Trascrizione completa di Transforming Alcohol Addiction Treatment with Jonathan Hunt-Glassman

unaware of it. Can you tell us a little bit more about the medicine? Like, ⁓ don't think people know there's medicine that can help ⁓ addiction. Jonathan Hunt-Glassman: That's absolutely the number one barrier to adoption in my mind is lack of awareness. So happy to provide some of the basics. There are actually three medications that are indicated for the treatment of alcohol dependence. The recommended frontline medication and the one that we focus the most on is called Naltrexone. the way that it works is it cools off ⁓ ⁓ and cravings for alcohol. And so if one does have a drink while naltrexone's on board, that first drink may be less exciting. There may be less of an urge for the second and the third. This is particularly helpful to people with patterns like my own, which was really struggling with binge drinking and losing control somewhere around that third or fourth drink. And then when we're not drinking or if our goal is sobriety, medication is also more effective than placebo at reducing the frequency and intensity of cravings, reward and anticipation are pretty closely linked through our brain's learning mechanisms. so for most people, it's not a magic pill where you take one and never think about alcohol again, ⁓ On the other side of that coin, it is one of the most effective tools that we have in just turning down the volume on some of the biochemical urges to keep drinking. And of course, can be combined with other things that we may want to do to achieve the goal, whether that's our own tracking and habit formation, working with a behavioral health professional, attending mutual peer support. Josh Broward: you were talking about this, it me, or ⁓ began think about my own ⁓ with depression. the first time a doctor to me about depression, I was just like, ⁓ nah. you know, ⁓ you then mentioned a little, you know, it talked about medicine. I was like, well, I'm going to do... I don't need medicine. I know what to do. And I, like, essentially, I did know what to do. I got therapy, I worked less, I slept more, I did all the behavioral things, but there was still a gravitational pull that I... To me it was like a crab trying to climb out of a bucket. Like I would get to the rim and be okay for a little bit and then something would pull me back down. ⁓ don't more than five years after I started even thinking this is an issue for me, I finally started taking medicine. And it ⁓ Like I was, it wasn't like the only thing, it was enough to overcome that. ⁓ call it the toilet bowl effect. ⁓ There's it, you can climb out, but when the water's constantly coming down, it it makes it ⁓ so so hard to get out and so easy to slide back. Jonathan Hunt-Glassman: That's a man. Absolutely. There are a lot of parallels between common mental health conditions depression ⁓ ⁓ which ⁓ too have experienced, and use disorder. ⁓ There are these kind of complex behavioral health conditions probably have multiple factors. ⁓ Sometimes we talk about as a biopsychosocial ⁓ condition. ⁓ And if really that that's ⁓ Josh Broward: Hmm. Jonathan Hunt-Glassman: through, then that suggests that the treatment options presented should go at each of those dimensions. We should be changing the environment. We should be working with ⁓ a professional or otherwise to correct maladaptive thought patterns. And yes, if available, we should be using medication that ⁓ helps to address some of the biochemical underpinnings. I am an employee of a company that focuses on medication-assisted treatment, I would never say it's the end all and be all treatment option for everybody. Rather, I hope that we're part of a broader movement to expand the menu of evidence-based options that people are presented with. If someone's ⁓ and able to sign up for all of the above, fantastic. That's probably going to maximize the likelihood of success. But I also think it's OK for individuals to start with one thing, ⁓ if it works, mix and match, do more of what's helping, do less of what's not. change things up. What's most important is kind of getting started in the right direction and then we can calibrate that ideal mix of modalities. ⁓ Josh Broward: I love the discussion. love the work you're doing. What is a win you and the Oar team ⁓ the last year? Jonathan Hunt-Glassman: Hmm. quite consistent with what we were just discussing. One of the things ⁓ we're of is extending coaching from ⁓ national board health and wellness coaches to all of our members included in the price of our membership. ⁓ And those coaches can provide assistance with things like medication adherence and getting, taking the prescribed medication into one's daily routine, side effects. And they help with things like healthy habit formation. We