From Passion to Purpose: Manny Nsien's Journey to Revolutionize Recovery

Rich Bennett 0:00
Thanks for joining the conversation where we explore the stories and experiences that shape our world. I'm your host, Rich Bennett, joined by, of course, my lovely co-host, Wendy Beck. And we're thrilled to welcome Mandy Jensen, CEO of Ripple Ranch, a recovery and addiction treatment center in Texas, which I don't know why Wendy and I just didn't fly out there to Texas to record this. But I guess Ryan went with me. Yeah, when this was booked, I wasn't flying yet. And now, since I fly again, we'll have to do that. 

Manny Nsien 0:37
So you guys are going be welcome. Yeah, it's going well. Thank you for the introduction and I'm excited to be here. 

Rich Bennett 0:44
So right off the bat, I always like to find out a little bit about our guest. So before or before Ripple Ranch or any of that, what was it that you always wanted to do as far as a career? Yeah. So high school, everybody always has it set. 

Manny Nsien 1:02
Yeah. So I you know, my my father was was a gastroenterologist, so he was a doctor. And so I grew up working in his practice. And so even as a little kid, I used to, you know, help the patients out to clean the rooms and get their their rooms ready for the next patient. And I did what I could, and I just fell in love with the health field. And I think it's more about servitude. I really love giving back and just seeing people, you know, go from maybe not so good position and kind of, you know, heal and grow. And and so immediately going into school, you know, in my mind, you know, it was to be a doctor, you know, that that was just like the goal for me. Everything I did, you know, in schooling, all the extra curricular summer courses and whatnot, even my undergrad and and college was bio immunology and infectious diseases. So I really love science. And so then I got to a point where I think it was a my, my, my second the last year of college and I did a master's level, you know, I guess focus where it was in health care administration and there was a active health care administrator that was currently working in the space. And he, you know, did is an adjunct professor and really enlightened me to a whole side of health care, which is more of looking at how do you develop the teams to expand access to care, provide exceptional care, better understand the market and the population that you're able to serve. So it's more of a macro level. Instead of working with one patient one after another, it's more of like, how do we set up systems that can expand outreach, help more individuals and also improve overall quality of care. So idea of just pivoting and instead of going to med school route, I ended up going to get my master's in health administration from George Washington University. And I just the moment I started that, you know, master's program, I was like, this is where I want to be. And yeah, and then the rest is kind of history. 

Rich Bennett 3:09
That's a big difference from cleaning up the room where they were doing colonoscopies. Yeah, Yeah. 

Manny Nsien 3:16
Absolutely. 

Rich Bennett 3:17
So how how is it you got into the addiction field? 

Manny Nsien 3:21
You know, it was by chance, you know, I was, you know, I really wanted I had a laser focus on working in a hospital. You know, that that's kind of what you think of with the health administrator. And I worked in the in the E.R. and I had the exposure to, you know, hospitals. And I really thought that's where I wanted to go. And then I had a contact. I was I'm a member of the American College of Health Care Executives. And so, you know, through networking, I met, you know, an individual that was working in this space and kind of inviting me to an opportunity in health care. And it was, you know, good compensation for at that time getting out of college. And I was like, you know, I'll try it out. And I was really just taken aback because I didn't know about the substance use space. And so when I thought of health care, I thought of just like, you know, surgeries, emergencies, all of those things. But little did I know there's an entirely separate space, you know, because we don't look at mental health and substance use the same as medical, physical care. And so I was, you know, just jaw dropped at like how, number one, how many providers across the nation that were in the substance use mental health arena. But also, I was captivated by the fact that it wasn't as mature and structured as traditional hospitals. You know, this is during the time when they were starting to really push a joint commission accreditation car for accreditation. There was a lot of like passion operators where there would be mom and pops that didn't really know what they were doing on a business sense, but they knew their passion about getting in the space. And so I was like, Well, hey, I'm a pretty structured person. And if if I can look at this space and say, Hey, this is number one, it's needed, but it needs to have better organization, better accountability, better, you know, just continuity. I wanted to be a part of that. And so that's really why I stayed in it, because I was like, wow, you know, if I can just bring a little bit of, you know, passion and drive to, you know, develop a product that really is providing good care and is monitoring its effectiveness or or whatnot. That's what I wanted to be a part of. So and I ended up just falling in love with the space. I mean, there's so many people that were able to help every day, every month, every year, and it's just such a rewarding experience. 

