Same - Addressing Social Isolation In People With Addiction

Nikolaos Pirounakis Bachelor of Industrial Design, Honours - 2016 Royal Melbourne Institute of Technology Supervisor - Dr. Areli Avendano Franco

Same Addressing social isolation in people with addiction Same is a design project focused on providing alternatives to the barriers of entry faced by people suffering from addiction, as they navigate their way through the journey to recovery. Through methods of service design, Same delves into the inadequacies of current streams of entry to addiction recovery programs.

Identifying opportunities for design intervention to assist addicts in overcoming the social and emotional barrier of entry to services, that is, social isolation.

Using user-centred design methods to inform possible avenues for social empowerment in addicts, the project explores peer-to-peer networking, in order to deliver a meaningful service design solution built upon empathy.

Same is a digital platform in which current and recovering addicts can share experiences and create bonds with others who share empathy for their situation, creating online and face-toface recovery communities and support networks to address themes of social isolation within the beginning of the recovery process.

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Contents Field 1 Design and Health 2 Service Design 4 Social Innovation 6 Contemporary Understanding of Addiction 8 Types of Addiction 10 Reasons for Addiction 12 Methods of recovery 14 Case Study: Portugal 16 Case Study: ActivMobs 18 Case Study: OpenDoor 20 Context and Application

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Health Services in Australia 24 Methods of Recovery 26 The Challenges 30 The Design Context 34 The Users 36 The Intervention 40 Changing Attitudes towards Addiction Recovery 42 Technology 44 Person Centered Care 46 Methods 49 Design Research Plan 50 Stage One: Shallow Dive 52 Stage Two Deep Dive 54 Stage Three: Contextualising 58 Methods of Evaluation 63 Evaluation 64 Formative Evaluation 66 Summative Evaluation 70 Design and Iteration 75

Ideation 76 Prototype One 78 Prototype Two 82 Prototype Three 86 Iteration 90 Conclusion 101 Outcomes 102 Reflection 112 Glossary 118 Appendices 120 References 122 * Words which are underlined have been defined in the glossary on page 118 *

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The Field

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Design and Health Access to addiction recovery programs Cocaine, Heroin and other illegal substances kill around 2 million people each year1, alcohol accounts for approximately 3.3 million deaths per year, and its harmful use, leading to related illnesses, attributes to 5.9% of all deaths, globally, every year 2, making it the third most harmful health risk worldwide. .

Source:3 Abuse of drugs - both licit and illicit - cause harm to us on a societal level: presenting chronic health problems, risking the well-being of individuals and their families.

However, embedded issues regarding access to appropriate treatments are keeping many people with addiction, wishing to make a change to their situation, from making the leap to recovery. The World Health Organisation (WHO) suggests that it would take some US$200-250 billion

(.3-.4% of the world’s gross GDP) to cover all of the costs involved in successfully treating these issues globally, however only 1 in 5 people who need this help actually receive it. The American Treatment Episode Data Set detailed that self-referral made up only 33% of addicts making the leap to recovery in America4.

Access to addiction recovery programs are a systematic issue, embedded into the fabric of our society through social and emotional barriers of entry. 27 million people worldwide are classified as ‘Problem Drug Users’5, however many of them do not receive treatment for their addictions due to micro-level roadblocks such as stigmatisation and isolation, and obstacles on a macro-level such as regulation and funding.

Deaths and disability-adjusted Disability-adjustedlife-years Life-years Deaths and

Illicit Drugs

Alcohol

Tobacco

Total

Deaths related to substance abuse (Millions)

0.245

2.3

5.1

7.6

Global deaths (Percentage)

0.4

3.6

8.7

12.6

Lost Disability-adjusted life-years (Millions)

13.2

69.4

56.9

139.5

Global Lost Disability-adjusted life-years (Percentage)

0.9

4.4

3.7

9.0

Source:3

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The facts make it increasingly apparent that there is a need to focus on empowering people with addiction to make the leap to recovery, however, in order to do this we must first address the hurdles they are faced with once they recognise a need for change in their circumstance.

The means by which people access addiction recovery services needs to be redefined. In order to overcome the barriers of entry facing most people with addiction, we need to develop new systems and services which are informed by not only designers, but addiction recovery professionals, and most importantly sufferers themselves. A collaborative approach to service design, within the field of social innovation, which will see an informed design intervention that leapfrogs the inadequacies of the current system.

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Service Design Intervention through design Service design tools and methodologies allow for the informed iteration of systems through analysis of user touch points, the relationships between stakeholders, the resources which are needed to execute the service, as well as the experience of the user as they travel through the system.

The adoption of service design as a tool for change allows designers and end users to work collaboratively in order to create and redefine services which are intuitive, wholesome and sustainable, overcoming common inadequacies faced by end users as a result of misinformed design.

We are surrounded by services, which encompass every aspect of our daily lives, from dry-cleaning to the emergency room; however, it is often the most valuable services that we take for granted. Service design within the health sector has been at the forefront of redefining the way that health services have been delivered for many years. With institutions like the NHS adopting service design methodologies for ongoing operational development6, as well as the emergence of service design consultancies which are

solely focussed on government and social services, like FutureGov7 and Snook8. As a design community, we are beginning to see value in the appropriation of service design in order to create lasting and transformative services through the use of these methodologies9.

Approaches such as participatory design are causing us to rethink the relationship between consumers and producers, the relationship is becoming far more balanced as approaches to human-centered design are causing designers to take on the role of facilitators in order to help produce collaboratively with end users10. Its methods like these that make service design an allinclusive design process; it leads to the creation of informed solutions, delivering outcomes informed by, and created with, end users. Design Kits such as those developed by TISDT11 and IDEO.org12 have commoditized approaches to human centered design by making them available to everyone.

Source:13

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Social Innovation Business for purpose, not profit Social Innovation sees the development of sustainable and efficient solutions to issues. The value of these solutions are primarily targeted towards social development, as opposed to the needs of the private sector14.

Products and services which are considered ‘Social Innovations’ should satisfy the user’s needs (the necessities to live equal/ethical, healthy lives), evoke a sense of empowerment within them (the ability to feel as though they can take control of their own situation), and be able to reconfigure social relations/ norms (stopping stigmas, the shifting of social standards). Once this trinity is achieved, Innovation will follow 15.

These three cornerstones are driven by research, action, and social change. Research bringing the ideological and theory based stimuli together, action being the collaboration and co-creation of concepts and outcomes, and social change being the impact and driving provocations of social empowerment16.

An example of a novel social innovation is IPaidABribe, a portal where users can file anonymous reports online regarding bribes they had to pay in order to settle personal affairs. The Indian website works towards exposing corruption in law enforcement and positions of power to help establish a bribery free future for civilians wanting to settle their dealings in a fair and just manner17.

The approach puts the power in the hands of the people, overcoming barriers of fear by leveraging anonymity in order to empower the wider community.

Source:18 Social innovation also explores the idea that business can be for purpose instead of for profit. There are many socially sustainable business models and regulatory standards to be explored, such as non-forprofit business models where all profits return to the operational costs of the business19, and B-corp, a standard which boasts a company’s transparency, environmental and social impact20.

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Contemporary understanding of Addiction A modern, inclusive definition Addiction is a global issue. People with addiction abuse particular substances or behaviours in order to find relief or rewards in areas of social, economic or personal troubles.

A recent study of recovering addicts currently enrolled in Methadone Maintenance programs in Scotland revealed that users abused drugs to escape the responsibilities of life, escape personal problems, and to feel normal21.

Substances or addictive behaviours (gambling, sex and so on.) engage the pleasure centres of our brains.

As these pleasurable feelings are engaged in an ongoing fashion, an individual may find them necessary to feel ‘normal’ or ‘function’ to their full capacity. This then leads to desire for this pleasurable feeling, leaving many users in the crux of what we call addiction22. Many addicts also find themselves battling underlying mental health issues.

Instances of childhood maltreatment or abuse have been known to lead to behaviours which cause addiction23.

The American Society of Addiction Medicine (ASAM) defines addiction as: “A primary, chronic disease of brain reward, motivation, memory and related circuitry. Dysfunction in these circuits leads to characteristic biological, psychological, social and spiritual manifestations.

This is reflected in an individual pathologically pursuing reward and/ or relief by substance use and other behaviors”24.

Many cultures, professional bodies and individuals still debate over the definition of the word. Members of the Farhangian University of Birjand, describe addiction as “literally mean{ing} erroneously being devoted to oneself; in other words, having a slavish habit of using {...} drugs to a point that they are detrimental physically and socially”25. We can see that in this definition, no reference to addiction as a disease is made.

This is because our understanding of addiction as a chronic illness is only a recent development within the field of addiction medicine.

9 The Australian Institute of Health and Welfare defines a chronic illness as “a disease(s) that tend(s) to be long lasting and have persistent effects�.

Some other chronic illnesses include diabetes, Cardiovascular disease and Kidney Disease 26. For a long time, addiction was not recognised as a chronic mental illness. This left people suffering from addiction vulnerable to stigma pertaining to their own selfish/ self-seeking need for substances and addictive behaviours, however this has recently changed. In 2011 ASAM released a new definition of addiction, referring to it as a chronic illness 27.

The recognition of addiction as a chronic brain illness means that we can begin to treat it in a wholesome manner, taking into account, not only the physical implications of addictions (withdrawals), but also the underlying psychological characteristics of the disorder. For the purpose of this project I will be using the ASAM definition of addiction as it is a far more encompassing, and inclusive definition.

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Types of Addiction The many faces of addiction Addiction is not only an outcome of substance abuse. Gambling, Sex addiction, Internet addiction are amongst many other behaviour based addictions which work in the exact same way, however they lack the chemical hook which is present in substance based addictions.

Most recently, we have seen trends within Internet addiction which is becoming far more prevalent. A Chinese study found that 6% of adolescent internet users in China suffered from the disorder, with users detailing school-based stressors as their reason for spending so much time online, leading to anxiety and other psychological symptoms 28.

Illicit drug abuse is still a major contributor to the addiction community. Cannabis being the most widely consumed illicit drug in the world, followed closely by Amphetamines. WHO finds that at least 230 million people use illegal drugs at least once a year globally, representing 1 in 20 people (aged 1564), and 1 in 40 use substances at a more regular monthly rate. Illicit drug

use seems to be a youth phenomena, with most people experimenting at around 18-25. Oddly enough though, people that receive treatment seem to be aged mostly between their late 20’s to early 30’s 29.

Though illicit drugs are seen to contribute greatly to instances of addiction, there is no greater contributor than those substances which are accessible through legal means.

Problematic drinking is 8 times more prevalent than problematic drug use, with 2.3 million deaths in 2009 attributed to alcohol alone. In contrast, illicit drugs contributed 245,000 deaths in the same year.

Shockingly however, the largest number of deaths was attributed to tobacco, with 5.1 million deaths in 2009 30.

Source:31 Abuse of controlled substances can also lead to instances of addiction.

Many people with addiction find themselves in a position of dependency on prescribed drugs; namely painkillers/opioids. In 1990

11 Age Distribution Prevalence of use (Single Month) Age Distribution Prevalence of Use (single month)

80 60 Alcohol

50 40 30

Tobacco

20 10 0

Illicit Drugs 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65+

Past Month Prevalence (Percentage

70

Age Group

Source:31

the US was producing approximately 2 tonnes of Oxycontin a year. In 2009, they were measured at manufacturing over 135 tonnes of Oxycontin per year. Though this can be attributed to medical supply, it begs the question of whether we are over prescribing these medications, and just how much of that is making its way into the hands of consumers through illegal channels 32.

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Reasons for Addiction A deeper look into the causes behind addiction People become addicted for a variety of reasons. Factors such as socioeconomic status, disposable income, childhood maltreatment, social dysfunction and other underlying risk factors all contribute to behaviours synonymous with addiction.