like to say that, you know, when you're less or not at all. It's a great time to be saying yes or more to healthy habits like exercise, quality time with family, ⁓ consistent with one who's kind of, ⁓ mentioned kind of a downward cycle that can be associated with a behavioral health problem. ⁓ The can be true. The kind of once we get things going in the right direction, can be a virtuous cycle of mental and physical health and less substance misuse. And so proud that we're kind of broadening the toolkit of what we make available to our members so that they can get simple access to the medication then ongoing access to tools that fit alongside it without becoming a program ⁓ or having schedule ⁓ appointments you must up to or will yell Josh Broward: Yelling at people is generally not a good business model. Jonathan Hunt-Glassman: Nor is it ⁓ consistent with how change typically occurs. ⁓ Josh Broward: Also that. Jonathan Hunt-Glassman: of my mentors in the early days of behavioral health said, remember, Jonathan, the person ⁓ doing the changing is going to do somewhere between 51 and % of the work. So although we have expertise and advice to bring to this. of my mentors in the early days of behavioral health said, remember,

Jonathan, the person ⁓ doing the changing is going to do somewhere between 51 and % of the work. So although we have expertise and advice to bring to this. we really need to get them engaged in the change process too. we really need to get them engaged in the change process too. And ⁓ Rarely is yelling the way to do that. Josh Broward: Yeah, but bringing up images of boot camp ⁓ know, maybe it's in some context, ⁓ need a little bit of reality, but in general, no, especially not. Yeah, anyway, sort of a side trail. So one that we often talk about at Wisdom Partners ⁓ is Jonathan Hunt-Glassman: ⁓ Totally. Josh Broward: most important things we usually learn the hard way. Sometimes even define wisdom as failure redeemed. So I wonder if you would be willing to share something that you have learned the hard way in building Oar health. Jonathan Hunt-Glassman: Yes. One of the simplifying assumptions that one makes when starting a telemedicine business ⁓ puts at the center ⁓ better ⁓ to generic medication that's been around for 30 years but is underutilized ⁓ is because of its generic status, ⁓ that will be ⁓ widely at an affordable price. ⁓ And that was our experience in the first few years of operating the business. And then in the fall of 2023, that changed when a global market-wide shortage of naltrexone developed, meaning that our assumption was wrong. And more than being wrong ⁓ was facing reality we might not be able to maintain medication in hand for our existing members, ⁓ let alone take new members. And the silver lining, because it's important to look for those, is we got a heck of a lot smarter on the generic drug supply chain very quickly. and started to build relationships with pharmacies, with pharmaceutical distributors, with manufacturers to solve the short-term problem of keeping medication in hand, which I'm glad to say we did. ⁓ then ⁓ the shortage went on for about two years and then ultimately began to alleviate, to have more robustness ⁓ survivability in our chain ⁓ so that could get back to growing, get back. to serving more members with confidence that we would be able to deliver what they were signing up for. So I think it fits to a Tee what you were ⁓ sometimes get the wisdom the hard way, ⁓ but you can turn it into a source of go-forward strength, then maybe it's worth it, maybe. Josh Broward: kind of is like necessity is the mother of invention. ⁓ your supply chain got disrupted, you had to build a more robust, multi-pronged chain. ⁓ Jonathan Hunt-Glassman: That was our experience for sure. Yes, exactly, exactly. Adding an additional pharmacy partner, with a wider range of distributors, working directly with manufacturers who were ⁓ considering whether ⁓ invest in supply of the medication. We were able to make that an easier decision for them because of all the demand that ⁓ our had for it. Yeah, that's exactly right. ⁓ was by necessity, but you know, that's kind of ⁓ nature of the early days in any company is you always have