Wendy Beck 5:44
What year was this when you started? 

Manny Nsien 5:46
What year to it would, I believe 2013. 

Wendy Beck 5:51
14. Yeah. So it really was it really was at the the ground level for addiction treatment because I like like I said, I started a nonprofit organization. And the reason that I did that in our area was because there was just not any services. So, you know, there were services, but there were there's not like it is today. So. Right. Can you tell us a little bit about the evolution from 2013 to today in that space that you have now? Kind of, I'm sure, restructured many times. 

Manny Nsien 6:24
Yeah. It's been 

wild. You know, because the space, like I said, was like I think there was a lot of good, you know, mom and pops that had personal connection to this, you know, to substance use. Right. They had a child. They had a personal experience or a family member or a loved one. And so they really wanted to give back. But then, you know, we started to see private equity, VC money, family offices that started to realize, well, after the parity expansion in 2008, which essentially allowed for, you know, equal coverage in a sense for mental health, you know, as the physical health side, there started to be a revenue opportunity for investor groups. And so, you know, I was I kind of got in during that period where there was a lot of money that was starting to pour into this space. You know, you had these very large organizations that were growing and acquiring facilities and really trying to expand, but they were acquiring so fast and they weren't really integrating, you know, they were just really measuring success based off of revenue at the time. And so it was an interesting case because you had people that weren't really doing potentially what was the best thing for the patient, you know, and and then it kind of hit this cliff and this cliff add probably, I would say 

2017, 2018, where there was a lot more accountability that was being required from the payer source for the insurance companies to basically say, well, we understand will reimburse for this care, but we want to make sure that you're actually providing okay care, like how are you measuring it? And that's where, you know, our you know, we started to see accrediting organizations be, you know, extremely pivotal and just leading to a maturation of how we operate it. You know, inpatient and outpatient organizations and make sure that we're not just running up the bill on patients and instead providing care and having meaningful, hopeful outcomes for the clients. And so, you know, I've seen now that the the money that's being poured in today in this space is really interested in organizations that are monitoring, you know, at least getting a good understanding of like what their outcomes are looking like, you know, where people are going to making sure that they're not just coming from all across the country to, you know, to a state that they they don't have any connection, no resources. And and they really want to look at how it can be more community based. And so I can tell you, for us, we wanted to be really intentional, that we didn't have a lot of people coming from Florida or coming from New York because what do we know about the resources when they go back home or when they have to go back home? And so, you know, I you know, I think the industry has now shifted to where can you, you know, on a localized basis, how can you make sure that when they leave, that they're going to have a better outcome because they have all of those downstream services to really support them with sober living, outpatient support, medication support or psychiatric care. So I think that's a very condensed way of looking at it. 

Wendy Beck 9:51
And the the whole, like you said, the evolution of caring for someone that has addiction. And now we're realizing first, you know this, you take yourself wherever you go. So you take somebody, you take them from Oklahoma and you take them to Texas or you take them from Florida and you bring them to Maryland. You know, you're right. They do have to go back into that setting because for their families or maybe their job or they decide to totally relocate and have their recovery community. So that and having said that, like, how has your program not like the administrative part, but the actual program evolved from day one today, today in helping these people? Because what you said is like it needs to be community based and with the community based. How do you support the community based organization, ones that are part of that aftercare? Do you have relationships with them? 

Manny Nsien 10:54
Absolutely. So, you know. Access Yeah, no, it's a really good question. And it's it's become the most important part because my this is my my words. I'm not speaking. I would say my organization's words. Right. We believe that the real work occurs at day 31. Right. If you think of people being in treatment for the inpatient for 30 days, that's a perfect environment. Everything's going to go well in theory, right? As long as, you know, they're, you know, showing up for their meetings and all that stuff while they're in our care. But really, the true work is at day 31 when they leave, when they go back into that community, where are they going to, you know, have the biggest issues or hurdles that could potentially increase the likelihood of recidivism. So to your point, you know, we've made a strong effort on just bringing people to the table and looking at, you know, number one, the first thing was being becoming in network. So we became, you know, majority in network provider, the majority of our population around 98% are in network. So it's number one, affordable. But it also allows them to go through a continuum, whether it's with us, our organization or if if they go somewhere else. So we partner with other facilities that are in network as well so that they're not, you know, coming from paying their out-of-pocket for inpatient to then have to pay even more money for out of pay for outpatient, it's allowing them to have a know continued continuity of care. The other thing is, is that not everyone's recovery experience is the same. You know, some people are okay with, you know, medication assisted treatment. Some people don't want to do that. Some people have more of a mental health issue that's underlying. And so we've made an effort to look at our community stakeholders and find where those resources are, you know, for anyone, because every every person has a unique experience. And we have to make sure on the case management side that the moment they start with us that we're meet, they're meeting with our case manager, we're identifying what their goals are, we're identifying what resources would best align with them. And while they're in our care, we're actually doing a lot of case management work to just make sure that at that day 31, that they're going to have a soft landing and easy transition to really support them through, you know, the chronic illness, which is substance use disorder. 