It is now widely recognised that comorbid mental illnesses/disorders are also contributing factors to addiction.

A comparison of the first and second National Australian Survey of Psychosis found that prevalence of comorbid illnesses in instances of addiction had risen from 1997 to 2010 respectively. Alcohol had risen from 28% to 51%, Cannabis from 23% to 51% and other illicit substances from 12% to 32% 33.

We have also seen evidence that proves that childhood maltreatment and abuse has direct links to behaviours which cause addiction.

Behaviours such as impulsiveness, emotional dysregulation and conformity motives were seen to be directly linked to forms of childhood emotional abuse, physical abuse and

maltreatment in Tramadol users ages 13-20 34.

Johann Hari, the Author of Chasing The Scream: The First and Last Days of the War on Drugs, outlines the fact that isolation and social rejection has increasingly become a contributing factor to addiction. Using the example of Vietnam veterans who were addicted to Heroin during the war.

95% of these veterans returned home and ceased to use the drug, most with no form of recovery action 35.

They were taken out of a hostile and desolate environment and returned home to loved ones, support and community.

Observations such as these show that professionals need to focus on underlying mental wellness, as well as family dynamics and social behaviours, in addition to the physical attributes of the disease.

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Methods of Recovery A complex and dynamic process Just like addiction itself, the definition of recovery is also rather convoluted.

Recovery means something different for everyone. Each person going through recovery can craft their own journey with an array of tools and programs. With this in mind, recovery as defined by the National Council of Alcoholism and Drug Dependence (NCADD), is a rather all-inclusive definition: “Recovery is a complex and dynamic process encompassing all the positive benefits to physical, mental and social health that can happen when people with an addiction to alcohol or drugs, or their family members, get the help they need� 36.

There are many methods and programs out there for people with addiction who wish to recover.

Alcoholics Anonymous (AA) and Narcotics Anonymous (NA) support and assist each other recover through the 12 step model (developed by AA)37.

Traditionally, institutions dealing in recovery programs have worked

with this 12 step model, based on abstinence. More recently we have seen the introduction of the harm minimisation model, including techniques such as methadone maintenance for those recovering from heroin addiction, as well as needle exchange programs.

One of the most common modern methods of recovery is Cognitive Behavioural Therapy. An approach which is focussed on the treatment of psychiatric problems through the identification of unhelpful behaviours, and the re-learning of healthier skills and habits 38.

All of these methods have their pros and cons, allowing people with addiction to choose the route which most suits their values/position, however there are barriers of entry to some of these programs. Funding, Stigma, personal biases often inhibit these people from getting the help they need. In 2010, WHO revealed that only 20% of recognised problem users actually received treatment for their addiction39.

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Some of these models have also come under fire, namely methadone maintenance programs face much debate as some claim that they are essentially replacing one addiction (that of a Heroin addiction), with another addiction (Methadone addiction) as users seem to become reliant on the drug to function40.

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Case Study: Portugal Policy-level change in the country of Portugal Successful macro-level interventions within the field are few and far between, as political barriers that prevent such interventions from becoming commonplace make these types of solutions difficult to execute, however they can be some of the most impactful solutions to such complex issues.

On July 1 2001 a law in Portugal took effect that decriminalised all drugs (this essentially took the severity of the demeanor down to an administrative offence, trafficking drugs was still highly illegal)41. The idea of the system was to minimise the stigma of addiction by removing the criminal connotation, creating a system that emphasised respect for the addicted person, as opposed to a system that punished them.

Offences were dealt with by a committee of addiction and health specialists instead of judges. Non addicted offenders may be sentenced payment of a fine, or a non-pecuniary penalty, up to the discretion of the officer, depending on the severity of the offence; whereas addicted

offenders could suspend pending sanctions if they seeked help 42.

The results years later showed positive impact. 6040 people in drug substitution therapies in 1999 increased 147% in 2003 to 14877.

Newly reported cases of HIV/AIDS had dropped, and prevalence rates (how many people have consumed a particular drug over their lifetime) of drug use decreased for most age groups; (13-15 yo) from 14.1% in 2001 to 10.6% in 2006, 6-18yo’s lifetime prevalence rate which increased from 14.1% in 1995 to 27.6% in 2001, decreased to 21.6% in 2006 43 . Fears that that Portugal could become a centre for drug tourism were unfounded, with 95% of those cited were from portugal, and close to 0% have been citizens of other EU states 44 .

Source: 45 Policy-level interventions such as these are effective in creating system level change. Macro-level change is certainly an achievable outcome, however, perhaps it is important to first look at what we can do on a micro-level to catalyse such change

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in the near future.

Design can play a role in delivering solutions on a micro-level far more efficiently, as there are less political barriers to deal with, and design interventions can work autonomously to many political bias’.

Portugal’s intervention was brought on by a desperate government,

needing to change the increase in addictive behaviours amongst its people, however many governments have yet to see the urgency of such issues, and so it is imperative that design interventions work towards solutions, but also act as catalysts for greater change.

Prevalence of Over use Entire over entire life Environment - School Environment Prevalence of Use Life - School

5

2006

10

2001

Percentage

15

0 Cannabis

Amphetamines

Heroin

Substance

Cocaine Source:

45

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Case Study: ActivMobs User-level change in the city of Kent Collaborative design helps to establish informed solutions to design problems. Collaborative Service solutions such as Activmobs allow for users to be in control of their own health by contributing to a larger eco-system of health-concious services which are not only present to serve their users, but empower them to take some of the responsibility into their own hands, to see the service grow and develop.

In 2005, work began between the Kent County Council and the Design Council to develop a service to promote more active lifestyle within residents, in order to mitigate risk of future chronic illnesses in deprived areas of Kent. Using the Double Diamond method developed by the Design Council, they worked together with key stakeholders, including Kent residents in order to develop co-designed solutions to their design problem46 Activmobs is an informal selforganising group of residents, who facilitate activities promoting healthy lifestyles by organising and executing

them themselves. This platform is facilitated with an online component where residents can register events like dog walking, yoga, meditation and so on 47. This solution allowed residents who were not comfortable with engaging in formal, regimented forms of healthy activity (like attending gym classes) to engage in physical activity informally. As of 2010, there were approximately 30 active mobs and 300 active mobbers who were engaged in the program in Kent alone48 .

Creating a digital platform where users could communicate and organise events easily seemed to be a key component of this program. The online component was quickly adopted due to its ease of accessibility, contrasting with current models of regimented activity like sports/gym memberships which require initial face/face briefings. The digital aspect of the design aided users in overcoming the barriers of entry to the healthy activity, pertaining mainly to being time-poor or suffering from a lack of initial motivation.

Source: 49

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Source:

49

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Case Study: OpenDoor User-level change in the city of Lincolnshire Micro-level interventions can assist in narrowing down the scope of a design intervention to a niche context.

Often this can create a far more valuable and effective design solution, as opposed to an intervention targeting the entire landscape.

Open Door is a service initiative which was prompted by the North East Lincolnshire PCT in order to address inequalities in health within Grimsby. The purpose of the program was to promote better health practice and health registration (with general practitioners) amongst ‘hard to reach’ people within the population (people addicted to drugs, sex workers, offenders etc.)50.

Leveraging Co-design techniques in order to develop design solutions, stakeholders were taken through discovery, define, develop, implement phases in order to develop potential solutions. The end result was a pilot program for Open Door, a social care enterprise, which revolves around an informal method of care, a place to go and meet people who are like minded in a similar situation of not engaging

in traditional methods of care51. This allows for openness when it comes to an individual’s health, allowing them to practice methods of healthcare which are far more accessible given their lifestyle choices52.

Within its first year the program reintroduced 187 people to mainstream health care resources, with over 1000 patients registered with the in-house GP53.

Programs such as open door are able to leap-frog barriers of entry which deter ‘hard to reach’ users from accessing services. A Purpose built enterprise such as this is able to work within the constraints of the context (conceived in a sector filled with isolation, stigma and so on) with the help of stakeholders in order to develop outcomes which leverage human-centered design techniques through participatory design. This again solidifies the importance of informed approaches to design through collaboration.

Source:54

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Source:54

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Context & Application

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Health Services in Australia How we deal with these issues here in Australia The Personal Welfare Services Industry assists in providing social services to a breadth of clients.

The sector caters to an array of clients ranging from children to the aged; with over 2000 business’ running within Australian listed with IBISworld55.

The industry deals with services pertaining to adoption, welfare counseling, disabilities assistance and many more. As we see the industry resting within the growth phase of its lifecycle, we are faced with many issues and developments within the social landscape which become key external drivers for the industry’s growth56.

One of these sectors of growth which sees much attention is driven by the growing amount of crisis work within drug and alcohol addiction services.

With the more recent epidemic of methamphetamine (ICE) use in Australia, there is a growing need for more services to cater for the varied demographics who may fall prey to addiction.

The Department of Health provides a standardised intake procedure for all health and human service

providers dealing in Alcohol and other drug (AOD) services within the public sector. People with addiction are expected to complete an intake assessment (usually through contact with the Directline Phone service), which identifies a ‘client’s’ AOD severity, as well as their life complexity, in order to assess what services may be appropriate with them57.

The downfall here is that these assessments are standardised across the industry. Clients are classified into 5 separate tiers, defined by their intake assessments. Tiers 1 and 2 are simply referred to online or telephone services, whereas tiers 3,4 and 5 are referred to more intensive levels of care including comprehensive assessment and Recovery coordination58. Though online and telephone support services are essential, many of these services lack the sustaining wholesome support that face to face counselling offers.

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The system boasts a ‘person-centered care’ approach, however, given genuine person-centered care approaches like the ActivMob and Open Door case studies, we can see a disparity between these approaches. In standardising a person’s severity of addiction, we diminish their chance of individual, wholesome care; and by prescribing standardised approaches to AOD services, we are also denying them this ‘person-centered care’ approach.

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Methods of Recovery Available avenues os recovery Detox Programs are usually the first step for anyone seeking recovery after having been assessed. They focus on solely treating the physical symptoms of addiction. People with addiction are sometimes required to complete a detox program before gaining entry into many public institutions, but this again depends on the severity of someone’s situation.

Many Private institutions include detox programs, surpassing the need to refer people with addiction to a third party detox program.

27 Public Institutions can be found throughout Australia, with some local Melbourne based programs such as Odyssey House only asking for clients to contribute their centrelink payments in order to gain admission after referral from a practitioner59.

The problem with Public institutions is that a lack of government funding means that there are limited spaces in both residential and non-residential programs60. With the rise in demand for treatment services, this presents a barrier for those needing immediate treatment,often having to deal with waiting periods before being accepted into a program.

Private Institutions on the other hand are far more abundant, but quite expensive. A 3 month long program at a reputable institution like Melbourne’s Raymond Hader clinic could cost an addict up to $32,00061. This cost is a significant barrier for people with addiction who need to gain access to services immediately, but lack the funds. They are likely to be pushed aside by both the public and private sector, leaving them to take their treatment into their own hands until they are accepted into a program or can gather the funds necessary.

Additionally, the private sector falls under some controversy regarding regulation as it still remains an unregulated body working within the health services sector62.

Behaviours which attribute to addiction make it difficult for people suffering from addiction to take treatment into their own hands.

Barriers such as isolation and stigma stop many from making the leap to unsupported person-centered care, many often opting to continue their addictive behaviours; however there are options out there for those willing to take matters into their own hands.

28 Therapeutic Communities, are a method of recovery that work alongside group counselling sessions, and assists in the formation of acceptable behaviours and routines for people with addiction. This method is often replicated within residential recovery programs.

Another popular option are Peer Support Programs like AA and NA. These are open and accepting communities of recovering addicts, which have succeeded in providing support to one another, however many of these communities are spiritually focussed. Those who do not believe in such powers tend to take advantage of altered versions of the program which dilute the presence of spirituality in favour of a more psychological, personal developmental approach.

