remote area, or if you are a wheelchair user who has trouble getting places. But I also wanted to talk about the comfort aspect. Are you finding that people are physically more able to get into a position in this so that they cannot focus on their pain or any other issues while they’re in virtual reality? 

[00:15:59] Dr. Chiodo: Yes. Absolutely. You can be in whatever position you want to be in. You’re not worried about – is your head up, what do you look like? I find that I end up tending to do them in my La-Z-Boy chair. Sometimes Amanda will have to say, “Chiodo, stop rocking,” because you know, I’m rocking back and forth. I have actually been so comfortable in a VR meeting before I fell asleep, and obviously that’s not what you want to do, but you really, really can be comfortable. Doesn’t matter what you’re wearing, none of that matters, and it does lead to a freedom of conversation – that level of comfort.  

 

[00:16:35] Dr. Wilson: I love the idea of empowering people, because differently abled people, people of color, or if you’re transgender, whomever, that they can show up in this space as whomever, and however they choose, is really important. And you can change that day by day. You could feel like you want to be purple with spots one day and another day you want to represent a different gender, whatever. I just think the opportunity to explore that is really valuable too and empowering. The freedom is something that you just can’t even really explain unless you’ve had the experience. 

 

[00:17:08] Monica: I do have a quick question about the virtual reality program. What are some of the accessible things for this? You were saying that you can be in any position, and I’m a virtual reality gamer, and I’m very frustrated with a lot of the controls not being accessible for people who are laying down. I’m guessing, from what you’ve talked about in a La-Z-Boy chair, that your program does allow people to lay down and you have actually thought through the disability access of these programs. 

[00:17:31] Dr. Wilson: We have, you can be in any position. Our room is set up at the moment as a circle of chairs, and this particular room is set up to imitate a group meeting. That being said, we envision having these one-on-one engagements in VR with peers, and a walk on the beach could literally look like someone moving in any way that they wish or not, and the beach is moving. It’s the experience of the 360-degree feeling of being in a space that is so open, and you can enable one person to be in a room that looks like a library, and another person to be in a room that looks like a comfortable living room.  

[00:18:11] They can be in the same room and have a different experience of the room. What feels comfortable to them – position can change, avatar can change, room environment can change. The environment can move and you can be in any space you wish, and you could be wearing sweatpants. Whatever is comfortable to you, right?   

 

[00:18:29] It’s a level of freedom that’s quite liberating and I think in this population where people are often expressing traumas that they’ve been through, for them to be able to talk about that completely freely, uninhibited, for people to be able to ask questions. I don’t know anyone who hasn’t been in a school scenario where they had a question, but were nervous to ask, because they didn’t want to look like they’re the only ones who don’t know. When you have anonymity, you can ask anything, “I want to understand this disease better,” and you’re not embarrassed to ask. You’re not embarrassed to share what happened to you, or what you used to think, or how you use to approach this, what happened in your relationship, what you’re embarrassed about, what happened that you’re like, “now that I know this, oh my goodness, I would have behaved so differently with my son,” or something like that.   

 

[00:19:19] And the ability to be so free, it’s a level of freedom that we just didn’t even realize how powerful that would be in how we are providing care to a group of people who are so isolated right now, even isolated within their own family systems, because they can’t talk to family. The few people that do know are often judgmental of it, and they don’t have a safe place to be. It’s a place of freedom on a physical level, and emotional level, spiritual level, every level. It’s really incredible.   

[00:19:50] Monica: Are the guides, the people who are trained to guide these groups, are they able to change their avatars, if someone’s been through trauma where a certain type of person traumatized them? Could that guide change their avatar to be more comfortable for that person? 

 

[00:20:04] Dr. Wilson: Exactly. Anything. Their name can be anything. 

[00:20:08] Monica: Wow. I’m just taking that in. I’m actually blown away by that. the idea of being able to be in a therapy session with someone who’s highly trained, but because of factors that the therapists themselves cannot control, it could be hard for that person to hear or be in a room with. 

 

[00:20:23] Dr. Wilson: They could be genderless, right? Because you could even have the person that’s conducting that therapeutic intervention mask their own voice.  