Wendy Beck 13:22
And that's exactly what's needed. So, you know, I commend you guys for that. I don't know much about the recovery community in Texas, but I know that we have a very strong recovery community in our area. And it and they really do they need to feed each other. So I guess being a nonprofit organization, you know, do you support other nonprofits and and recovery houses with an aftercare program? 

Manny Nsien 13:49
Sure is a good question. So I will say, you know, for starters, we are we are a nonprofit, so our organization is a nonprofit. And so, you know, part of what we do in our, you know, fundraising events and charity events is raising funding for people to, you know, to minimize some of the struggle of just accessing care. That's what we do. But we also try to look outward our external into the community to say, well, if we know that a high likelihood of success is that someone, after leaving this inpatient, very controlled environment, is that they need housing, then we try to identify sober livings and communities that align with them first off, but also if there's a way that we can donate, we can put money of our, you know, fundraising towards helping them, you know, maybe for the first, you know, step as they're, you know, just trying to get a job and trying to get back on their feet. Those are things that we look at. There's a lot of area foundations that also support the sober living that will provide free care as long as they're showing engagement, or at least they'll give them a month free to let them get on their feet. So, yeah, so we're very connected in that sense to look at, you know, what are the areas that are very common, you know, I guess stress, stress points for our patients that maybe lead to them relapse or lead to them, you know, having an exacerbation of maybe an underlying anxiety or whatnot. And we try to find a solution for that. And so the air in Texas, there's a lot of there's a huge, sober, sober living community. I mean, there's Oxford Homes, which is, I think in national. But we also have individual, you know, individuals that are very passionate and really just want to help, you know, help people have an easy transition. So it's very present here in most of the metropolitan areas. You'll find really good resources. What we really have issues with are when people go into the back to their rural communities, that's where it's not as strong. So you find that, you know, people tend to gravitate towards those metropolitan areas because that's really where the resources are, unfortunately. But I would say, you know, in San Antonio, I'm really proud to say that we're doing a lot to just expand the access to some of the area rural county areas like Kerrville, Comfort, Texas, Centrepoint. Those are areas that are outside of large metropolitan areas. But we've you know, we've identified that that's where people are going back to. And so there's been a lot of, you know, people that are interested in just raising capital and providing solutions. There. 

Rich Bennett 16:29
Okay. I actually have a question for both of you, because maybe when we started, you said you're at a convention right now. Yes. And Wendy, I know you also work with a lot of other nonprofits here in Maryland. Do either of you know if there is anything nationwide that pulls all these different organizations together, like a convention, like a national convention or anything? Because I think if kicking ideas off of each other just helps, you know, more and it helps the people that are in recovery. 

Manny Nsien 17:09
Yeah, I mean, what I would say, the one that I that comes to mind is NetApp, which we're we're a member of that organization. And I think they do an incredible job at pooling the resources together. And then you have SAMHSA who you know, on the federal level is just, you know, plethora of resources for both for profit and nonprofit options. And I always say, like if there's someone who's, you know, uninsured or underfunded, like go to SAMHSA because they just have a plethora of data on this space and can be a huge resource for them. So, yeah, so there is. But but the difference is, is that there's there's a lot of regional play, you know, like the the issues that are occurring in Maryland may not be the same in taxes and the drugs of choice are different too. Right. You know and so that that's also something that's challenging to you know, we can obviously speak to common language and say we all you know, we really care about, you know, substance use, you know, get, you know, addressing that. But how we do it is is it may differ. And then also the payer source, right. Texas does didn't expand Medicaid maybe like I don't know if Maryland did or but you know some other states did do a lot more funding for under-insured and uninsured. And so that's that's what makes it challenging because we can't we have to really look at our our state initiatives and kind of look at what we can do in our respective states. 