People with addiction can also take advantage of The Australian Medicare Rebate Mental Health Plan (the Better Access Initiative). This is a government initiative for improved access to mental health services.

With a Mental Health assessment from a General Practitioner, users can claim medicare rebates to access free counselling sessions63.

People with addiction need to be supported in their decision to make a change to their situation. We should not be putting barriers in front of them. Access to services is structured in a way that does not allow for fair entry to these programs.

Notions of patient-centered care are not intrinsically supported and are very sparsely considered. In order for someone to be successful in their recovery, they need the tools to change to be available to them immediately, not put on waiting lists.

Pre-Program

Illicit Substance Abuse

Licit Substance Abuse

Self Directed

Savings/ approval from HCF

GP Referral

Co-Morbid Substance Abuse

Intervention/ Recognition of change

Directline/ Dep. of Health

Non substance Addiction

Current Avenues of Entry

Leap to Recovery

Intake Asessment

Outpatient

Tier 5

Program Selection

Mental Health Plan

Therapeutic Communities

AA/NA

Outpatient

Inpatient

Inpatient

Detox Program

Collateral/ Online Resources

Tier 4

Tier 3

Tier 2

Tier 1

Reduction of Use Reintegration (Belonging) 12 Step Completion

Psycho-social Development Spritual/Art /Sport Therapy (etc.)

Sober Houses

Active within Program

Counselling

12 Steps/ Peer Support

Achieving Goals

Mental Wellbeing

Physical Recovery

Cognitive Behavioural Therapy

Dual Diagnosis

Therapeutic Communities

Harm Minimisation

Abstinence Model

Post Program

Recovery

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The Challenges Barriers to recovery faced by those suffering People with addiction face common barriers of entry when it comes to making the leap to recovery. These lie on a micro (client) level, however the industry also faces issues on a macro (or enterprise) scale, which also need to be catered to, in order to catalyse long term development within the space.

Barriers of Entry

Stigmatisation

Isolation

Ego/Denial

Lack of Support Networks

Access to Information

Micro Level

Recovery

Macro Level

Funding/ Grants

Regulation

Conversation Between Sectors

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Micro - Level Stigma plays a huge role in the decision making process of someone who is looking to enter themselves into a recovery program. Fear of being stereotyped or discriminated against is often what stops people from reaching out for help, or enrolling in counselling programs for many mental illnesses. External factors (public stigma) and personal factors (private stigma) play into this greatly. Often we will see someone with a mental illness be stereotyped or self stereotype, which then leads to internal prejudice in agreeing with such beliefs, which then leads to self discrimination by failing to participate in the treatment64.

Access to Information plays a vital role in ensuring that people with addiction have access to information regarding their options of recovery.

As it stands now, there is no explicit central hub for people to gather information about addiction recovery programs, application processes, etc.

Isolation, as highlighted earlier, plays a significant role in an addicted person’s mindset. A direct result of their context/ environment, we seem to push people with addictions away from us instead of aiding them in their recovery. Too often we will hear threats of ‘if you don’t give up the drugs i’m kicking you out of home’, further isolating them, instead of nurturing and supporting them in their endeavours65. Lack of Support Networks also fall under isolation, this refers to the lack of peer or family support. Many addicts burn bridges with old friends and family, leaving no support network to push them to make a positive change to their situation.

Ego/Denial are another internal barrier which come as a symptom of an individual’s addiction. The ideology of having their addiction under control, and the claim that they could stop using the substance or behaviour at their own will. Often the first step to recovery is admitting that you have a problem, and is indeed the first step within the renowned 12 step program 66 . Another issue that can arise is one of multiple choices and options. Online recovery communities have vocalised that once they hit a point in their addiction when they were ready to ask for help, the option of succumbing to another episode of dependency was a far more accessible and easy option than asking for help 67.

32 Maintenance of care seems to be a new issue that has arisen out of the new definition of addiction which classifies it as a chronic brain disorder. This essentially takes into account the way we evaluate treatment. Currently it is a retrospective practice, where a person with addiction completes treatment, and then some months later they may receive a follow up to see how well the treatment worked. Many argue that we should be evaluating these treatments concurrently, such as with other chronic illnesses like diabetes, where care is ongoing and constantly being measured for its successful application68.

Macro - Level Funding is a rather pertinent issue in today’s political climate. The reality of the matter is that there is an extremely high demand for addiction recovery services within the public sector (as not every person suffering from addiction can afford private institutions) however, lack of funding means that this demand cannot be met. This leaves many on waiting lists, waiting for someone to complete or drop out of a program in order for them to access the help they need69.

Regulation is an aspect of the industry which only really effects the private sector at this stage. In Australia, many public institutions answer to the Department of Health with a slew of Key Performance Indicators that they must meet in order to retain their funding. As private institutions are privately funded, they answer to no regulatory body. Essentially this means that they are able to charge whatever they wish, for whichever services they wish to provide. This leaves people with addiction quite vulnerable to being taken advantage of, as they could be overcharged for substandard services, not to mention the risk of not being provided with the level of care that they need in order to attain their goal of recovery70.

Conversation between Public and Private sectors at this stage seems to be non-existent. Competition within the private sector, as well as a lack of communication between the public and private sectors means that institutions do not work together to tackle issues on a macro level. This is crucial for the development of initiatives to enable industry growth to cater for demand. Currently the only addiction conference is the Addiction Australia Conference held on the Gold Coast 71, where representatives gather once a year to talk about issues and initiatives within the industry, however this relationship needs to be ongoing, and maintained, in order to reach wholesome outcomes.

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The Design Context Narrowing focus through design For the purposes of this study, I will be focussing on the Barriers of Entry to programs which are faced on a Micro level. The Design Intervention will be prompted from the question below: How can we break down the social and emotional barriers of entry to addiction recovery services? Enabling easy, secure and personalised access to recovery services.

The aim of this question is to challenge the current barriers of entry to programs, in order to assist people with addiction in making the leap into recovery, instead of continuing to succumb to addictive behaviours. If we can break down these barriers through the design of new, discreet and user-oriented pathways into recovery services, as well as change attitudes towards accessing recovery services, with the adoption of true person-centered care, we will be able to give people with addiction a renewed confidence in their own ability to reach out for help.

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The Users The targeted marker segment The design intervention will be targeted towards people with addiction who are looking to make a change within their circumstance, but face an extremely common barrier to entry, Social Isolation.

The intervention will be developed for a Victorian context initially, with a focus on Young adults (aged 18-24) who are socially isolated; however, I will be considering approaches which would allow for efficient scaling to a national (Australian) level.

There is also a segment of users within the world of addiction recovery who do not wish to take part in traditional AA/NA due to philosophical and methodological differences. This will be a key segment to consider.

Empathy will play a key role in the success of the intervention.

Discussions with a counseling professional found that many outreach workers cannot reach their clients on an interpersonal level as they don’t understand what it’s like to be addicted, they lack empathy.

Creating empathy between people with similar circumstances will be crucial in overcoming aspects

of social isolation, this is why the following personas are both current/ past addicted individuals. (See Appendix 4) I have developed 2 personas, made up of an addicted individual who is socially isolated, and a recovering addict who is continuing to work on their sobriety. These personas will be consulted throughout the entire design process to ensure that the iteration phase stays relevant and user-centric. (See Methods: Personas) Stakeholder Mapping also identified key stakeholders who qualify as secondary, indirect users. In a bid to start a conversation between sectors within the industry, professionals from various sectors, social, medical and policymaking backgrounds will be engaged through feedback loops embedded within the design intervention. (See Methods: Stakeholder map)

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Logan -

24 Years Old

-

Recently Unemployed

-

Opioid dependence

-

Socially isolated

-

Cannot join AA for logistical and philosophical reasons

Logan began experimenting with illicit substances in high school. His curiosity followed him into his young adulthood. Through experimentation on nights out with friends, his friendship circles began to shift, he found himself surrounded by new friends with an affinity for pushing the limits. He has been regularly taking oxycontin and other opioids, and has fallen into a dependance.

Logan has been recently let go from work and has hit rock bottom. He has no one to call for help as he has burnt many bridges over the years, he just wants to talk to someone who understands, and can help him to make a change.

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Ryan -

29 Years Old

-

Employed

-

Recovering opioid dependence, 1 year clean

-

Lives in Melbourne

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Active member in recovery community

-

Recovered through a Private facility

Ryan overcame his opioid dependence and is celebrating one year of abstinence (having recently come off his maintenance program).

He’s looking to involve himself more within the addiction recovery community, in order to keep himself clean. He has heard of peer to peer mentoring that takes place in AA/ NA, but he hasn’t gone to a meeting since leaving rehab and does not agree with the philosophical side of the program. Additionally he wants something with less commitment than AA/NA, as he doesn’t have time to go to meetings almost every other day. He feels as if he cant talk to his partner about his stresses for fear of her not understanding his situation.

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The Intervention How design can help to provide solutions Given the sheer volume of client level barriers of entry, there is a need for a design intervention between the Pre-Program stage, and the Program Selection/Eligibility stage (detailed In the figure on page 29). This stage, named the ‘leap to recovery’, details the stage in which people with addiction take action in order to secure placement in a recovery program. This may range from researching possible recovery options, taking part in an intake assessment within the public sector, sourcing funds in order to pay for a public institution, or simply facing internal social and emotional barriers of entry in order to make a decision to change their circumstance.

An Intervention which is outside/ separate of any public or private health institution, or government body, aimed at Prospective Recovery Clients/Addicts (contemplating changing their circumstance through self realisation).

A Client level intervention to improve access to recovery programs for those who face common barriers of entry on a client (micro) level.

I will be exploring possible design interventions through methods of collaborative service design. Taking advantage of research and design methods through a double diamond inspired approach. The first phase encompasses a discover and define phase, where the bulk of the design research will be completed, and the second phase will include a Develop and deliver phase, as the intervention is developed72.

Source: 73 I would also like to develop the project to a point at which it could possibly be implemented in the real world. Working towards a solution which is efficient and sustainable economically as well as socially is important, and so I wish to explore facets of social enterprise, such as business models for Non-for-profit businesses as a possible vessel for the project to be implemented74.

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Double Diamond

op el ev D

D el iv er

D is c

Contexualisation

ne efi D

ov er

Shallow Dive

Deep Dive

Source:

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Changing attitudes towards Addiction Recovery How behaviour change can help The process of effective behaviour change can more or less be summed up in 5 steps75.

Precontemplation The introduction of change to an individuals thought process Contemplation The individual thoughtfully considering taking action Determination The individual preparing to make the change Action the individual beginning to make the change Maintenance The individual creating entrenched habits around the new behaviour

These stages need to be considered if we are to make long term change in the behaviour of someone suffering from addiction, however, people with addiction can face a slew of mental barriers when it comes to behaviour change. The fact that substance abuse can alter a person’s brain chemistry, as well as having to deal with chemical hooks which are synonymous with many substances, could affect a person’s ability to adhere to these steps.

As we are only concerned with the changing attitudes towards the leap to recovery, we need to focus and leverage tools of behaviour change, to develop positive habits and routines surrounding isolation, stigma and denial in addicts; only then will we have delivered an effective design intervention.

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Behaviour Change

Precontemplation

Contemplation

Progress

Preperation

Relapse

Action

Maintenance Source:76

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Technology Wholesome digital service delivery Digital service delivery is quickly becoming one of the most common ways to reach users. With the rise of smart devices, the Internet of Things (IoT), and the increasing popularity of software development, we can reach users in ways that we never thought possible.

We have already seen the Australian Government take advantage of Digital Service Delivery with its applications for ACCC recalls, which alerts consumers to items which have been recalled by the Australian Competition and Consumer Commission, Dangerous goods app can I pack that? Which gives users an insight into what goods they can fly with and which goods present a risk, and so on77.