 

[00:20:31] Monica: Such a revolutionary idea for therapy. This is such a change for everything, and for people who are deeply vulnerable. Addiction comes from many places, but a lot of people have been very traumatized and what a beautiful way to feel very safe. 

 

[00:20:46] Dr. Wilson: The other piece too is, a common belief in AA, a common principle, is something that they’ll refer to as “men with men, women with women”. That is a principle because the belief going back to the 1930’s and Bill W, and the founding principles of AA, was that men should not pair up with women as their mentor, for example, or their sponsor, right? Because of the potential of there being some other tension there that is based on a relationship risk.  

 

[00:21:12] That goes away, and if you only allow men to pair with men and women to pair with women, then you’re missing out on half of the population, their perception, their experience, their impact. Men are dealing with trauma too, and might be more uncomfortable about talking about that, and now they can be free to do that. You can have them learning from women who’ve been in trauma or vice versa and have these kinds of experiences in a way that’s so freeing.   

 

[00:21:38] Eliminating gender alone is so huge, but also eliminating color, and the ability for people who today, when they go into any therapeutic environment, everyone judges in advance what that experience is going to be based on who they’re seeing across from them. You’ve eliminated all of that. Now you’re just meeting the human, really just meeting that human where they’re at.  

[00:21:59] Monica: That’s a beautiful thing for the entire world, a wonderful idea of how we could actually just meet as people, as souls, without that pre-judgment. And I love what you were talking about, that there’s so much that we can learn from each other without just deciding that this person has these experiences based on these body parts. And there’s so much that gets missed in that experience, especially as more men are coming forward. So as more and more people who present as masculine are starting to discuss things like childhood trauma and other kinds of physical trauma and are being more public about it – what an amazing safe space be able to do that in something that isn’t gendered. 

 

[00:22:36] Dr. Wilson: That’s exactly right. 

 

[00:22:38] Monica: I wanted to discuss a little bit about time off, because that’s one of the huge issues with looking for help for recovery, not just people having access to it, but being able to take that time from work, from life, from family. What does VR offer for that?  

[00:22:54] Dr. Chiodo: The amazing thing about VR, and in general the program that we’re creating, is unlike your typical rehab that you have to go to, you have to admit it to your employer. You need to say, “I need like 30 days off of work”. You have to leave your family. Oftentimes women are trying to figure out who’s going to care for their children for 30 days. None of that has to happen. You can receive care in your home, on your schedule.  

[00:23:20] We’re going to have VR groups at all times of the day, and into the evening, so that it can be on patient’s schedule. We are literally bringing the care to the patient in a time that it works for them and not asking or demanding that they come to us at a time that’s convenient for us. These VR meetings can happen at any time of the day or night.   

[00:23:42] Dr. Wilson: Weekends, nights, middle of the night, it’s a 24/7 program. So, we’re bringing a comprehensive rehab experience to the patient at home. All of the medical care, all of that support through VR, all of the visits, all of the individual support counseling, all of it can happen through these methods of intervention now, so that no one has to leave home at all and they can keep working.  

[00:24:06] We want to help people that are much earlier in the disorder, who are starting to have a problem and worried, but wouldn’t quite be at the point where they would say I would tell my employer. People end up often not going today until they are at risk of losing their spouse, they’re at risk of losing their job, they had a DUI, there are lots of awful reasons. We want people to be able to get treatment immediately, accessibly, at home, without embarrassment. That’s the vision.  

[00:24:34] Monica: What are some of the ways that you think that people surrounding someone could see a sign – if there’s someone who’s a boss, or human resources, or someone’s family? There’s a lot of ideas that we have from our movies, if we haven’t been exposed to addiction in our own lives, what is a positive way without shame to help someone?  

[00:24:54] Dr. Wilson: I would say that the number one thing that a person can do is care for that person unconditionally. In my first company, I was treating patients with opioid use disorder, we’ve treated over a hundred thousand patients at this point. What I learned from that, over years, was that the number one thing that helped people be successful was knowing that there was just even one person who unconditionally loved them. Making this person aware, whether it’s a coworker, whether it’s a family member, that you understand that they may be experiencing a struggle in their lives right now, and that you unconditionally want to be there to support them. They don’t have to meet any criteria for you to want to provide that support. They don’t have to be drinking or not drinking. They don’t have to be going away or not going away. They don’t have to be attending meetings or not attending meetings.  