Rich Bennett 18:40
Right. Okay. Yeah. I didn't know if there's like national conventions or anything for that. But yeah, there are. We think about that different drugs and everything. 

Manny Nsien 18:50
Yeah, there are. And I mean I think that's the challenge. I mean because we, we we tend to focus on opiate use disorder because of all the, you know, just all the media and everything. And it is bad like fentanyl issue is, is real. It's a problem. Right. But, you know, if you look at it for us, you know, the most common drug of choice is alcohol. You know, that's what we're seeing still as a leading cause of people having, you know, a lot of disruption in their life. And so, you know, we have to also have a better understanding of like what really is occurring, you know, because opiate use disorder is a problem for sure. But I mean, alcohol is also and that's that's legal, right? You can go buy that. Right. But that's a big problem that we see. 

Wendy Beck 19:36
Yeah. And that's never going to go away. So yeah. So yeah, we're just getting better and we're just learning more. And in the past, I guess ten years we've really jumped from knowing basically nothing to where we are today. So you know that that does give hope. And I believe people are recovering. I'm not saying that relapse isn't real and there aren't triggers and stressors, but, you know, people are actually recovering. And I, I mean, I don't have numbers, but recovery communities are growing and it's because of this change. And that's amazing. 

Manny Nsien 20:09
Mm hmm. Absolutely. I agree with you. I do agree with you. 

Rich Bennett 20:12
One of the things I would like to say is, you bet, Ripple Ranch, A and Wendy. Wendy, if I'm wrong, correct me here, but you guys, it Ripple Ranch, it's not just about addiction recovery. You also help people with PTSD, anxiety and depression. Mm hmm. And I'm not sure if. Is there anything like that around here? 

Wendy Beck 20:34
Yeah. 

Rich Bennett 20:35
Yeah, because I never heard of one man. 

Wendy Beck 20:37
Wellness is focusing on other and other outpatients are now focusing on anxiety and depression. And, you know, of course, PTSD, I think, is hitting a new level of of treatment with. Right and not not that what is it called. What's that stuff. 

Manny Nsien 20:53
Called. 

Wendy Beck 20:53
India in India I guess. Yeah. Yeah. But yeah so there you know it is, it is evolving as well. 

Rich Bennett 21:02
But I like to see that because you know with, with anxiety, with mental health, mental illness, a lot of it leads to addiction. And I love the fact that you guys are helping with all of that. 