more things you'd like to do than you could. And sometimes it's just a particularly sharp ⁓ jab the side that you wouldn't have asked for that gets you focused on an important part of the business. Josh Broward: Okay, so I want to ask two specific follow-up questions. first one is, what going through your head when you first realized we might be able to give ⁓ addiction ⁓ medicine people ⁓ who are on us ⁓ to stay ⁓ Jonathan Hunt-Glassman: Yeah, it was not a good feeling. ⁓ from the beginning, as you said in your intro, we consider ourselves a mission-driven business. One of the things that means in practice is that we think about a wide range of stakeholders as important. Maximizing shareholder value is not the only value that we subscribe to, although it is one. And you know. always right up there is our members. That's fundamentally why we're doing this. That's where we get continuing energy is their success stories. That's what we want to succeed or fail on is their success. So the prospect of not being able to deliver on the most basic nuts and bolts element of the value proposition was very, very distressing. What it helped with though was setting clear intent amidst a crisis. Something I've been told years before, but only really had the chance to apply here was like in a crisis, ⁓ job as a leader ⁓ to ⁓ clear from the beginning. And ⁓ us, said our number one goal is we're going to maintain medication in hand for all members. ⁓ If that our costs go up, we'll live with If that means we have to ⁓ turn off marketing in certain channels because we need to control volume that way, we'll do that. If we need to start a wait list to join, we'll do that. And we ended up needing to do all of those things. in some ways, the pain ⁓ the thought ⁓ running out ⁓ a good thing once it was channeled away from panic and despair ⁓ clear priorities and action. Josh Broward: Thank Yeah, You're triggering thoughts for me about adaptive leadership theory. It's by a guy named Ron Heifetz out of Harvard. He says there's two kinds of challenges. There's a technical problem and an adaptive problem. A technical problem is somebody somewhere knows how to solve this and we just have to hire the right person to do it. I am not going to be the one who fixes our plumbing. I will hire a plumber. I know there's a plumber out there who can do it. But adaptive problem, in your case, ⁓ this sounds an adaptive problem. It's we don't know what the solution is. Nobody actually knows what the solution is. Jonathan Hunt-Glassman: Yeah. Josh Broward: kind of have to become a different kind of ⁓ to this work. And we're to have to talk to a lot of people that we didn't normally talk to. And when that the needs to do couple of things. ⁓ One ⁓ is maintain the attention the issue. And that's what I heard you say is declare your intent. We're going to make sure our members get the medicine that we promised. then the second is cook the conflict. Or not but another one of the themes. And so the is you hold ⁓ often an adaptive have ⁓ conflicting values. So ⁓ wanna grow, wanna money. We also want to be faithful to the people who are relying on us. so ⁓ don't let go of any of those ⁓ and values, but you create a safe container and maintain your people's attention on the core issue and say, how are we going to deal with this? It sounds like that's the approach you took. ⁓ Jonathan Hunt-Glassman: Mm-hmm. Yeah, I think that's a perceptive description of it. ⁓ And of the unanticipated positives as you said, focusing attention ⁓ on a and being open-minded ⁓ about how were going to achieve it is some solutions I would not have thought of personally. ⁓ emerged. For example, ⁓ people take the medication in a targeted way rather than daily. So targeted to drinking occasions or high risk scenarios. And we reached out to a broad swath of people and said, ⁓ how's medication supply? Your next ⁓ refill scheduled for this date. We're having a shortage. We're pretty transparent. If you want to, if you're able to delay your next shipment so others can get theirs that they're relying on, ⁓ give you a discount. And that was an insight from folks who were on the front lines ⁓ of support, because they had more understanding of these unique dynamics the way that people actually use the medication. ⁓ And we're to ⁓ couple that with ⁓ kind of our overall intent in an environment of focus and continued ⁓ discussion. I think that's a great, I'm gonna obviously steal that framework, because I think it definitely ⁓ to the past and I'm sure will in the future. Josh Broward: Yeah, it's well worth it. one of the most that their sort of first article is called The Work of Leadership. one of the most read Harvard Business Review articles in history. ⁓ tell me about the time when you went to your marketing and or sales team and said, don't sell more. Please slow Jonathan Hunt-Glassman: interesting. You know, not what any growth leader wants to hear, but it went over easily once the you know, I think we had ⁓ hired for ⁓ a few ⁓ being driven, being ⁓ driven. ⁓ and having a little bit of a mindset, even in the folks who don't have that job title, by which I mean seeing ⁓ specific like growth ⁓ as service of a broader mission. ⁓ So was not a difficult conversation. It was painful for everyone involved. ⁓ No one likes to see their growth. It looked like a hockey stick, but kind of one held the wrong way. No one wants to see that. But to our growth team's credit, they kind of challenged themselves to say, all right, if we're going to be getting back ⁓ hours in our week that would be focused on growth marketing, what should we be doing with that? ⁓ so we used a portion of the shortage, good three to six months, to think about retention. ⁓ And all the reasons that folks were deciding ⁓ not continue with us, not to continue with the medication as long as the clinical guidelines, which are to stick with it for at least a year, potentially indefinitely if your goal is moderation

