Avoid the Conformity Trap.

Most people agree that our systems are broken. Yet we too often fall into conformity traps that impede our abilities to respond to change and fix what no longer works. We fear failure. We try to fit in. We give into cynicism. Not surprisingly, things stay the same even when most of us do little more than talk about broken systems that need to change.

Take the opioid addiction crisis in America. Today, between 2 and 4 million Americans struggle with opioid addiction, a tragedy impacting families and communities for generations. America’s approach to addiction treatment is held hostage to an overly complex health care industry grounded in shame and punishment, fueled by revenues, focused on short-term treatment rather than longer-term accompaniment.

Discarded syringes used for injecting drugs in downtown Portland (Photo: Rian Dundon, Magnum Foundation)

Enter Stephanie Strong, the founder of Boulder Care, a health care company that conforms neither to the accepted practice of 28-day rehabilitation centers nor the requirement of place-based centers that expect individuals to show up daily for treatment. Stephanie’s story is personal, based on her own understanding of how isolating our broken health care system can be. Her story is one of deep empathy and of using technology simply to solve a complex problem. And her story is one of timing – the pandemic accelerated government policies allowing for the use of digital health care even in the dark corner of the health care world, opioid addiction.

Stephanie based Boulder Care’s model on three insights that stood in juxtaposition to established norms. 

First, Stephanie converted a place-based model to a technology-driven approach to address the fact that more than 80% of communities in the United States lack treatment facilities. Moreover, Stephanie says, “addiction centers are almost always in a really inconvenient and unsafe part of town, because of (community) pushback.” In bypassing the need for physical centers, Boulder Care solves multiple problems. Individuals can avoid feeling ashamed when standing in line at treatment centers. They avoid the expense of time and money needed to travel for treatment and can meet with counselors online when their children are at school or after the workday has ended. In all of this, dignity is preserved.

Boulder Care CEO Stephanie Strong (right) outside a company meeting at their downtown Portland offices (Photo: Rian Dundon, Magnum Foundation)

Second, Stephanie pushes back on the 28-day in person rehabilitation programs: “I think reframing addiction as a chronic condition is so helpful... There's a 5% success rate in (28-day programs), but how heartening to know that with medication and evidence based support… their chances of success increase to 85%.” Stephanie believes in data and evidence — and she uses both to convince wary individuals of her evidence-based approach.

Third, Stephanie insists on accompanying the people Boulder Care serves. She knows what it feels like to have a health crisis and feel completely vulnerable in a byzantine health system. “I had a cancer diagnosis when I was a teenager and just became immediately the most fragile,” she says. “For people with addictive disease… when the system is supposed to be lifting them up, instead [it] is often kicking them down.”

The U.S. health care system is riddled with barriers that make it difficult for individuals to overcome addiction. In Boulder Care’s case, technology has been a humanizing force, enabling the company’s team based care model to help its patients flourish. At Boulder Care, a dedicated team of three is assigned to each patient: a prescribing clinician, a care advocate, and a peer recovery coach. “These teams are built to address all the clinical and non-clinical barriers and really help for longitudinal care. Get people anything they need, so they can focus on their well-being in their recovery goals. And all of this is available through our platform, as a mobile app for patients, where they can do visits over telehealth video or secure messaging.” They are accompanied by their peer counselors who themselves have suffered addiction and know the courage and grit it takes to overcome it.

Justin Schumacher, a peer recovery counselor with Boulder Care, at his home office where he coaches clients undergoing addiction treatment (Photo: Rian Dundon, Magnum Foundation)

Stephanie shared the story of a 60-year-old patient from a remote town in Washington who came to Boulder Care during the pandemic. The man had lost his brother to police violence and been treated for intravenous heroin use. After a year with Boulder Care, one of the clinicians reached out to him to ask when he had last used heroin. The man responded: “Well, that’s easy. Actually it was the day that I found you guys.”

During the pandemic, Acumen provided Boulder Care with two emergency grants. A $150,000 grant enabled Boulder Care to work with the most vulnerable people in the Pacific Northwest, including many who lost everything they owned during last year’s fires.

The second, a $60,000 grant, has been used to help Boulder Care pilot a program for patients within the criminal justice system. In the U.S., incarcerated people often are released late at night in places where the only people who show up to meet them are drug dealers. Boulder Care is experimenting with a different model, one that truly accompanies people, expecting them to do the hard work, yet being disciplined in supporting them to do so.

While impressive, you might still ask whether a private company isn’t just creating another profit-oriented approach to a problem that should be solved by government. Here again, Stephanie is a nonconformist who sees the world with moral imagination, a lens that rejects either-or notions and instead creates new fields of possibility. “I think the government can play a really important role in expanding access to health care services and in covering the cost of care. But realistically, there are strengths that startups have that governments or even large corporations don't.”

In being so close to the problem itself, this nonconforming yet entirely effective entrepreneur for a new economy is both hopeful and fiercely pragmatic about the kinds of policies needed to change the system for everyone. And she understands the balance between compassion and accountability. But Stephanie leans to encouragement in dealing with a problem that impacts people across every geography and socio-economic level. She believes we can beat the opioid crisis if we see potential in each other and build systems that help us tackle our dragons and find the beauty in ourselves.  

I have known many people who’ve suffered with addiction. It is a disease that is symptomatic of the brokenness in our communities and in ourselves, and it ultimately impacts all of us. As a new kind of leader, Stephanie Strong reminds us that we do not have to conform to accepted models. In fact, we cannot. Not if we are serious about solving our problems.

This is part six in Jacqueline Novogratz's monthly series on Moral Leadership, featuring a new generation of leaders for a new economy. The photos in this piece were created by Rian Dundon, a grantee of the Magnum Foundation, as part of a partnership to invite readers into the stories that are shaping our shared future.

About Acumen 

Acumen is changing the way the world tackles poverty by investing in companies, leaders and ideas. We invest patient capital in businesses whose products and services are enabling the poor to transform their lives. 

About Magnum Foundation

The Magnum Foundation is a nonprofit organization that expands creativity and diversity in documentary photography, activating new ideas through the innovative use of images. Through grant making and fellowships, the Magnum Foundation supports a global network of social justice and human rights-focused photographers, and experiments with new models for storytelling.