Manny Nsien 21:14
Yeah. So our so our philosophy, you know, as an organization is that we believe that people people do struggle with substance use disorder that that's a very yeah that that's there no one's questioning that. But what we believe is that there's something that's always underlying that led them there. That's just that's, that's our cardinal belief. We believe that there is there's most commonly a mental health illness or disease that has led to them, you know, to use them to use drugs or illicit drugs. Right. And so we focused on three areas which were, you know, anxiety, depression and PTSD. Number one, the reason why we did those three is because there's national tests that are recognized, you know, for for depression. We can do the Q nine for anxiety, we can do the GAD seven and for PTSD, we can do the PCL five or six. And so we wanted to be able to measure it. So those are so those are nationally recognized tests that measure the severity of depression, anxiety or PTSD. Oh, and okay. And so everyone that comes into our care, we start them with a baseline and are while they're in our care, we're actively testing them, you know, throughout the week, monitoring them, seeing their highs, seeing their lows, seeing if there's something that we discussed in session, seeing if there is an EMDR session that maybe exacerbated in anxiety or depression or PTSD or trauma, we we measure that. And whenever it you know, it's all through like I they're filling out surveys to do this, you know throughout their time with us and it will kick information like so if somebody scores really high on anxiety or depression symptomology, it will send that to their clinician and then our clinicians know to kind of get with them because they're maybe a potential for an increased risk of asthma or someone leaving against medical advice. And so we measure them while they're in our care, and then we also measure them after as they leave. And so, you know, we've found that a lot of the individuals that you just treat focused on substance, that they tend to sometimes have a relapse. And relapse, I think is part of, unfortunately, the journey. Right, because that we expect that may happen. We don't want it to. But as any chronic illness, if you were to compare that to diabetes or asthma, there are there's a rate of recidivism, right? There's people that will relapse and some that will not. And so we look at addiction as the same thing. But what we found is that if you're not addressing that underlying mental health issue, you're really just addressing maybe the the minor issue, which might be the substance. So, you know, getting them off of the, you know, through detox and residential, that might be the the easy thing for them, right? Because they're using medication and it's supporting them and addressing their Paul's or post-acute withdrawal symptoms. But what leads them to want to use again, and that's what we found, that there's most commonly a mental health issue that's underlying that maybe they had an adverse child event or an ace that occurred that is keeping them in this negative core belief that they're trying to numb by by using drugs. Right. And so if you don't treat that incident, then there there could be a higher likelihood of recidivism, which we want to prevent. So that's why we do a mental health focus as well, in addition to our substance. Because if somebody has gone, you know, somebody has gone to a treatment center and and I like to say we're a zebra among horses in taxes because, you know, we we're a treatment center, but we focus on that mental health, which is a little bit different because there's a lot of them are just more of the substance. And so if they've gone to five different substance programs and we all do the same thing, I like to say that there's different people, you know, that you engage with, of course, But we all do the same things in regards to like detox, residential epilepsy. So then what's going to be different, you know, And so that's where we've seen a lot of success because we're like, well, we understand you have a substance use disorder, but what else is going on? You know, what's going on under the hood. And that's where the mental health aspect comes in. And we've we've seen really good outcomes on addressing that. 

Wendy Beck 25:48
Good. I wanted to ask, is there a ranch element to this because you're called Ripple Ranch. Is there like some kind of like therapeutic spin that. 

Rich Bennett 26:01
It. 

Wendy Beck 26:01
All that makes you guys different? 

Manny Nsien 26:04
Yeah, Yeah. So, I mean, there is like we always try to say that our additional therapist is nature. You know, we're sitting on 25 acres. We utilize about five acres and the rest is all wooded. And so it is a very beautiful, serene, you know, even when I go there and I'm, you know, in the morning, I'll get a coffee or tea and I'm just sitting there and I'm like, man, can't you love life? You know, just being out here in the in Comal County, which is, you know, beautiful area. And and, you know, even down in our neighbor, some of our neighbors have horses and whatnot. And and so it is therapeutic in that sense in which we've found it specifically for our mental health clientele, that that's sometimes really helpful, you know, because if they're in the hustle and bustle of the city and, you know, all the you know, just all the distraction and noise, you know, just sometimes getting out of that and being here where you can reflect and really center yourself, you know, that's important. So we do we are on the ranch for our inpatient, which I think is, you know, as a next element, a positive element to the experience. But then our outpatient center is in the city in San Antonio. So they kind of get to get away into the ranch environment and then they go into the city. So they can go back to school, go back to work, etc.. 

Rich Bennett 27:19
So with the because the nonprofit part is what the Foundation for Ripple Ranch, right? 

Manny Nsien 27:25
That's correct. 

Rich Bennett 27:27
So what what kind of fundraisers do you guys actually do to help raise money besides asking for donations? Of course, which helps. But what are some of the fundraisers? What are some of the the best ways that you guys raise money for that? 

Manny Nsien 27:40
Yeah, I mean, we've we've started doing luncheons. Luncheons are really helpful. And during that time it's a good opportunity. Yeah, it's a really good opportunity to bring, I would say, atypical partners to the table, like we had one we had a Friendsgiving event that was in November of last year, and we brought, you know, the first responders, we brought police, we brought fire, we brought, you know, EMT, EMTs. So that that's those are atypical, I would say. But they're so pivotal because sometimes they're getting that first call. So we also want to educate them about, you know, what we're doing and how we can be a resource. We also bring in other private businesses and in our hope for the foundation is mainly education. And, you know, because like like my experience when I when I was, you know, wanting to just work in hospitals, I didn't really know there was an entire community. And I think that's the most painful thing is when a family or a community member doesn't know about what to do when a crisis occurs. So our hope is to bring, you know, for profit companies and, you know, first responder agencies to the table, educate them about what we do, what resources. And we're not it's not a competitive thing because we're also bringing our competitors to the table, too, because we want them to be, you know, a resource as well, because we aren't the right, you know, fix for everybody. But we want them to know that there are so many resources and so many people that care about the space. And so that's our attempt. So we do the luncheons. We also do very healthy things like five ks. So, you know, I have an ongoing thing because I run and I, I think we did we've done two years of five ks. I was in first place for the first one, second place for the second one. So it's an ongoing thing. I kind of say, Hey, come to this five K and try to beat me, you know, like be that inspired, you know, and, and so that that gets the community out and just thought we want to talk about wellness and just overall just doing things you don't have to run you can walk but just getting out in nature and running on the trails, we want that community focus and then the other things are, you know, applying for grants, you know, that specifically target substance use, you know, organizations. We want to make sure that we're reaching out to, you know, those charitable foundations that can help to fund and provide some, you know, funding within the community. So, yeah, that's those are the things we do. 