[00:25:45] In other words, there are so many, perceived notions that are universally understood to be true. That, for example, family, or friends, or coworkers have to monitor someone, have to constantly be on watch for them because they can’t manage themselves. It’s very disempowering. So, saying to someone I’m here to support you through your journey and it’s yours, and I want to help you find support to help you get through this, but I’m going to be with you all along the way, no matter how you navigate this process, this path for you. It’s your path. That would be profound. I think that’s what’s missing. Everything is so laden with judgment and stigma today that people think that they’re helping, but sometimes they’re not.  

 

[00:26:29] Monica: The person who is supporting someone with addiction sometimes has their own boundaries that they need to feel like they’re keeping themselves or their families safe, and still want to engage in helping the person with addiction. Does allowing that therapy to take place in virtual reality allow that person to be deeply compassionate and supportive while still maintaining the boundaries? 

[00:26:52] Dr. Chiodo: I absolutely think that there’s a lot of truth to that and we’ll know more about that as we care for more and more patients. What I can say that – when you have a family member told to watch that individual, watch for them to fall, watch for them to fail, count how many drinks they’re doing, there’s all of this negative judgment that is put on these family members and it is not compassionate. The family members feel a lot of stigma themselves because they’re going through a process and people often look at them and go, “well, why are you staying? You should not be staying in this situation”. And there’s embarrassment and humiliation about staying in those situations.  

 

[00:27:36] In VR, family members are able to talk about what’s happening in their life. Talk about the things that they have done, the things that they’ve said, that they’re maybe sad that they’ve done and said, in a very free way, where they’re not worried about getting judged.  

 

[00:27:52] We’re really trying to send a very different message, that recovery has so many different paths. It might be an abstinence-based path. It might be a non-abstinence-based path. It might just be a wellness path. We really are trying to put wellness first. A big thing for both patients and families is education and understanding this disease. With a lot of chronic diseases and disabilities patients and families end up learning quite a bit about that disability or that disease. That’s not true here. In addiction patients don’t know anything about their disease and their family members don’t know anything about their disease because everybody’s so embarrassed. That stigma goes away in this VR space and people can ask questions about their disease and learn about it so they actually can be supportive.  

 

[00:28:41] Monica: What I’ve seen in my own personal life, dealing with friends and family who have had addiction issues, it puts a lot of the onus on the person who’s trying to help and care for that person to monitor that person. It changes the entire relationship. This sounds like with this 24 hour support, it gives autonomy to the person who has the addiction.  

[00:29:00] Dr. Chiodo: Absolutely does give them some autonomy so that they can reach out and obtain help from someone who was trained in providing that help, so they are not taxing family and friends, but what we’re also really trying to make sure we do is provide support to the family and friends. It is really hard to be supportive for someone who’s going through this if they’re not also getting support.  

 

[00:29:23] So, we’re going to be supporting the caregivers and the loved ones to be able to better provide that support. And yes, it does provide some patient empowerment to receive care and support at any time of the day, where they’re not having to text their support group.  

 

[00:29:39] Dr. Wilson: The family is put in a really uncomfortable position when they’re asked to monitor. They should get to just be family and love the person they love and not feel like it’s their responsibility to provide this oversight as if the person is not capable of caring for themselves. It’s just not true. They can care for themselves. They just need treatment that would help them succeed, and we believe that medical treatment can restore brain health quickly, and enable people to succeed very quickly, and retain their power, retain their autonomy, while getting love from their family and support from us. They all need support. That whole system actually needs support.  

 

[00:30:17] I was thinking about your earlier question about boundaries and it occurred to me that – while each of our patients will have a peer that they meet up with individually, and that could look more like a very individualized, therapeutic relationship – when they’re in a group environment, the peers themselves, our employed peers, can show up as any avatar with any name themselves. The ability for them to then freely share things that happened to them, and not be worried about that in the same way as they might if they were the leader of a group in person, for example. They might be pretty uncomfortable saying, “this happened to me too”, or “I want to share this story of my own,” because they are identified as whomever they are in some leadership role. This takes that away too, so that they also get to participate as someone who also has lived experience and share what they’ve learned, in a way that’s completely free. I think that the potential of that therapeutic engagement is so much greater because it’s all the more authentic.  