More health-based initiatives include efforts by BeyondBlue with their popular Checkin application which informs people on how to talk to a friend who may be struggling with depression78. Their online presence also extends to an application for suicide prevention called Beyondnow, which re-interprets common suicide safety planning in a digital space

in order to improve access to the service often offered by counselors79.

The Healthdirect application by Healthdirect Australia which gives users access to diagnoses tools, as well as access to information regarding service providers in order to make informed decisions about their health is another example of digital implementation80.

The advantage of a digital service delivery within the scope of this project would be to protect a client’s anonymity. As we know, stigma can play a large role in someone’s decision making process when it comes to making the leap to recovery, and so visiting a bricks and mortar establishment to take part in a service may not be a process that they are willing to partake in. However, digital service delivery alone may not be an all encompassing solution. As we know, face to face contact is preferred, especially when it comes to delivering clinical services regarding health and wellbeing.

45 How could you replace a practitioner with an application? There is a lack of wholesome IT solutions which can provide the same level of support that a face to face visit encompasses. The digital aspect of the design will be part of a larger service, In which its sole purpose will be to connect people in a face to face environment. Source81 I will still need to consider how to make the digital aspect of the service approachable and accessible by all, Person-centered care could possibly be one avenue to explore in order to overcome this.

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Person Centered Care Taking into account a persons lifestyle choices Person Centered care could be essential in developing patterns of ongoing behaviour change within the maintenance phase. Making people responsible for the networks and resources they use to support their health and wellbeing puts the user in the control of their own health practice, essential in building routine and lifestyle choices surrounding health and wellbeing.

Person Centered care takes into account a person’s family situation, social standing and lifestyle choices.

Humans are not standardised beings, we all have different desires and needs. Person Centered care allows for patients to work collaboratively with these services, and make decisions which aid in improving their health and wellbeing whilst taking into account their lifestyle choices82.

In order to design an effective intervention, we must consider the approach of person-centered care. As it is people with addiction and their immediate family/friends and loved ones that make the leap to recovery, they are essentially at the centre of their recovery, and need to be empowered to make decisions about

their situational health and wellbeing, whilst having their lifestyle choices considered throughout the process.

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Methods

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Design Research Plan Informed through ethnographic research The research methods outlined in this chapter were undertaken to gain a critical understanding of the field of Addiction recovery services, to assist in better defining the context of this research project, as well as fill knowledge gaps that may have arisen throughout this research phase.

The research was completed in 3 stages, each stage informing the next:

I began with some initial Desktop (Secondary) Research in order to gain a general understanding of the field, as well as an insight into the key players involved. Once the stakeholders were identified, I proceeded by engaging practitioners, secondary desktop research and user engagement via an online community of recovering addicts. This was all cross-referenced using triangulation, to ensure that the research was indeed factual, and could be validated through other methods of research.

Stage 2

Deep dive (confirmed through triangulation - see methods of evaluation)

These methods gave me the necessary information to move forward in mapping the industry and its users through journey maps and personas, as well as proposing possible solutions through the creation of asset maps and stakeholder maps.

Stage 1 Shallow dive - Literature review to gain initial insights to inform deep dive

Stage 3 Contextualising (using the insights from deep dive to inform the context)

The steps were inspired by precedent set in the Open Door project, by the Design Council, where they implemented a Shallow Dive and Deep Dive phase in order to inform the projects collaborative research phase83.

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Methods of Research

1. Shallow Dive

2. Deep Dive

3. Contextualising

Personas Qualitative Interviews Industry Journey Map

Triangulation

Website Research User Insights

Quantitative/ Qualitative Desktop Research

Asset Mapping

Stakeholer Map

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Stage one: Shallow Dive Initial Desktop Research/ Literature Review The first few weeks of the project consisted of gathering some initial insights regarding the field of addiction recovery services, and some of the challenges faced by stakeholders within the industry.

Secondary research was key in the development of my understanding of the field; using case studies and reports from the field of psychology and recovery services ensured the collection of scientifically validated information relevant to addiction recovery. Reports published by internationally known health bodies such as WHO, were imperative in establishing the scale of some of the issues at hand. Website analysis and newspapers articles regarding local, Melbourne based practitioners within the field were also used to determine which local stakeholders could be called upon to collaborate on this project.

The information gathered during this stage was crucial in gaining a basic understanding of the field, as well as identifying the stakeholders which I would be contacting in my second stage of research.

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For example, an article found on theage.com84 spoke about the need for regulation within the private sector of addiction recovery services. This information prompted me to seek out practitioners within the private sector, in order to gain their understanding of the issue. Similarly, I consulted the Open Book of Social innovation by NESTA85 regarding which possible methods of research to undertake, coming across professional insights as a pathway for the research phase of the project, this prompted me to organise meetings with 4 stakeholders.

Ensuring that i comprehended the field before engaging key stakeholders was crucial, as the information gathered during stage 1, informed the interview questions I asked my stakeholders in stage 2.

Using both Google scholar and search engines to find relevant articles, reports and case studies proved fruitful in providing the relevant resources. Many of the texts have been published by those studying within the fields of addiction medicine or social sciences, however some design texts such as the Open Book of Social innovation by NESTA86, IDEOS Field guide to Human-centered design87 and Marc Stickdorns TISDT88 were crucial in designing the research plan.

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Stage two: Deep Dive Qualitative unstructured Interviews After reaching a point of confidence in my knowledge of the field, it was time to begin consulting the professionals. I made contact with several addiction recovery service providers, as well as an outreach worker, to organise interviews.

Once I had secured a time to meet with the practitioners, I set out to develop a set of prompts to provoke a conversational interview process.

I took an unstructured approach to interviewing, beginning by building rapport with the interviewee, and then continuing on to have a focussed conversation-like discussion, instead of a question answer format89.

Instead of asking questions outright such as “How do you feel about the Abstinence vs. Harm Minimisation debate?”, I may begin with a broad opening question as an ice-breaker to gain rapport, such as “How did you make your way into the industry?” and then slowly direct the flow of conversation to the topic of the debate, by prompting with “i’ve done a bit of reading into the current debate regarding abstinence and harm minimisation, it seems like quite a hot topic at the moment”, and may continue asking prompted questions

as the interviewee details their stance on the debate90. (for the question/answer sheets to these interviews please see the appendix 1,2,3,4) Interviewing practitioners from both the private and public sector of the industry was crucial in gaining an all-encompassing understanding of the industry. I was able to interview practitioners at 2 separate private institutions, as well as a consortium which encompasses a non-for-profit service provider within the public sector.

The information gathered through the interview process covered many of the controversies, challenges and operational facets of the industry (such as the introduction of harm minimisation, government support and regulation) from two distinct points of view. However, as some of the responses may have been slightly biased given the nature of the methods, i would have to crossreference many of the insights with case studies and user insights later on, in order to validate them.

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Following the first few weeks of shallow dive research, I contacted many public and private recovery service providers in a bid to secure a more in-depth understanding of their operations, as well as organise a possible time to meet. Making initial contact through telephone calls, I then created a template email, outlining the project brief and interview proposal, which I proceeded to email to each stakeholder.

I have continued my relationship with 3 of these practitioners, based within both public and private sectors, using project updates as an opportunity to gain critical feedback on the relevance of the design direction. This will continue throughout the development of the project through update reports, in order to inform the design process through a collaborative approach.

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Qualitative/Quantitative Desktop Research In order to confirm the insights gathered in the interviews, I engaged in further secondary research to gauge the plausibility of the practitioners views/opinions. Using scholarly articles, qualitative case studies, quantitative research reports and media/newspaper articles, I was able to validate the issues and challenges which were presented in both the interviews, as well as the secondary research.

I was able to gain insights into the the challenges faced by many addiction recovery service providers and their users, as well as proposed new methods of recovery, including case studies which covered issues faced by the industry on a micro and macro level, confirming many of the points made by practitioners in our initial interviews, insights including the need for regulation within the private sector, the presence of denial as a definitive barrier of entry, as well as the role that stigma and isolation play in an addict’s journey through recovery.

However, many of these insights were yet to be confirmed by users, which I tackled in my next method, User Insights.

Similar to the secondary research completed in Stage 1, the majority of these case studies, reports and articles were found using a combination of Website searches, including search engines, google scholar, and online databases through the RMIT library search.

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Online -User Insights Engaging users through posts to a popular Sub-Reddit, REDDITORSINRECOVERY, allowed me to confirm and cross reference the information which was gathered throughout my secondary research, and initial interviews.

This was successful in correlating with the previous information I had gathered, providing confirmation that the insights that I had gathered thus far were universally understood by many of the key stakeholders within the industry. For example, ego and denial seemed to be a common theme amongst the professional and client communities.

I had read several biographical posts written by former addicts on the REDDITORSINRECOVERY forum, as well as the SoberRecovery forums91 . Users detailing their journeys of addiction, into recovery, gave crucial validation to the claims made by practitioners and academia, regarding the challenges faced by addicts. I had also read many biographical stories of addiction published by Phoenix house 92.

In a bid to collect more defined information, regarding my specific area of interest, barriers to entry, I engaged users on the subreddit with a qualitative prompt, a question asking which barriers of entry they faced when they attempted to make the leap to recovery: “What were the barriers that were stopping you from getting the help you needed? Were they Financial? Were they Social?

Was it because you felt isolated or afraid to seek assistance? Does your local council/government not support health plans for addiction?

Etc.�

(Appendix 5)

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Stage three: Contextualising Personas Using the triangulated data from Stage 2, I began to create User Personas, ensuring that each section of my target market was represented by a relevant archetype. These personas were detailed through demographics, as well as their interests, challenges, needs and aspirations93.

These gave me an starting point for the beginning of the ideation process, as I was able to constantly refer to the personas, and question their behaviours when subjected to certain design scenarios. The first round of personas I created were solely addicts, but I soon realised that I may also be targeting Family, friends and loved ones of addicts, the second round of personas have reflected this refined market direction.

Each persona was crafted from the information gathered throughout the deep dive phase. Namely, the users stories on the subreddit provided an excellent cross-section of user behaviours and sub-types, which I could call upon to craft each character profile.

Beginning with 5 personas focussing on different target markets (including people suffering from substance abuse, behavioural addictions;

and even those who are indirectly affected by addiction like family and loved ones), I narrowed down the segment of the personas through continued research into online communities, as well as insights gathered from interviews with health professionals/outreach workers.

(Appendix 6)

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User Journey MapExisting services Mapping the field was essential in communicating my understanding of the process of access for users.

The fact that the Industry is separated into private and public sectors somewhat clouded my understanding of routes of access to recovery for addicts. Mapping this out allowed for a comprehensive, user journey map, which detailed the different paths that an addict could take which could then lead to recovery94.

This journey map was critical in identifying the intervention point for the design proposal. The majority of the challenges identified throughout the deep dive regarded access to the system itself, as addicts had to overcome personal barriers to make the leap to recovery; this method allowed me to map this exact intervention point.

I began by mapping out the different interaction points and pathways for entry into different methods of recovery (Public, Private, Therapeutic Communities, Mental Health Plan), and then continued to detail an addict’s journey through to recovery, creating a visual artefact which represented the field through the eyes of a user.

(Appendix 7)

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Asset Mapping Asset mapping is a visual representation of the relevant assets, which could be used within a design intervention to catalyse the impact of an intervention95.

This helped to identify cultural and social assets such as community groups, physical assets such as technology and infrastructure, as well as human resources like services, professionals etc.

The key finding was that most of the relevant assets seemed to deal with face to face interaction, such as social work, community support networks, cultural networks and the like. This led to my understanding that (at least within the scope of this project), some sort of human interaction is vital in achieving results, and will definitely be explored. Technology also proved to provide some valuable assets worth exploring.

Beginning with 5 distinct sub headings of the different types of assets, possibilities were brainstormed and added to the map constantly within a 10 minute time limit for each. The end result was a visual representation of valuable assets to the addiction recovery community.