Rich Bennett 30:11
I love the luncheon idea. 

Manny Nsien 30:14
Luncheons are powerful. I think they're okay. 

Wendy Beck 30:16
Yeah. Yeah. So you said you had 35 beds. Is that is that correct? 

Manny Nsien 30:20
35 inpatient beds, 35 beds. 

Wendy Beck 30:23
And do you have residents that come from around the country or are they mainly, you know, locals or. 

Manny Nsien 30:32
Yeah, about 90, 

99% are from the state of Texas, About 70% are from our county. So Comal County, Baker County. So we're hyper focused in our community. And then the other, you know, Delta is 30% or so that are, you know, 29% that comes from like just around Texas. So it can be Austin, Dallas, Houston, you know. Yeah. 

Rich Bennett 31:03
Do you guys actually use peer recovery specialists as well? 

Manny Nsien 31:06
We do. We do. We do. We do. And we try to inspire our you know, we do have some individuals that work with us that are in early recovery. And so, you know, that's, you know, a really good way for them if they because a lot of them want to get back, they're like, you know, I want to save my life. I want to I want to go into this. I want to become a counselor. So we we do pride ourselves on being a teaching institute, that we do pride that we do pride ourselves on being a teaching institute. And so we will we have people that, you know, our peer recovery support specialists. We have people that are LCD, LCD eyes, which is licensed chemical dependency interns, and they can go through our our organization and get their hours so they can work towards independent licensure. And then we also have a psychiatric psychiatry rotation or residency program with Texas A&M that comes through our organization. And and that is hopefully to bring in the next wave of addiction medicine specialists that focus on psychiatry and addiction medicine. So we do a lot of things to try to bring interest and education, you know, to it, to just our surrounding communities so that we can hopefully inspire people to be the future. And then also like for, you know, future or future staff, because some people will stay with us and they'll leave for new opportunities. Then we have someone who went through our program. They're like, Hey, I really want to work here now. And so it's a great opportunity for us. 

Rich Bennett 32:39
All right, man, he wins the book coming out. 

Manny Nsien 32:41
I know, right? Right. I don't know. I don't know. I mean, it's you know, it's a learning experience for me. Every day in this space, I'm able to learn. And the the key way that I'm able to learn is looking at the patients we serve, but also just the staff. You know, I always like to say I'm important for bringing things together, but the people that are truly on the ground that work tirelessly to really give back to our community directly, they're the change makers. And so, you know, I really get inspired by what they go through. We love to, you know, do huddles and share, you know, just little wins and talk about how we've made a difference. And I think that's what keeps us going actually. 

Rich Bennett 33:24
Can you share a I guess like a feel good story of one of the patients that has gone through Rebel Ranch? 