 

[00:31:20] Monica: I think the two of you just very eloquently defined what excites me the most about this technology for therapy, for mental health. I would like to discuss, just for a minute, for people who are not familiar with addiction, why a lot us do consider addiction to be a chronic illness.  

 

[00:31:36] Dr. Wilson: There are a whole host of reasons why addiction is a chronic illness. Much like diabetes, much like many other medical diseases, thyroid illness, there are imbalances that cause a person to be predisposed. There are genetic predictors that can tell us, and we do get everyone’s genetics. We can predict whether someone is most likely to have a binge drinking problem or a daily drinking problem. You can predict when they’re likely to get it in their lives – earlier in their lives versus later. There’s so much information now that shows exactly what predisposes someone and puts them at risk.  

 

[00:32:12] This disease manifests visually in the brain. We have images that show what the brain looks like when it’s functioning normally, when it has normal perfusion, when there’s normal amounts of neurotransmitters in the brain functioning. We also have images of what the brain looks like 10 days after someone abruptly stops use, and when you look at the brain in that scenario, only about 10% of the brain is firing.   

 

[00:32:35] It’s actually really profound when you see this image because the brain is shut down. All the neurotransmitters that have been being released are just used up, and not available, and there’s nothing else causing the release of those neurotransmitters. They’re fully depleted. If you look at that same person’s brain 100 days after initiating abstinence as an abrupt intervention, 100 days later about 25% of the brain is firing. And the part of the brain that’s least perfused, least functional is actually the frontal lobes. It’s the part of the brain that helps you make decisions. It’s the part of the that takes us to the ability to think forward, to dream, to anticipate, to make good decisions.   

 

[00:33:20] We’re asking someone to come out of a week-long detox, or a 30 day stay, have no medications, have no nutrients to replenish that depleted brain of which there are over 20 that are critical. No one provides those, and they come out now with a brain that’s completely not functioning the way that they would have previously. And then we ask them to make all the right decisions and then we blame them when they don’t, and they can’t, And we’re not really providing the kinds of medical interventions we would with any other medical illness.   

 

[00:33:57] You give someone with diabetes insulin if they need it, and we don’t blame them when they need it. It’s just a really interesting thing to us that this has not really been widely adopted. That the interventions, while we believe in peer support, obviously, while we believe in counseling, and other interventions, not using a medical approach to this, in our opinion, is not addressing the comprehensive nature of this illness in the way that it needs to be addressed. And we think taking that clinical approach, and adding the ability now with full autonomy and full empowerment, to be able to be themselves, and really get support now at home whenever they need it, we just think that’s going to be an amazing combination to drive success.  

[00:34:42] Monica: Still stuck on this idea of 10% of the brain and the frontal lobe is the most affected. And I am gobsmacked by that. I am fairly familiar with addiction, and I have never heard of that before, and the idea of treating medically and with virtual reality is fantastic, compassionate way of handling this.   

[00:34:59] I’ve been hearing a lot about neural draining. Basically the neural draining is the idea of distraction. It’s taking the brain from focusing on discomfort and on discomforting thoughts, and focusing it on something like a walk on the beach. Where do you see this going, as far as right here on the front lines of a very exciting change in therapy in virtual reality world? What are some of the things that you’re looking forward to in virtual reality in effects of therapy and addiction, but isn’t quite there yet?  

[00:35:31] Dr. Wilson: This concept of neural draining is really interesting to me. I’ll share that I think that one of the reasons why we think immersion is so important in this is really that. I can tell you from months now of back-to-back-to-back zoom meetings, there’s a reality to zoom fatigue, and I think that that in part is because of distraction. And when you feel like you’re actually in a three-dimensional space, where there are no other distractions, you’re not looking at a single thing and trying to focus there specifically, you’re able to look around the room as though you’re in one, and engage with the people around you, and hear them around you as they sound. If someone is sitting to your right, they sound like they’re right there. So, you can have an engagement that’s much more authentic and real, and I think that diminishes that drain, that feeling of being pulled.  