(Appendix 8)

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Stakeholder Mapping Stakeholder mapping enabled the creation of a visual representation of the relevant networks, actors and relationships between them, in order to gather an understanding of who to consider when delivering the design intervention.

Identifying direct and indirect stakeholders through stakeholder mapping allowed for a comprehensive understanding of the networks of which the industry of addiction recovery is a part of. Identifying key stakeholders who are indirectly affected by the industry, such as police, local communities, councils/government bodies gave me an insight into which other stakeholders will need to be considered during the development of the design intervention, and how we could design an intervention which provides feedback loops to key indirect stakeholders such as government, communities and regulatory groups.

By brainstorming possible actors within both direct and indirect networks, I was able to create a comprehensive list of stakeholders.

After the initial list was completed, relevant relationships between each of the stakeholders were added to the map, defining the more important and relevant networks96.

(Appendix 9)

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Methods of Evaluation

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Evaluation How can we measure success?

In order to measure the impact of the design intervention, a slew of evaluation criteria must first be defined. Measuring the success of a social innovation can be quite a daunting process, as value metrics such as profit, scalability and market share are not as relevant within the social context as they are in the privatised business sector97. This then poses the difficult question of which value metrics are relevant in measuring the success of an innovation within the field of design and health, more specifically addiction medicine?

The methods of evaluation outlined have been chosen to provide a comprehensive analysis of the success of both the research phase of the project, as well as the summative success of the project itself. We must keep in mind that the design intervention tackles issues surrounding entry to recovery programs, and so we must focus on metrics which determine the the success of this factor.

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Formative Evaluation Ongoing evaluation throughout the project The following forms of formative evaluation have been employed to measure the success and credibility of the design research phase of this project98. They have been used in conjunction with the research methods (see: Methods) to create a cross-correlated research plan.

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Triangulation In order to ensure that the insights I was gathering during stage 2 of the research plan were factual, I used a method of triangulation. This was vital in ensuring that the design intervention would be informed by information which was ubiquitously understood.

By comparing the opinions offered by the practitioners, secondary research and user insights, I have been able to validate the findings of each method of research by correlating similar findings using the other two methods of research.

A notable example of this was the insight given by practitioners that denial plays a key role in the process of an addict making the leap to recovery. This was found to be confirmed through the engagement of online recovery communities, with many recovering addicts echoing concerns of ego and denial being their primary internal barrier of entry to recovery. A further example of triangulation concerns the role that stigma plays in the life of a recovering addict, with practitioners stating that there are stigmas that take place not only publicly, but also within recovery communities. confirmation of this belief was found in a case study which looked at the effects of methadone maintenance on recovering addicts in Scotland, where participants felt stigmatised by their peers whilst attempting to participate in recovery programs whilst undertaking methadone maintenance, as other recovering addicts didn’t see them as being clean or abstinent99.

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Service Prototypes Service prototyping can give excellent insights into the viability of a system before any commitment has been made regarding the execution of a final design. This tool can assist in gauging the successful aspects of a prototype, in order to iterate accordingly100. Quantitative value metrics could be collected through questionnaires and interviews completed concurrently throughout the duration of the prototype test.

The data captured allows for a comprehensive evaluation of the users experience as they navigated the service, how they felt during certain touch points (perhaps using check in points in a diary/ questionnaire), as well as the need for any improvements.

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Expert Evaluation In order to gauge the effectiveness of the design intervention from an industry perspective, practitioners will be engaged throughout not only the development process, but also after the launch of the intervention, in order to pursue continuous improvement and development of the platform. It is important to understand the effect that this intervention has on professionals and their dealing with addicts. As it will serve as a platform of delivery to services, the system must also be designed with industry in mind. This will be executed through follow-up interviews with practitioners, as well as stakeholder updates with information regarding the status of the project and its direction.

The feedback gained from these interactions will assist in creating an informed platform.

It will be important to avoid biases when it comes to choosing the practitioners to engage for a postlaunch evaluation of the design intervention, and so it would be in the best interest of the project to consult impartial, academic or government-based practitioners.

This would mitigate the risk of bias, especially within the private sector, where revenue plays a more imperative role in the success of an intervention.

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Summative Evaluation Final evaluation at point of completion A summative form of evaluation will be used to determine the success of the final outcome of the project101.

The success of the finalised design intervention will be validated through scrutiny of defined value metrics and key performance indicators regarding the success of the intervention as a social innovation.

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User Experience Surveys and Patient-Reported Outcome Measurement Surveys will be used to evaluate user satisfaction rates. Containing both qualitative and quantitative questions, this will evaluate the user experience for the ongoing development of the design intervention after its launch, as well as assessing health outcomes which have been facilitated by the service102. These can be delivered through digital means, as well as face to face interactions in the form of ‘user satisfaction surveys’.

There will also be a focus on quantitative data pertaining to user retention, participation, users who have successfully reached services, and so on; this data can be captured through patient-reported outcome measurements (PROMs).

These surveys assist in reporting a patient’s symptom status, mental health, social function and wellbeing through means of a qualitative survey. Used by the NHS to measure the success of a variety of common surgeries, these surveys have become vital in reporting health outcomes103.

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Cost/Benefit analysis A cost/benefit analysis will allow the evaluation of the efficiency of the system. Are the resources which are being used to execute the system being put to the best use? The costs associated with the service are compared to the benefits that it creates. The benefits and costs of alternative solutions are then taken into account in order to ascertain whether the costs of the service in question are being put to best use.

For example, in Holland, this technique was used by the government to assess the viability of building the Polder dams. They evaluated the costs it would take to rise the dam, alternative solutions, the cost to life if the dam was not raised, as well as the likelihood of the sea-level rising, in order to make an informed decision104.

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Design & Iteration

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Ideation Ongoing evaluation throughout the project During the initial ideation phase, a generative question was used to assist in contextualising the findings of the research phase into designscenario specific questions to act as design prompts. The phrase was purposefully left blank in certain areas in order to allow for consistent structure throughout all prompts: The prompt question was: How can Party A assist in Problem scenario, in order to reach Ideal User Scenario.

The Following design prompts were developed using this technique.

How can recovering addicts, provide advice to those currently suffering from addiction, in order to promote access to support networks for addicts?

How might addicts in denial, become aware of the dangers of addiction, to ensure that they make informed decisions about their health and consumption of substances?

How could loved ones find the next step in helping their addicted loved one so that they could ease pressure on the public system?

Following this, a bout of timerestrained brainstorming helped to form some initial ideas, 3 of which (one from each prompt) were chosen to be prototyped:

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Prototype One Person-Centered Care health diary How might addicts in denial, become aware of the dangers of addiction, to ensure that they make informed decisions about their health and consumption of substances?

This idea materialised as a Personcentred care health diary, which took into account a person’s intake of alcohol and other drugs. The premise of the system would be to collect information regarding a person’s health habits and give them monthly feedback, particularly regarding their intake of drugs and alcohol.

These updates would include how they stack up against average consumption of the drug Australia wide (to put perspective on their use) as well as recommend treatments, events and activities to help them reach peak physical health.

This service was targeted towards those in denial of their addiction, in order to help them understand the effects or severity of their habits, whilst taking their lifestyle choices into account.

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The prototype The prototype was essentially a standard health diary which reported a person’s intake of calories, fats, as well as exercise and mental wellbeing. In addition to this, each diary page has a section dedicated to substance and alcohol intake, and a separate diary entry section, to promote daily use as it also functions a regular diary.

Date

Calories

Breakfast

Sodium

Fat

Lunch Dinner

Totals

Mark your general mood today somehwere on this scale

Excersise Distance Time

What has made you feel this way today?

Diary Entry

Alcohol Intake Standard Drinks Prescribed Medicines (

)

MG’s Other Substances (

)

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Validation Through informed design research, I decided to create a user-case scenario, which took one of my initial personas, Logan, through the journey of using the service. This in conjunction with the user journey map helped me to realise that the likelihood of my persona, sticking to a regimented routine, and constantly updating a health diary is highly unlikely. Initial research informs that many addicts (and those in my segment) live extremely chaotic lifestyles, and sticking to routines or positive habits is a rather difficult task. In addition to this, in order for the service delivery to be viable, it would need to become an online experience; resulting in difficulty in getting users to actively participate in the use of the service as the space is filled with competing applications.

Unfortunately, due to viability issues, as well as embedded issues with adoption from the target market, the service was not taken into development.

User Journey Map

Stage

Awareness

Touch Points

Desk Display at GP

Investigate

Commit

Service Delivery

Service Delivery

Retention

Targeted Mailouts

Targeted Mailouts

Diary

Diary

Diary

Website

Website

Online Diary

Online Diary

Online Diary

Downloads Logging Application or begins to fill physical diary

Application gives monthly feedback relative to Aus Health average

Diary recommends possible ways to improve results, including services

Continues use until incentive period over, regular user

Willing to try, nothing to lose only to gain

“Wow, I use a lot more than I thought I did”

Reduces use or seeks help from links provided

Still online, very easily disregarded, doesnt hold weight

Still online, very easily disregarded, doesnt hold weight

Possibility to fall back into bad habits

Reflection on results

Action from results

Retention through service functionality, fading reliance on incentives

Targeted Mailouts

Social Media Presence

What is the user doing?

Possibly visiting GP, Collecting mail, Checking SM

Weighing up the pros and cons of committing

What is the user thinking

They see incentivised program for little effort, maybe worth their while

Willing to try, nothing to lose only to gain

Pain Points

Possible target market is younger and less prone to undertake

Not expecting results, skeptical, in it for incentives

Research into what incentives on offer

Decision making point. Will they make the commitment?

Doesnt take it seriously, not a priority, may drop off

“This really helped... imagine the changes I could make to my health”

Moment of truth

Action

Emotional Status

Commitment, Users make account or begin to log info daily

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Day in the Life

Logan wakes up, wating breakfast before he goes to work, he updates his Calorie intake on his Digital Health diary.

Arriving at work, he sits at his office desk strung out for hours. He needs something to calm his nerves

He heads to his car to take a dosage of Oxycontin to relieve himself. He has been slowly cutting down his daily usage.

Its the end of the month, and as Logan is making himself something to eat he recieves a Push notification from his Digital Diary

Logan finished up for the day and walks home, logging his distance and route through the GPS enabled application.

He notes down the dosage amount and time in his digital diary, then heads back to work.

He is being told that his calorie intake for his body weight has been over this month, Also he has cut out almost 1/3 of his Opioid Intake.

The diary then gives Logan a selection of helpful links to help lower his calories intake, and a few mental wellbeing sessions in his local area.

Happy with this months results, he checks outs the link to local wellbeing sessions and chooses to attend one on monday, he continues to eat dinner.

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Prototype Two Support networks for addicts and loved ones How could loved ones find the next step in helping their addicted loved one so that they could ease pressure on the public system?

The outcome for this prompt was a peer to peer sponsor program based around interactions between addicts and those who have been indirectly affected by addiction.

The premise of the service is to connect socially isolated addicts, with people who have lost contact with their own loved ones due to addiction.

This is to promote understanding between the two parties in hope that it will prompt them to re-invigorate past relationships which have been lost through addiction.

Targeted towards loved ones of addicts, as well as addicts themselves, a mother who has lost contact with her son who is an addict, could be connected with an addict who has isolated himself from his family situation. They console one-another in hope of reaching an understanding of the other party’s situation, creating support networks and lasting friendships in the meantime.

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The prototype This prompt took shape in the form of a website where users can sign up to have contact with one another to provide support. The site explained the workings of the system, download links, as well as user testimonies to entice new users.

Scan QR code for prototype

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Validation Customer Journey maps and User case scenarios allowed me to monitor the emotions of a persona as they make their way through the service touchpoints. The emotional status of the user is rather low throughout the majority of the service delivery stages, this would not be great for user retention, as they have to overcome bouts of reluctance, awkwardness and skepticism in order to actively participate in the service.