Manny Nsien 33:33
Yeah. I mean, I don't I, I would say the I'm not sharing their information, you know, because they're they're very open about it. But one of our employees went through our program and was able to find her footing and get her life back and really build back her family. And then she became, you know, a manager. She's a manager currently in our organization and now gets to see people that were in that spot that she was where she felt hopeless and didn't know a way out. And I'm so proud of her. I won't say her name, but, you know, but I'm so proud of her. And she's come such a long way, you know, from being a patient with us to now getting patients the care that they need. And she's grown just, oh, man, just significantly, you can tell that she's passionate about it. We really love to focus on our alumni and and share those stories. We all I get to I'm a part of the alumni group and what we've been doing is the alumni are you know, they're they're now sharing their journey, saying like, hey, you know, this is my name. I went to report. This time I'm a year sober, I'm two years sober. I'm doing these things. I'm a mother again. I'm going back to work. I'm starting a business. And that those we share that information with our staff because those are that's that's important. Because it is it's a tough space. And, you know, I think we can you know, if you're in, you know, how challenging it is because the really the the the horrible side to this is that some people don't make it out. They don't they don't win that that fight. And you know, you know and I think we take it seriously. So when we look at the champions that are going back in, we like to say there are they are a part of our ripple effect. That's why, you know, they go into the community, we're able to help them. Then they're able to help their family. Their family is able to help their community, and then hopefully they help someone else that needs there. And so we our motto is the ripple effect. That's what we do. Every single person on our team is a part of that ripple effect. Every patient, every family member, every partner in the community is a part of that ripple effect to really make a change and improve our, you know, overall community. So it's exciting to be a part of it. 

Wendy Beck 35:52
I love that. But can I ask you a question? Have you ever had any personal experience with a loved one struggling with any type of addiction? 

Manny Nsien 36:03
Yeah, I've had I've had both addiction and mental health. And so, you know, I'll tell a story. You know, I've had someone really close to me, you know, my mother had has she's always she's been she's been inspiration to me. And, you know, she's such a phenomenal person. But, you know, she struggled with it. I had an aunt who, you know, fortunately she passed away recently, but she struggled with it as well for substance use. And in that, I would say, wasn't the catalyst. I actually learned more about it being a part of this space. And it kind of pained me a little bit to say like, Well, man, I didn't really know. Number one, these resources were here. I didn't know I didn't know this existed at that time. Yeah, well, that's true. That is true. There may not have been right. And even now, we're still we have we have some work to do. But we've come a long way, like you said earlier. But, you know, so I've seen that side of it and that's been a motivating part because I was just one aspect of it. I think that families need to talk more, you know, because substance use disorder is such a silent killer. There's the the sad thing is that there's a lot of loneliness for people that are going through that. And I think the people that are struggling with it, they would want someone to just reach out. And so I will we try to focus on is trying to make the family and or support systems very open about the conversation and trying to find ways to not blame the person but understand the illness and understand how they can help and be a support for them and then for them. 

Wendy Beck 37:52
Yeah, well, I'm sorry. Do you have family? No necklace programs? Do you have family recovery programs? I know that there's a I've been to workshops and stuff like that for the family myself. I had, you know, loved ones that experienced, you know, some devastating effects of the devastating effects of addiction. There was a local treatment center here where we I went to it was like a weekend. I didn't have to come because it was close enough, Like I didn't have to stay overnight to take it. I just came daily. But I really found that very eye opening just because most of the time people have no clue like what to do. And then they become enablers, they become codependent. They think that they're causing it or they can fix it. Do you have an element to your program that brings the family in and has that kind of, I guess, arm to of support? 

Manny Nsien 38:50
Yeah. So while people are in our care in the inpatient environment, we do have a family, you know call and really that's just more working with the family and whatnot. But in addition to that, we also have a weekly family virtual session because we found that some people are in different areas and maybe can't physically get there. But we do it just every week and it's, you know, an hour to hour and 30 with one of our clinicians. And their focus is to number one and talk about most, you know, most frequent questions, but also just support them and educate them on like what to do when their when their loved one comes back. Because, again, like, if there's not yet the same 40 and again. 

Wendy Beck 39:36
Have trauma and they're like, yeah, this loved one that's coming back that's supposed to be getting better is going to trigger them into the old habits that they have, which is going to trigger exactly why you came back to be better. I the. 

Manny Nsien 39:47
Exactly. Yeah. And sometimes the family is the reason that you know things happen because families are complex. Right. You know and so yeah we we try to focus on that during that time to educate them on not not to blame them or say they're the problem, but more of say like do your own work to like meet with a therapist. You know, here are some resources that we recommend because you may not know that. And most commonly we see that a lot of families just don't know what's out there. And so our focus is to connect them with while their loved ones getting care with us, because that's, you know, we're trying to work on their loved one and then they need to do the work so that when they come back home that they can be a support in this journey. So that's that's really what we we focus on. 