 

[00:36:20] I also think that we’re talking about people who we know are actually drained. They have no magnesium left in their system. They have very much depleted their Gabba neurons. They’re missing key neurotransmitters that can’t function because of what’s happened from alcohol exposure for a long time. They’re already drained. We know that 10% of their brain is firing. If we put them in a calm environment where they are able to not have any distraction, and the only thing that they’re engaging with is that person or the persons with whom talking, it probably will enable them to have a much more meaningful interaction.   

 

[00:36:58] The walks on the beach are examples that we’ve come up with, and it’s just the beginning of ways that one person can meet with another. And instead of going for coffee, as they ordinarily would, instead it’s do an activity that they love – build a three-dimensional Jenga, any type of two person activity – that the patient is saying It would be helpful for them to have an experience that just feels comforting.   

 

[00:37:23] It could be anywhere. It could be in a living room. They can create the space that they feel most comfortable in, and that helps all of us create our own spaces in a way that helps us, and we can’t know what everyone’s ideal space is. Well, now let’s create everyone’s ideal space for them. I think that the potential of that, the potential of enabling someone to have that kind of control over their environment, so they feel safe, has a huge impact and not having other external distractions like your phone going off or other things I think will make a very big difference too.   

[00:37:54] Dr. Chiodo: I can tell you as someone who has their own attention challenges, that being in VR rooms and being in that group environment in VR, with almost no distractions, really does help you stay engaged in that environment in a way that even frankly in real life doesn’t happen.  

[00:38:13] Dr. Wilson: You’re usually aware of how your body is in space. You might be thinking about how you’re sitting, how your clothes are on you in that moment, how do you appear to other people in that moment? And that is distracting. You actually realize you look down at yourself in virtual reality and you realize, oh, it doesn’t matter at all how I sit, it doesn’t matter at all what I’m wearing. I don’t have to adjust anything or be mindful of my own body in that space. I’m really just mindful of the interaction I’m having. There’s no other thing. 

[00:38:42] Monica: You brought up a really interesting idea about this 3D physicality of virtual reality. I just to give a quick explanation for anyone who has not been in a virtual reality room. You can actually play basketball. Like it feels like the ball’s in your hand. I’m bad at it. I’m very bad at it, but you can in theory, make a basket, not me, someone else. And you can play backgammon or games where it feels like you’re picking up the pieces and moving them. You can have interactive games where it feels like you’re touching and moving 3D objects between each other.  

 

[00:39:12] Is that something that you’re looking on the horizon for getting better, or is there another aspect of virtual reality that you’re looking towards as, “gosh, if that one thing was there that would just make this so much more believable or this one thing would make it so much more helpful”?   

[00:39:25] Dr. Wilson: It is evolving so quickly and that is an exciting thing for us. Right now VR is at a remarkable place and the room that they built is extraordinary and we’re really happy with it, but we are looking forward to these improvements as they come. We already have a game effectively within our room where it looks like you have a small beach ball and the patients can pass the beach ball back and forth to one another. It’s a great ice breaker. It’s a great way to both learn that this is an engagement, you’re tossing a ball to someone, they catch it and toss it to someone else, as silly as that sounds, it’s really just a way to participate and to take the ice off of an early engagement. So, there may be more activities.  

[00:40:06] I would love to see where eventually our patients can get up, and in three dimensions, feel as though they’re walking around, or moving around a space, and be able to whiteboard issues, or talk to each other about things, demonstrate things, share, and show things.   

[00:40:22] There’s a term called spawning. You can literally spawn something. So, you could say, “I want to have a teddy bear in my lab right now, that would help me”. And you could manifest a thing you’d like to have with you as you’re talking to somebody. A literal baton could be passed, if you want it to do that. Literally anything is possible. As the technology continues to improve, we’re very excited about all of those possibilities. What would they envision would help them as we start out in providing this journey for patients and we can learn what’s best, what would help.  

[00:40:52] Monica: What would be some of the things to overcome as far as teaching other therapists, other mental health professionals, how to begin to use virtual reality? Is this something that we could start in college levels? Is this something that we could be doing in conferences? What are some of the best ways to get over this wall?  

[00:41:08] Dr. Chiodo: I think we have to start early. I would start teaching that in undergraduate level of education. I think that a lot of people who are in healthcare are actually tech averse. I remember when that shutdown happened, when you were starting to meet with providers, we’ve met with a nurse who said, “well, we’re going to have to do this over a tele-health platform and I just know this isn’t going to work, but we’re going to have to try it anyways,” A couple of months later she was convinced, and she was just amazed at how much easier it was for her to access her patients or for them to access her. She was blown away by how wonderful this tele-health world was.  