Having spoken to an outreach worker, we discussed the need for empathy in services regarding addicts. This service lacks an emphatic aspect, as people who have only been indirectly affected by addiction would not understand the situation of someone who is going through the illness themselves. This would be quite a barrier for many addicts. In addition to this, stigma plays a role in people not wanting to associate with addicts, and having to overcome the emotional and social barriers for those indirectly affected by addiction is not the focus of the project, and so this intervention lacks a level of specificity to the project scope.

User Journey Map

Stage

Awareness

Investigate

Search Engine Optimisation Touch Points

SM Presence

Website

Targeted Marketing What is the user doing?

On internet, SEO has triggered advertisment

Weighing up the pros and cons of committing

What is the user thinking

Moment of desperation, this could be their break

I miss my friends/family, maybe I can try this again, with new people

Pain Points

User must be willing to take part, AD must entice

Addict may be reluctant

Commit

Service Delivery

Application

Application

Web Login

Web Login

Downloads Application or logs in on website. makes account

Matched with person affected by addiction through criteria.

Similar interests

Service Delivery

Retention

Application

Internal

Web Login

Face to Face

Face to Face

Conversation evolves help eachother to understand. Bond created

Continues friendship, begins to reflect on personal relationships

Nervous, meeting new people who might not understand

Nervous, conversation may be stale at first

“Wow shes really making an effort, it may have been hard for her”

“Its been a while, maybe i should call Mum, tell her im ok”

What if users on the other side dont understand, people would be reluctant

Users may not be able to break through barrier of awkwardness

Users may opt out before this point due to nerves.

Good chance this would not happen in majority

Begin use, Conversing

New friendship, meet up

Moment of truth

Action

Emotional Status

Research, casual Internet usage

Decision making, why would they want to people non addicts just wanting to understand?

Commitment, Users make account and fill in criteria forms

End goal to reconnect with loved ones lost for support

85

Day in the Life

Logan spends the day at work stressed. Hes fatigued from the party he went to last night, he used a little more than usual.

Kelly asks if Logan has spoken to his mother. He tells her hes organised to meet with her on saturday, Kelly gives some advice on how to handle it.

On his lunch break he opens his phone and messages Kelly. He met her through the service, shes a little older and has a son thats in a similar position to Logan

They speak for about 20 minutes, she helps to calm him down, and they organise to grab a coffee after work.

Logan Meets with Kelly. Kelly tells how she met with her son, for the first time in months, Logan gives advice on how her son might be feeling.

Kelly sends Logan a meeting request, with location and time notifications.

Logan accepts the invite.

Together they are eachothers support system. Helping one another to understand how the other may be feeling, to help them reconnect with loved ones theyve lost contact with.

Kelly buys them both dinner and the spend the rest of the night talking about their weeks.

86

Prototype Three A peer to peer support network for addicts How can recovering addicts, provide advice to those currently suffering from addiction, in order to promote access to support networks for addicts?

The idea I had chosen to pursue for this prompt was a Peer to Peer mentor network which put current addicts in touch with recovered addicts in order to provide a supportive and empathic network of support for those suffering from addiction. Similar to current networks within AA and NA which utilise Sponsors and Sponsees in a mentor-like capacity, however, the systems main focus, was to match participants based on their interests outside from addiction. Users would have a basic yet anonymous profile and would be connected with those who have similar interests to remove the focus of the conversation from addiction.

Initially this particular solution was to target those who have been socially isolated, as well as geographically isolated. However, validation was vital in further segmenting the system towards those who do not wish to attend AA/NA due to philosophical or administrative

differences (including spiritual connotations and methods used within the program).

A novel aspect of the approach would be that the system would be situated digitally as a way for people to connect anonymously and without discrimination, as well as connect with those who are geographically isolated.

87

The prototype The prototype was created using Marvel, an online wireframing toolkit. It was an extremely low fidelity mock-up which included chatroom functions, user profiles, as well as an information centre for addicts and family members on possible avenues of recovery etc.

Scan QR code for prototype

88

Validation This particular prototype was pitched to an online community of recovering addicts on Reddit (note that the prototype itself was not shown, the idea was only explained in writing to evoke interpretation and feedback Appendix 5), and was received quite well. Users gave feedback on possible ideas for further segmentation, as well as well as points which needed further development, for example; I had initially wanted to use recovered addicts, vetted through AA/NA programs to be mentors, users on reddit alluded to this not being possible, and that merit alone would have to suffice.

own tailored programs. Contact with an outreach worker also validated the need for empathy in dealing with addicts as opposed to sympathy, and the need for mentor like figures within the community is often vital in giving addicts hope in times of need, as they have someone that they can relate to.

“4 years or so ago, I might have tapped on an app just to see what some person recovering from heroin addiction had to say” “I think it could be an extraordinary supplement, another valuable tool for alcoholics and addicts. :)” The initial research phase completed within the first half of the project also helped to inform me on whether the service was viable or not. The Peer to Peer mentor system has been proven to be effective through AA and NA, and has become adopted by many private facilities within their

Stage

Awareness

User Journey Map

Investigate

Commit

Service Delivery

Website

Download

Application

Website Touch Points

Flyer Social Ad

GooglePlay/ Appstore

GooglePlay/ Appstore

Website

Service Delivery

Retention

Application

Application

Website

Website

Face to Face

Face to Face

Word of Mouth What is the user doing?

Researching possible avenues of help

Weighing up the pros and cons of committing

Downloads the application/logs in on website, registers interests

Talking to like minded people, empathetic

Ideally Meeting in person, events/ activities, establishing real relationsihips

Becoming a mentor to someone else

What is the user thinking

Uncertainty, Hit Rock Bottom, no way out

Willing to try, nothing to lose

I have nothing to lose, its anonymous

Its great to talk to people in similar situations with similar interests

I have someone to confide in and give advice

Ive come far enough to give back, I have support and now I can support others

Pain Points

No empathy for their circumstance

Skeptical at this stage

Skeptical at this stage

Still online, not very interpersonal

Research

Decision-making, do they want to meet similar people?

Commitment, Users make account and register their interests

Possibility to fall back into bad habits

Moment of truth

Action

Emotional Status

Talk to recovering addicts with similar interests, use these interests as talking points, learn of their stories

Meet, establishing long lasting relationships with a mentor-like figure

Eventually become a mentor, meet more people in a similar situation nd give back

89 Day in the Life Logan recieves a Notification from his Leap application, reminding him that the soccer game hes attending is starting soon at the park.

Logan is exhausted and bids farewell to his friends, on the ride home he feels like a pick-me-up, but reaches for his phone instead.

On his way he messages David, a friend he made through the service, to see if hes attending, he has work but will be at the next one

Logan asks lindsay if he would like to be a contact on leap, Lindsay agrees and so they connect online

He opens the share functions and sees a few new posts highlighted in blue, signalling amphetamine related users. He reads a few

Logan arrives at the park, the rest of the guys are getting ready by the goals, he joins them and meets a few new faces.

After the game they all go for Lunch, Logan talks to Lindsay about EPL, and they really hit it off

Deciding to chat to david, they talk about the game and a few other personal problems Logan has been going through, he feels much better now

Outcome Prototype 3 was chosen to be developed as it showed most promise of all the proposed interventions. It was the most likely to be adopted (given the known habits and lifestyles of addicts informed through design research) and was received well within the community of recovered addicts through Reddit. Practitioners also saw promise in the service, proving that it would be welcomed by the industry.

After developing the idea with the use of a customer journey map, several pain points were recognised as possible avenues for development, these will need to be addressed in the next stage of development.

- - -

-

-

How can we create empathy for a person’s circumstance at the awareness stage?

How can we overcome skepticism?

How can we promote interpersonal relationships and possibly incentivise aspects of face to face contact through a digital platform (how do we make digital wholesome)?

How do we mitigate the risk of recovered addicts falling back into addiction? (vetting system) How can we make this more segmented towards addicts?

90

Iteration Design development Peer to peer networks Peer to peer mentoring networks have been used within the field of addiction recovery for over 40 years105. The support of buddies (senior, often recovered addicts who are put in contact with recently sober addicts by health professionals) or sponsors (senior members of recovery communities who offer support to newcomer ‘sponsees’) is often integral in ensuring that those still suffering from addiction (on on their journey to reaching their recovery goal) are supported emotionally and practically throughout their recovery journey106.

The AA Questions and Answers on Sponsorship pamphlet defines a sponsor as ‘an alcoholic who has made some progress in the recovery program and shares that experience on a continuous, individual basis with another alcoholic who is attempting to attain or maintain sobriety through AA’107 . These sponsorship programs have been adopted by addiction treatment programs throughout the field. It allows sponsees to benefit from emotional and practical advice of an empathetic and knowledgeable individual, and sponsors to maintain their active involvement within the recovery community.

In 1998 a study into the use of peer to peer networks when attempting to quit smoking saw that 27% success rate in abstinence with a buddy, as opposed to 12% in those without a buddy108.

The peer to peer model is a proven and effective model of aiding recovery. Within the context of this project, I believe that leveraging digital services to deliver a peer to peer support network where users can interact on their own terms, with the option of anonymity, would be beneficial in overcoming aspects of social isolation through the creation of a network of empathetic individuals, with similar interests and experiences.

91

92

Second Iteration The second prototype saw a more refined application with multiple functions outlined below. In addition to this, to promote access on all devices, a website counterpart would also be created with identical functionality.

Profile

Share

Users need to create an account in order to take advantage of the application, but can choose to remain anonymous with the minimum input of a username and password, as well as the type of substances they are abusing/have abused (ie: opioids).

The app would have empty fields for an individual’s interests, which would help match them with people with similar interests.

This is a digital wall where users can post short thoughts, stories, experiences or even advice. It can be about anything, but the idea behind this function is to allow those currently suffering from addiction to see the point of view of someone who has been in a similar situation, without having to make direct contact. The colour of each post will communicate the type of addiction the user who is posting is dealing with/has dealt with.

Community This function was an events page where users can post meetups or events. It is localised and users are able to attend or upvote the event to ensure that similar, popular events are held in the future. Users can post events like sporting groups, meditation sessions, etc.

Contacts The contact tab allows users to create a list of contacts with people that they have connected with through the chat function. They can continue chatting, view their contacts, and even their profiles through this function.

Chat The primary function of this application. The chat function instantly connects you with another user to chat with. If you are currently suffering from addiction, you will be connected with a recovering addict with similar interests (based on metadata from your profile) and vice versa.

93

Share

Community

Profile

Chat

94 Web Homepage

Web Menu

95

Challenges Asking users to download an application, create an account and enter details in order to access the application function is quite counter intuitive when the purpose of the application is to reduce these steps to make it easy and commitmentfree to access these services. I will need to look at refining these steps or even removing the login process completely.

Another challenge arises in the possibility that certain users could take advantage of the platform to create a space for propagating drug use. This is a true concern as it could reap harm on those in a very vulnerable situation. A level of moderation will have to be employed to ensure that conversations stay on topic, however this will be difficult to monitor in private chats between users, as we would not want to compromise a user’s right to privacy.

Scan QR code for prototype

96

Third Iteration The third prototype saw the platform shift from an application to a website.

Using responsive web design, the website can be viewed on any device in a resized form-factor.

Forum:

Profile:

The forum style sharing platform allows users to comment, reply and vote each others posts in order to keep the thread alive with opinion and experience. This function combines the private chat and ‘share’ function of the previous prototype to make conversations public and accessible by all users, promoting a user-moderated environment with minimal external moderation.

Issues with users having to engage in too many steps before accessing the functions of the service have meant that the user profiles had to chance from the last prototype

Community: Events organised by users to meet other users face to face can be created on the community page.

These events focus on getting users out of the digital space and into positive, real world environments with a focus on recovery, as well as other interests.

Users can now enter and browse the site as ‘guests’. As a guest user, they can browse the forums and comments, however cannot interact unless they make an account.