rather than sobriety. ⁓ We uncovered these insights, talked to members, and kind of up with a range of things to work on from the very tactical self-management of one sub... ⁓ subscription to things like that eventually grew into things like coaching for ⁓ who had questions about why ⁓ weren't working as well as they had hoped or how they could make them work more effectively. Josh Broward: So I think you answered the next question I was going to ask is did you have to lay anybody off? ⁓ normal response is, we can't grow. ⁓ salespeople. ⁓ come in a year when we have medicine to sell. ⁓ And sounds like what you did is repositioned them strengthen your ⁓ Jonathan Hunt-Glassman: Yeah. Yeah, that's right. We run pretty lean ⁓ felt there was still a good match between ⁓ talent and that would add a lot of value ⁓ to business in the run. Not all circumstances ⁓ have that lay the land, but I'm glad ours did. ⁓ Josh Broward: Yeah, great. thinking about present day, what's the biggest challenge you're trying to solve now? Jonathan Hunt-Glassman: We want to offer more to our members, more medications that can help with drinking less or quitting, more forms of support that fit them, whether that's peers, coaches, professionals. And so that's a good aspiration, but there are a few challenges that come with that. One is following the evidence as opposed to instinct. ⁓ GLP-1s a good example of that. I think they're very promising signs ⁓ that they be helpful to at least some people some of the time in drinking less or quitting, but they're not for that purpose. So, kind of striking balance between ⁓ innovation and safety is a priority. ⁓ And then on psychosocial support There are so many things that can be helpful to people. And there it's a matter of prioritization. What are our members who, to some degree, by opting into a convenient, private, online-first solution, may not be as inclined to sitting in a room with folks, whether that's one therapist or 20 peers, to talk about their issues. And so kind of, you know, picking from the menu of evidence-based options, which as I mentioned is longer than many people believe, but kind of prioritizing those in a logical way that responds to our members' needs is a challenging but interesting and invigorating thing to think through. Josh Broward: Okay, so you think about your journey with Oar have evolved as a leader? Jonathan Hunt-Glassman: Maybe a little bit counterintuitive answer, but I've become confident in my ⁓ within core the business relies upon before. ⁓ So I'm going to make better tactical decisions about. ⁓ RoAS than our growth leader or better UI decisions than our designer or goodness knows better ⁓ coding decisions than our engineers with or without AI assistance on my part. But I've actually become more confident ⁓ in setting intent informed by the we were talking about in the... ⁓ my instincts about our consumers, since I talk to them more than anyone, with the possible exception of folks on our member support front end. And in the responsibility someone in general or ⁓ CEO or founder seat ⁓ take ⁓ valid inputs insights and preferences from different of the org and ⁓ instead of trying to them out to find an answer, ⁓ of give ⁓ even it's disappointing to some people, to give clarity. My background, as you mentioned, before starting Oar was in ⁓ management consulting then internal strategy roles in very large companies. ⁓ And I that past experience... probably amplified a natural tendency that I have in my personality to want to all the inputs. And I think what being in seat ⁓ has ⁓ me is more that what's necessary is to actually put a stake in the ground. And that's often what ⁓ folks want and are happier with, even if they would have put the stake somewhere else. ⁓ Josh Broward: Sometimes it's what they need more than what they want. So then the follow-up question is, do you think you still need to evolve? What's your evolving Jonathan Hunt-Glassman: Yep. I'm working on being more risk tolerant. think in distribution ⁓ of founders, whatever you want to call it, I'm ⁓ risk ⁓ by nature. I'm trying to pay attention to the accumulating data I think shows two things. One ⁓ is sometimes taking really off. ⁓ And then two, ⁓ case scenario is actually not that bad and very survivable. Josh Broward: Yeah, there's a bit of a mental game in processing risk. Jonathan Hunt-Glassman: Yeah, I'm not saying it's easy. And it's so interesting how people have, yeah, they're really, I think there so ⁓ variance, among successful, capable people on this ⁓ dimension. So don't maybe some of us are kind of come into the world perfectly calibrated, but I wouldn't put myself in that camp. so, yeah, I think... coming up with ways to think through risk more systematically, but also attend to the ⁓ that come with taking any risk, even if you're confident you've made the ⁓ ⁓ of trade-offs, ⁓ definitely things I'm still working on. ⁓ Josh Broward: How have you invested in yourself and your own leadership? You talk about how you've evolved and how you still need to evolve. How are you sort of fueling that fire? Jonathan Hunt-Glassman: Probably not as systematically as I should. What ⁓ found most helpful ⁓ is ⁓ I of as kind of an informal ⁓ board advisors. have a board to ⁓ exercise fiduciary duty, I like to think that I have a little bit of ⁓ a personal board that overlaps with our board of but also includes others kind of in related industries, related or similar stages of companies, or just good friends who can ⁓ kind of clear-eyed feedback. ⁓ most useful thing kind of find that I learned ⁓ through, you experience. so ⁓ what found valuable is kind of in those tough moments, in those tough decisions, being able to have thought partners who are going to be empathetic but aren't going to be yes men or women, are going to kind of who, where there's enough trust in the relationship that they can disagree. Josh Broward: There's a... I like I'm name dropping a lot, but ⁓ did

leader development for a long time. There's equation that these two scholars also out of Harvard, Kegan and Lahey they pain... plus reflection, then it has in parentheses, in sufficiently supportive community ⁓ equals Jonathan Hunt-Glassman: Mm-hmm. That makes a lot of sense, a lot of sense to me. Yeah, we're social creatures that while I like being alone with my thoughts, don't get me wrong, almost always kind of pressure testing with someone that you trust in two ways. I think there are two dimensions that trust that comes to mind. One is that they know what they're talking about. whether that's through their own experience in comparable situations or being a student and scholar of similar situations, but then also that personal and emotional trust that leaves room for voicing anxieties, exploring radical ideas, then viewing that as good grist for the mill. Josh Broward: Yeah. So if somebody out there is listening to this they think, or health is amazing, who can they introduce you to? I of course, users, ⁓ if know someone. As you we're one or two degrees removed from people who might need this. But other than ⁓ are there particular of that you're trying to meet? Jonathan Hunt-Glassman: Yeah, one of our projects ⁓ year is meet and work more closely with leaders of ⁓ substance disorder behavioral health organizations that can either be as compliments to medication and support through Oar Health, or that may be better fit the folks who come to us and aren't good candidates for treatment via some aspect of their needs is better suited to in-person care. We're in this moment where during, really reaching peak during the pandemic, telehealth exploded and we're one part of that. Now, I think we're in an era ⁓ of ⁓ that of point solutions. ⁓ being better stitched together into a continuum of care that lets somebody start treatment from home, when they need something more intense, get that too. ⁓ And ⁓ want are already starting to build some of those relationships so that we can be. that, but would like to be introduced to folks who maybe run a inpatient treatment program, but know that like a telehealth ⁓ aftercare option when folks leave treatment, for example. Josh Broward: Great. Well, if you're listening out there, connect all your addiction recovery leaders ⁓ Jonathan. solve the problem. ⁓ thanks, Jonathan. I'm ⁓ for you to spend with us. ⁓ You know, we Wisdom Partners Jonathan Hunt-Glassman: Yeah, well said. Josh Broward: We believe best startup founders are trying make the world better. They're trying solve a real problem that needs to be solved. ⁓ And ⁓ a business. You're trying to solve it in a way that people will pay for because they find much value in it. ⁓ But that becomes self-regenerating ⁓ Because people find value it, ⁓ fuels the business and fuels the mission to expand to serve even more people. ⁓ Health a classic example of mission-driven business ⁓ that we to succeed. So, thanks for taking ⁓ Jonathan Hunt-Glassman: I really appreciate that. Thank you for having me. I learned a few things and had a great time.