 

[00:41:48] People just sometimes have to try it and it’s easier to get people to be more open-minded to new ways of providing care when they’re just learning how to be the provider of that care, as opposed to someone who’s been doing something for a very long time, in a certain way who might not be as willing to change how they do it. But I think just telling people, “try it first.” We had a couple people who are on our team at first, who were very hesitant about the ability of this to work, and he said, “you just cannot create community in VR,” and they are now openly saying all the time, that’s just not true. You can actually create community in VR much easier than you can in any place, including the real world. You just have to find a way to get people to try it, I think. too.   

[00:42:37] Monica: That’s a wonderful idea. I love the idea of starting with undergraduate. Mental health is such a news study as far as hundreds of years of what gets studied, and we’re on such a precipice of understanding mental health from a much more compassionate standpoint than I think it’s ever been done in history. 

[00:42:52] This is a really exciting conversation and I would keep you all day. One of the parts that really excites me of this conversation, which is the daydreaming moment, and this doesn’t necessarily even have to do with your field, it’s just technology in general. I really feel like technology is the intersection of where we can all find autonomy and some sense of equality. What are you the most excited for – for me as wheelchair user, I’m really excited for self-driving cars so I don’t have to keep begging for rides – what are your, “I can’t wait for this to exist thing” thing even if it’s not yet on the horizon?  

 

[00:43:24] Dr. Wilson: This is gonna sound silly, but years ago, Star Wars and you see the projection of Obi-Wan Kenobi in front of you in three dimensions, right?  

 

[00:43:33] Monica: Holographs, yes! [Laughs] 

 

[00:43:34] Dr. Wilson: I remember when I was first founding my first company thinking, oh my goodness, what if we could do this at home holographically? People were coming to try to get treatment who didn’t have cars, who had transportation challenges. Addiction treatment is high touch. People were coming in frequently for visits and it resulted in so many people not being able to stay engaged in treatment because they just couldn’t do it. The idea of being able to have people be able to be in their homes, and access whatever kinds of supports they need. You don’t need to go somewhere in order to get what you need. So, I’m very much looking forward to AR.  

 

[00:44:12] And the potential of what AR has in healthcare, in my opinion, and in behavioral care especially, is enormous because you could have these same exact engagements where a provider is wearing glasses that are see through, they can be documenting what’s happening in that engagement, but still be with a group of people, and it looks as though that group of people is in the room with you. And you’re able to conduct that meeting.   

 

[00:44:35] We plan on doing that in the next year and a half. It’s not far away. VR is, to me, the stage one, and stage two will be you’re looking through AR at selections. I really need a behavioral intervention person who has special ability in this. We are providing a menu of options from yoga, and mindfulness, and Tai Chi, and any kind of intervention that that person thinks is a part of a menu of options, in their home, completely private, whether they want to show up as themselves, or they want to show up as an avatar, it’s limitless possibilities of engaging with people in a really authentic way.  

 

[00:45:14] Monica: That is very cool. [Laughs] 

 

[00:45:16] Dr. Chiodo: That’s really what we’re wanting to get to. That’s our goal.  

 

[00:45:19] Dr. Wilson: A three-dimensional engagement with people where they are literally represented in front of you in their totality. Our rooms today are a bit more limited in terms of what your avatar looks like, and the total avatar is essentially from the chest up. A whole body experience where someone appears in front of you and looks as they look, if they want to, or as an avatar, if they want to, that option, the ability to be whomever you are in three-dimensional space with another person, or to, more mimic, in three dimensions around you an experience.  

 

[00:45:51] But, that transparency, there’s some added benefits on the provider side of things, being able to continue to do things that you need to do in terms of documentation and things like that. So, it’s a vision that we have about how this will evolve and sort of the next generation of this from virtual reality, to our thinking, could be at least for components of what we’re doing AR, because of that ability to have that transparency. So, that’s one example, and flying cars would be cool. [Laughs]  

[00:46:16] Monica: [Laughs]  

[00:46:19] Dr. Wilson: Lots of neat things on the horizon, I’m hoping. 