When making an account, users are asked to establish one recovery goal which is publicly viewable on their profile. Additionally they are required to enter login details (username and password) as well as define a few of their interests. This metadata is then used to filter results and forum posts which may be more relevant to their situation.

Subscriptions/care package: Once a user makes a profile they are automatically subscribed to mailing list with updates on local events, events of interest, recovery options/ placements etc. This may be difficult to execute in the first phase of the services launch, and may be delivered as part of an ongoing scaling plan

Emotional Status

Action

Selects enter as guest

Cant get full functionality as guest

Possible target market is younger and less prone to undertake

Pain Points

Prompted to try something out of their comfort zone

Happy to browse anonymously as a guest user

They see anonymous program for little effort, maybe worth their while

What is the user thinking

Moment of truth

Tossing up pros and cons of joining

Website

Investigate

Possibly visiting GP, Collecting mail, Checking SM

Social Media Presence

Desk Display at GP

Targeted Mailouts

Awareness

What is the user doing?

Touch Points

Stage

User Journey Map

Exploring functionality

Sees how simple and commitment free the service is

Tossing up pros and cons of joining full time

Website

Commit

Exploring functionality, reading posts

Feels good to see there are people in a similar place

Reads through posts users have shared

Website

Service Delivery

Creating free account, setting recovery goal

Wanting to take full advantage (post etc.)

Sets up profile with more details, username/interests

Website

Service Delivery

Subscribing to mailing list

Doesnt want spam or constant annoying emails

This is a good way to know how to get more info

Automatically Subscribed to targeted emailing

Website

Targeted Emails

Service Delivery

Attending event

Perhaps skeptical to go and meet people

I can find some help or make friends

Attends an event held in his area to meet others

Face to Face

Service Delivery

Attending event

Perhaps skeptical to out themselves

I can find out how to help my situation

Attends Sponsored recovery events

Face to Face

Service Delivery

Active in Community

Possibility to fall back into bad habits

Active in Recovery

Wont take advantage of the information

I still have options to explore, tailored to me

Still Recieving Updates on recovery options

Becomes active participant in recovery community I can help others by sharing my own experience

Face to Face

Website

Targeted Emails

Retention

Face to Face

Website

Targeted Emails

Retention

97

98

Challenges In a bid to possibly release a functional service, certain features may need to be cut from the service in order to launch a minimum viable product. These services may be launched later one as part of a scaling timeline once user retention and engagement is achieved. This will be an iterative design which is constantly evolving through use, and so constant updates to features and functions will be necessary to accommodate the growth and use of the website.

The site will be primarily user moderated, however, there is still a chance that certain unwanted behaviour may still take place on the forums (people making fake accounts, harassing users etc). A backstage moderating plan must be put into place in order to protect the best interests of the users and preserve the integrity of the service.

Getting users to take an oath may be relevant in ensuring that members are aware of everyone’s reasoning for being a part of this community.

Perhaps having an understanding that others have similarly taken the same oath, the community comes across as more legitimate, breaking down the barrier of skepticism.

Getting the service in front of users still presents a challenge.

During the awareness phase, we are relying almost solely on search engine optimisation for results. To accompany this, I believe that an advertisement campaign may be necessary. Video and print media will have to be considered to maximise the intake of the program.

Asking users to define a recovery goal is an excellent way of ensuring that they connect with individuals that share similar goals or have experience in achieving these goals, but it does not help to identify the underlying issues which stop them from achieving these goals. Perhaps it would be far more effective to ask users to define a recovery goal, and then ask them to identify what is stopping them from achieving this goal. Perhaps this would assist them in realising which aspects of their addiction to focus on in order to reach their goal.

At this stage, the service simply acts alone, as a stepping stone to recovery.

Through assisting people suffering from addiction to create supportive networks, the service assists in giving addicts the support to make a leap to recovery, however, no aspect of the service is linked to recovery services.

Some sort of link to additional services should be made available to addicts if they wish to make the next step.

99

100

101

Conclusion

102

Outcomes The final design intervention Informed by an immersive research component, and refined through an iterative design process, the following deliverables reflect the findings of this design inquisition, culminating in a digital service design intervention. Along with accompanying collateral, to further contextualise and communicate the barrier of entry to addiction recovery services which is, social isolation, as well as the proposed design solution, the following pieces are outcomes of this project.

103

Website

Users led to Responsive website homepage, viewable on any device

Awareness

Users targeted by Search Engine Optimisation triggered by keyword use on social media/searches, Accompanying Video Advertisement Campaign, Posters advertised through community noticeboards

Touchpoints

Metadata

Choose up to 3 interests and enter a recovery goal’ users also asked to define substance(s) they are/have abused.

Metadata used to deliver user-specific content

Security

Choose basic login and security details.

Password/Username are chosen during this phase

Profile Setup

Take the Oath. A decleration of respect and understanding that all users are here for support and recovery

Oath

Logged In

View Only

Once users have setup their profile, they’re immediately logged in, allowing them to explore and utilise the websites functions to full capacity

Users can enter the forums and browse as guest users, no usernames or passwords necessary, completely anonymous with minimal commitment. This is a read only view

Guest User

Post

Users are able to post their own events at any time.

These are internally moderated before going live

Attend

Users can choose to attend by submitting their RSVP via the event page. They can also upvote events to push their popularity

Events that are organised by users, for users. This is where like-minded people with similar interests and a focus on recovery and support and meet face-to-face

Users can comment on another users post, as well as post their own stories to the boards. These vary from interests (eg. photography/sport), to recovery specific posts

Users post to different ‘boards’ within the forums, both related and unrelated to addiction. Posts are highlighted with the type of substance the user has/is struggling to overcome

Events

Post

Users post of their experiences, tips and knowledge regarding their recovery and journey through addiction

Explore

Forums

Options to move forward to recovery are constantly present on the homepage with links to Directline and other services. When users feel ready to make the leap beyond the service, the options are available

To Recovery...

104

Support Processes

Line of Internal Interaction

Back stage Interactions

Line of Visibility

Front of stage Interactions

Line of Interaction

User Actions

Physical Evidence

Service Blueprint

Print Posters, Create social media presence and embed SEO through API’s

Make sure community noticeboards have posters.

Social media presence and Advertisement accounts are paid and appropriately linked

Browses as guest user

Guest User

Host site on dependable platform, buy up additional bandwidth as buffer

Website hosting payments are made, enough bandwidth is allocated to cater for web traffic.

Browsing website at own will

Is sent to the website/service

Becomes aware of the service

SM advertisements S.E.O Noticeboad Posters

Website

Awareness

Immediately logged in

Logged In

Users details are linked with a username and password which allow access to the websites functions and settings

Webdesigner to create website utilising metadata collected from user profiles

Metadata collected is displayed on users profile page and is used to deliver user-specific content

Enters necessary security and metadata information

Sets up user profile

Profile Setup

Posted events are moderated by internal administrator, when approved they go live

Interacts with events pages, post their own events and attend

Interacts/attends events

Events

Internal admin working part time in order to maintain site

Website hosting payments made, enough bandwidth is allocated to cater for traffic.

Reports made against users investigated by internal moderator

Reads stories and experiences and posts on forums

Browses/interacts on forums

Forums

External links send user to another websites

Interacts with additional help links, taken to other sites

Seeks out additional recovery options

Beyond

105

Developing Costs

Server costs

Recoup only the costs necessary to run the model (Non for profit)

Cost Structure

Recovering addiction communities

General Practitioners

Consumer Groups

Department of Health

Regulatory Bodies

Key Partners

Business Model Canvas

Angel Investment

Fund-Raising

Government Grants

Lisencing Costs

Recovering addicts wishing to make a difference

Socially isolated individuals suffering from addiction

Customer Segments

Volunteer work

Brochures at clinics and G.P’s

Targetted Marketing (E.D.M)

S.E.O

Channels

Face to face

Digital

Industry Partnerships

Volunteers

Customer Relationships

Philanthropy

Revenue Streams

A peer mentoring system for those who are socially isolated

Creating support networks around people suffering from addiction by connecting them with recovering addicts who have empathy for their situation

Value Propositions

Marketing Costs

Mentors/Mentees

Regulatory Lisences

Administrative staff

Servers

Developers

Key Resources

Peer Mentoring

Connecting addicts with recovering addicts

Key Activities

106

People can share stories and moments of weakness

Matches people based on interests other than addiction / recovery

Events for addict/rec. addicts only

Digitally connects recovered addicts and current addicts

Features

A place to seek advice from people who have had experience

Judgement free community

Provides Empathetic environment

Brings likeminded people together

Non-discriminatory environment

Empathetic community values

Easily be accepted by others

Meet new likeminded people

Find new interests

Things DO get better

Feel like there are others out there just like you

To reduce use

Discrimination/ Stigma

Fears

Stabilise mental health factors

Other aspects of livelihood Access to advice

Skepticism Fear of relapse for mentors

Fear of criminal sanctions

Misunderstanding

Ongoing loneliness through failure

Social Re-invigoration

Local support network

Needs

Livelihood

Empathy

Anonymity Will not attend AA/NA

Recovery options

Understanding

Companionship

Wants

Benefits

Experience

Customer

Service

Value Proposition Canvas

107

108 Campaign Video

Scan QR code for Video

Website Prototype

Scan QR code for Prototype

109 Scaling Plan

Rollout Australia Wide

18 Months

Rollout Subscription / News service

Initial rollout of events function in Victoria

12 Months

Begin Evaluation plan with metadata gathered

Focus on retention of initial users

6 Months

Fundraising / Meet & greet events held by Admin

Establishment of business admin / moderators

Initial Rollout of forum

Establish business model - Non for proďŹ t

Campaigning recovery centres for initial cohort Finalise Webdesign, launch ready website

Fundraising - Investment and philanthropy

Engage stakeholders/consumers - ďŹ nal validation

3 Months

110

Community Noticeboard Posters

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Visit Same.com.au or scan the QR code

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112 ease, speaking to practitioners and professionals with a relative understanding of their field with respect and empathy for their practice.

Interviews

Reflection Key insights and deviations My desire to work within design and health stemmed from a longstanding interest in service design, as well as social impact within the services industry. I truly believe that as designers, we are gifted with a set of unique skills which enable us to tackle issues with a renewed and informed perspective. Why don’t we use this skillset in order to tackle some of the problems that we face on a societal level? Instead of designing products and services which contribute to an unsustainable practices in landfill and consumerism, we should be designing with users, for users, in order to contribute to solutions which empower us all to make a greater change to society.

Having experienced an instance of addiction within my own family, my own experience propelled me to look at the industry objectively, realising that it is riddled with ethical conundrums, industrywide challenges and user level inadequacies; it was the perfect jumping off point for a project within the health sector.

The networks I had created through this industry experience enabled me to gather information with

Possibly the greatest insights I received were my Interviews with practitioners from Malvern Private clinic, Raymond Hader clinic, and Stepping Up Consortium.

The practitioners in question were extremely thorough in communicating the challenges they faced within the industry, scope for design intervention, as well as their enthusiasm for the project. Their insights were critical in creating an initial understanding of the structure of the field, controversies and developments within the industry, which I used as reference whilst analysing case studies and engaging users in an effort to confirm these beliefs.

The ongoing communication with these stakeholders has been key in cross-referencing new information as it is discovered, as well as reviewing the direction of the project through an industry scope.

User Journey Map Using insights from my desktop research and interviews, I created a flowchart which depicted the journey of an addict through recovery. This chart was key in assisting me to identify where the system was falling short. I found myself constantly referring back to it throughout the research phase, updating it, reconfiguring it as the project progressed. The end result was a comprehensive visual representation of the field, the relationships between stakeholders, as well as the challenges faced by these stakeholders.

Having this visual representation gave me an artifact which could be scrutinised time and time again.

A valuable canvas which was ever evolving and constantly informing multiple aspects of the project.

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Case Study Analysis

Triangulation

During the Desktop research phase, I was beginning to realise that the practitioners and stakeholders were more concerned with macro level change (law reform, funding etc.), however, many of the case studies I was researching were discussing micro level change (user level change).

As soon as the project was beginning to gain momentum, I was faced with an issue which threatened to bring much of the critical research to a halt. It was brought to my attention that the project may not pass ethics approval due to the embedded risks synonymous with the field of research. This essentially meant that I would be unable to talk to ground level users (addicts or recovering addicts) directly. Unfortunately this meant that I would not be able to gain insights from those whom this project is targeted to. I had my heart set on an informed and co-designed intervention, however this was now threatened.

These findings caused me to second guess my efforts in tackling macro level change, as I felt that this was beginning to fall outside of the scope of the project. After discussions with my supervising group, as well as insights gathered from users, I was able to determine that in order to achieve macro level change, we must first address micro level issues. Flow on effects and feedback loops can later be utilised to propagate macro level change, but for now it would be important to focus on the challenges faced by ground level users in order to address concerns surrounding primary service inadequacies, in order to assess their effects on industry wide macro level change, and then work towards these changes accordingly.

Stakeholder Updates In a bid to keep my stakeholders engaged throughout the research process, I sent out a research update regarding the direction of the project, as well as the work which has been completed up to that point in the project. The feedback I received was quite assuring. It seemed that many of the insights that I had gathered through my research were beginning to be confirmed by stakeholders. The directions they proposed were in the same vein as my own; it was relieving to know that we were on the same page.

These updates also gave my stakeholders an opportunity to scrutinise some of the aspects of my research, with many changes being made to the industry journey map to include information which had been missed.

My salvation came in the form of a Reddit thread which I encountered during my own personal experience with addiction. The REDDITORSINRECOVERY subReddit was essential in my understanding of addiction as I navigated my own journey. As Reddit is an open forum where users are able to comment at their own discretion, I was able to gain user insights by engaging this online community indirectly. The insights I gained allowed me to continue my research unaffected by the hurdles of ethics approval.

Though it would have been valuable to have spoken to recovering addicts directly, I am happy to have had the ability to engage this online community, and will continue to do so throughout the ideation phase.

The open book of social innovation One of the most important resources in defining my methods of research, design and evaluation was NESTA’s ‘The Open book of Social Innovation�.

This resource detailed many techniques and methodologies which were not necessarily design focussed, but focussed on the ideologies of Social Impact, and how to gain informed insights for purpose as opposed to profit. This resource was indispensable to me throughout the entire project.

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Ongoing Research I was beginning to reach a point in my research where I had gathered enough information in order to begin collating my thesis, however I kept coming across additional case studies, opinions, methodologies and theories which kept postponing my progress. At some points throughout this process I began to question my findings, as I would find theories which speak both for and against some of my findings. I was soon confronted with an ultimatum, to cease my research and begin writing my thesis, or continue to delve into the never ending sea of findings. I decided to work with the information I had, and would seek out additional research as needed.

However, the time that I had taken to reach this realisation meant that I had spent far too long seeking out the information needed to collate my thesis, as opposed to refining the piece itself.

Media Though they did not inform the project greatly, immersing myself within the context of health and addiction services through media (documentaries, movies, news stories etc) assisted me in creating a deeper personal understanding of how addiction is depicted and consumed by the public.

With movies such as Darren Aronofsky’s ‘Requiem for a Dream’ using the medium of cinema to communicate that addiction can happen to anyone. Russell Brand’s own documentary ‘From Addiction to Recovery” took a hardline approach on abstinence, which is reflected by many practitioners, promoting this bias in the public eye. Some other videos such as ‘The Oasis’ by Shark Island productions deployed an unbiased story-telling approach to the issue of homeless youth in Sydney. Consuming such media not only propelled me to do better work as i was able to recognise that this issue is certainly real, but also gave me a reason to ensure that my research remain unbiased, yet easily consumable, mitigating the risk of misinformed design through confirmation bias.

Snook Visit Sarah Drummond from Snook came to visit the university as part of a studio on digital service delivery. I had the pleasure of sitting in on one of her classes in which they invited several stakeholders within the mental health industry, as well as digital service providers. She also gave a public presentation on the importance of informed and wholesome digital services at RMIT. As I am working within design and health this was an excellent insight into the some of the implementations of Digital service delivery, as well as service design within a similar scope.

Digital service delivery is a key theme moving forward in my project; being able to hear stakeholder feedback regarding the needs and inadequacies of current solutions was helpful in framing the challenges faced by professionals when attempting to develop digital services which can offer the same empathy that face to face services boast.

Personas/focusing down the research My personas, after my research phase, stood at 5 archetypes. 3 addicts, and 2 concerned loved ones.

I couldn’t help but feel that this may have been too many, and that the project needs to be more focussed on a narrowed target market. Choosing to focus on either addicts, or loved ones could prove to be more valuable than to target both user groups, this is something that I had to consider when creating my final target segment.

Similarly, there are also an overwhelming amount of social and emotional barriers of entry; narrowing the focus of the project to a particular barrier of entry took quite some deliberating.

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Convergent Thinking As I began consolidating the thesis, It was brought to my attention that much of my data was far too broad and not addiction focussed. For example, I would quote statistics related to the effects of alcohol and drug abuse in general, but make no reference to numbers which pertained to addiction solely. I found myself speaking broadly concerning these issues on a global scale, I was missing information from my direct context, Melbourne.

This was a outcome of my convergent thinking process, I had failed to communicate the information that was important, and was simply communicating as much information as I could in order to show the amount of knowledge I had accumulated on the subject. It was only after supervisor review that I began to remedy this.

Meeting with an outreach worker A major turning point in the project was meeting with an outreach worker, who visits people suffering from addiction in their homes and attempts to work through their issues with them. My conversation with her focussed on a gripe of many social workers, who feel that they cannot connect with their clients, as they lack the personal experience of addiction, and cannot relate on an interpersonal level. Many of them attempt to get their clients in touch with recovered ‘buddies’ who have empathy for their situation, this is where my interest in the peer to peer network began.

We spoke of issues surrounding support networks and it was found that social isolation was a major factor in a person’s hopelessness when it comes to their recovery, prompting the re-focussed project direction towards tackling social isolation in addicts.

Not knowing the outcome One of the major obstacles I faced whilst writing this thesis was the fact that I was unaware of the outcome of the design intervention whilst writing the bulk of the material. Writing about methods of design evaluation without knowing what you’re evaluating makes for a difficult piece of writing, because of this phenomena, I had to go through several drafts and iterations of the thesis before it reached its final form.

Designers vs. Industry: Validation Keeping in contact with my stakeholders ensured that the project stayed grounded within the industry.

I had many doubts throughout the process of iteration, as I was anchoring my work within the school of design, I would often question the usefulness of my solutions, as I was seeking commentary from design professionals.

After meeting with my stakeholders and showing them the progress made through iteration, I found that some of my initial ideas (such as the community page where addicts can meet each other face to face, which was cast aside due to feedback given by design panel) actually held value within the industry. These industry professionals saw value where design professionals could not overcome bias about the sector.

I learnt to respect the concerns of design professionals whilst understanding that the final validation must be based within industry in order to gauge the success of such an intervention. The relationships I had created with these industry professionals proved vital in substantiating my design outcomes, just as the understanding of design professionals helped to substantiate my design process.

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118 Addiction “A primary, chronic disease of brain reward, motivation, memory and related circuitry. Dysfunction in these circuits leads to characteristic biological, psychological, social and spiritual manifestations. This is reflected in an individual pathologically pursuing reward and/or relief by substance use and other behaviors.” - ASAM114 Chronic Illness “a group of diseases that tend to be long lasting and have persistent effects.” AIHW115 Controlled Substances

Glossary Problem Drug Users “A service user who may be homeless, engaging in crime, experiencing health and social problems and living a ‘Chaotic’ lifestyle peripheral to social norms”(as a result of their drug use)- Hubley and Palepu 109 Micro-level Small Scale interactions/processes between individuals/parties 110 Macro-level Large scale social processes and interactions pertaining to industry/ enterprise context111 Social Innovation A novel solution or approach which is socially sustainable, more efficient than a current application 112 Participatory Design “The active involvement of potential or current end-users of a system in the design and decision-making processes”Stanford University113

“Controlled substances are drugs that are regulated by state and federal laws that aim to control the danger of addiction, abuse, physical and mental harm {...} Such drugs may be declared illegal for sale or use, but may be dispensed under a physician’s prescription.” - US Legal116 Co-Morbid “The co-occurrence of two or more mental health problems” - Louisa Degenhardt117 Recovery “Recovery is a complex and dynamic process encompassing all the positive benefits to physical, mental and social health that can happen when people with an addiction to alcohol or drugs, or their family members, get the help they need.” NCADD118 Alcoholics Anonymous Fellowships of recovering addicts who share their experience and journeys in group environments in order to support and assist each other recover. Focussed on addiction to alcohol119 Narcotics anonymous Fellowships of recovering addicts who share their experience and journeys in group environments in order to support and assist each other recover Focussed on addiction to narcotics.120 12 step model A Method of addiction recovery developed

by Alcoholics Anonymous which helps addicts to “stay sober and help other alcoholics to achieve sobriety without judgment or segregation” - Addiction. com121

119 Harm minimisation

Private Institutions

“Harm minimisation aims to address alcohol and other drug issues by reducing the harmful effects of alcohol and other drugs on individuals and society. Harm minimisation considers the health, social and economic consequences of AOD use on both the individual and the community as a whole.” - Department of Health122

“The private sector encompasses all forprofit businesses that are not owned or operated by the government.” Investopedia128

Methadone Maintenance “A comprehensive treatment program that involves the long-term prescribing of methadone as an alternative to the opioid on which the client was dependent.

Central to MMT is the provision of counselling, case management and other medical and psychosocial services.” Portico123 Cognitive Behavioural Therapy “A collaborative and individualised program that helps individuals to identify unhelpful thoughts and behaviours and learn or relearn healthier skills and habits.” - AACBT124 Person-centered care “Person-centred care is a way of thinking and doing things that sees the people using health and social services as equal partners in planning, developing and monitoring care to make sure it meets their needs. This means putting people and their families at the centre of decisions and seeing them as experts, working alongside professionals to get the best outcome.” - Health Innovation Network125 Detox Program “A period when you stop taking unhealthy or harmful foods, drinks, or drugs into your body for a period of time, in order to improve your health” (in this case a program where the main aim is to detox) - Cambridge Dictionary126 Public Institutions “The term ‘public sector’ refers broadly to the entities that exist and people employed for public purpose. The public sector supports all three arms of government - the ‘executive’ arm (the Government of the day), the ‘legislature’ (Parliament) and the ‘judiciary’ (judges of the various courts). {...}” - Public Sector Commission WA127

Peer Support Programs “Peer support is a system of giving and receiving help founded on key principles of respect, shared responsibility, and mutual agreement of what is helpful.” - Intentional Peer Support129 Therapeutic Communities, “A treatment facility in which the community itself, through self-help and mutual support, is the principal means for promoting personal change”- ATCA130 Stigma “A set of negative and often unfair beliefs that a society or group of people have about something” (or in this case someone) - Merriam-Webster131 Behaviour change “A research-based consultative process for addressing knowledge, attitudes and practices. It provides relevant information and motivation through well-defined strategies, using a mix of media channels and participatory methods. Behaviour change strategies focus on the individual as a locus of change.” - UNICEF132 Service Prototype “A tool for testing the service by observing the interaction of the user with a prototype of the service put in the place, situation and condition where the service will actually exist.” - Service Design Tools133 Abstinence “Not doing something, such as drinking alcohol or having sex” - Cambridge Dictionary134 “World Drug Report - United Nations Office on Drugs and Crime.”

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Appendices

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