[00:46:21] Monica: I take it you’ve been in a few traffic jams lately. The flying cars are high on your list. 

 

[00:46:25] Dr. Wilson: That would be really great. Exactly. As long as it’s well controlled and people can’t hit each other. [Laughs] 

[00:46:31] Monica: I feel that’s a pretty good one. Replicators would be another one that I’d be highly interested in – food on the go – would be great, all Star Trek. [Laughs]  

 

[00:46:37] Dr. Wilson: Exactly! Love it.  

 

[00:46:39] Monica: Well, thank you so much for your time and your clarity, and this is a beautiful precipice to be on with very compassionate and interesting therapy. I hope more people are willing to start learning about this way of doing things. 

 

[00:46:50] Dr. Wilson: Thank you. Thank you very much. We really appreciate your time and your great questions. 

[00:46:54] [Music Plays]  

[00:46:57] Monica (Recorded): Thank you for listening to my conversation with Dr. Wilson and Dr. Chiodo. The work they’re doing in the virtual reality space to improve the lives of people navigating alcohol use disorders shows how impactful virtual reality has the space of mental and physical healthcare.  

 

[00:47:14] So, a long time ago I was in therapy, and as a teenager not only was just the physical aspect of getting to therapy very difficult, it was also that, while the therapist himself was incredible, I had been going to therapy for an issue that I had been experiencing with men and to have a male therapist, even though he was so good and the exact right person for me, it was already the step I had to overcome in that he was a man, that’s not something he could have helped. If I had had this experience of virtual reality, where he could have presented in a way that would have felt safer for me, that would have been one less hurdle I would have needed to overcome, to be able to be vulnerable and really discuss the issues.  

 

[00:48:00] Support spaces, such as the one built by North-Star Care, understands that patients – they’re not one size fits all. And giving them that freedom to find comfort in their own space – that can create an increased level of change in recovery in the patient. The opportunity to stay home and stay anonymous creates a level of accessibility that’s just not possible in the use of in-person treatment or even video call spaces.  

[00:48:29] I am so incredibly excited to see how virtual reality can support patients of all kinds as this technology continues to grow and innovate.    

[00:48:41] The takeaway learnings from this episode are:  

[00:48:44] 1. The use of virtual reality in therapy and support spaces can allow for anonymity in ways that in person and video conferencing can’t. Using avatars and voice changing technology, patients and therapists can create and present a persona that works for their particular session.   

[00:49:06] 2. Addiction is a chronic disorder and it should be treated as such. We can reduce stigma and increase support to our loved ones who are struggling by reframing and understanding it as a chronic disorder.  

[00:49:23] 3. In VR, support groups can be created to target specific demographics, such as caregivers with young children or people who have PTSD. This allows for increased opportunity for connection. This is possible due to schedule and location flexibility.  

[00:49:43] 4. VR allows for an increased sense of focus due to its fully immersive capabilities, which reduces the opportunity for distraction.  

[00:49:56] The actionable tips from this episode are:   

 

[00:50:00] 1. If someone in your life has disclosed addiction or a chronic illness to you, try to actively listen and start from a place of compassion. It really important to make sure that you’re also taking care of yourself. When both you and your loved one are in a place to be able to support one another, try to stay present and open-minded.   

 

[00:50:23] 2. If you’re looking for therapeutic support for yourself, find what works best for your physical and your emotional comfort level.   

 

[00:50:32] 3. If you’re considering VR for therapy, take a moment and reflect on what supportive environment would look like and feel like for you. Be specific. This way you can really customize the best therapeutic opportunity for yourself.   

 

[00:50:50] For more information on North-Star Care, check out our show notes.  

 

[00:51:07] Every episode of Technically Sick has a page on empoweredus.org, where you can find extended show notes – including tips and takeaways, transcripts, and relevant resource links.   

 

[00:51:08] If you would like to share your own tips related to this topic or just to connect with us, visit the EmpoweredUs Contact page or reach out to us on our social channels.   

 

[00:51:18] Technically Sick is an Empowered Us Original presented by Good Days, hosted by me, Monica Michelle. If you liked this episode, be sure to rate and subscribe to our show wherever you get your podcasts.   

[00:51:37] [Music Ends]  

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