Wendy Beck 40:36
It's a family we have. Absolutely. It's a family disease. And no family is as immune. So if you're not treating the family, absolutely, you're not really fixing anything. So it sounds like an amazing program. I mean, it really does. Like I wish that it was closer because I would love to take a visit. 

Manny Nsien 40:53
Yeah, I'm I'm proud of it. I mean, again, like we when we talked about when we acquired the facility, you know, we got the dream team together and we we looked at a lot of literature, actually. We, you know, one of the books that we utilize a lot is the Body Keeps the score. And that looked at just, you know, looking at a fully you know, just looking at addiction is not just the substance but looking at other issues, other traumas, underlying things. And we really looked at developing a curriculum that embodied some of the themes that, you know, were presented in that book. And we referenced to that, you know, to look at how do we provide an experience that is a little bit deeper than just talking about substance use and how it's bad or you shouldn't do that. We want to really dig into the things that are problematic that are, you know, chronic for these individuals. 

Wendy Beck 41:43
I mean, I know we talked about how things are changing, but do you feel like your facility and I don't want it to sound stupid when I say cutting edge, Do you feel like you guys are taking that next step, taking that that extended care and taking that those that mental health piece and throwing it in there? Do you do you feel like you're you're on to something that like other treatment centers aren't doing? I know that they're starting to build that a little bit more just because that's the way addiction treatment is evolving. But like in in terms of like ripple rants like, you know, give us all like a little elevator pitch about why it's so awesome. Mm hmm. 

Manny Nsien 42:26
Yeah. No, I think, you know, without. Without. Yeah, without feeling, you know, seeming to, you know, centered on our program, I would say that we were the first to the dance on a lot of things. You know, one of them was being open, open to M-80. I always I said the zebra among horses, because there is a lot of programs in Texas that were just abstinence based. You know, they're they're very religious and abstinence based programming, which I'm not knocking that like there's a place for that. If what people want, that's fine. But I think we have to look at there's individualized needs. And so we we were one of the earlier programs that were okay with Matty and using medication. And we don't look at medication as the thing that we want to just put it on you and you use it and you're going to be on that for the rest of your life. We understand that it is sometimes a need it or a necessary tool within a toolbox of many different, you know, techniques that you can utilize to address, you know, this chronic illness. And so I would say that we were very we've been aggressive from since I've been a part of the organization for six years. I've been like, that's what we are doing. That's who we are as an organization. And our medical director and our team believe that we hire people asking them like, Are you okay with that? Because that's going to be what we implement. And so our team is very on board with that. Not everybody uses empathy, but that's something that we say if you need it, we want we want you here with us. We don't want you to overdose. We want to get you on something. Yeah. 

Wendy Beck 44:03
That that had a stigma all of its own. Like, like around here. Exact just like being a mom of of an addict. Way back. Gosh, over ten years ago, one of the forms of treatment that she had, you know, chose for herself was an M-80. And I'm going to be honest, at that point in that time, I was like, I was almost as devastated about that as I was about the disease of addiction that she was struggling with because I didn't understand it. And we've come such a long way. And one of our houses that we have, the sober living for women, is actually empty house. And it's the first in our county for women. So like I can see, you know, how grateful they are and how, you know, just because this is their path that they're taking, it doesn't need to be discriminated against or make them feel shameful because even in the rooms and going into to, you know, you know, the NRA or the AA community, like sometimes that has a stigma all of its own. So, you know, just co-mingle, seeing people on maintenance and co-mingling, you know, people who are not can be like a touchy situation. 

Manny Nsien 45:18
Absolutely. And so where we found there was, you know, again, like if people were going to, you know, 15 different centers because that's how people do sometimes they go to 15 different centers and they're all the same, and they had none of them. And, you know, corporate would incorporate. And then we're like, okay, like, let's try something different, you know? And so that I would say that we were early adopters of that philosophy. Then the other part of it was we're also early adopters of looking at the mental health side of it. And we've seen now more programs that are following us. Now they're they're doing mental health tracks and mental health focus. And for us, it's not a situation of, oh, well, we were first. It's more of like, well, thank you, because we want to move the conversation to be more encompassing of of like what's really going on with people because we don't when if people, you know, overdose and die, we don't want that. So if we can be a resource, we try to look at it as if somebody comes to us and they say, Hey, I want to know what you do on your your curriculum and how you do your mental health. I'll be the first one to tell them everything we do, because I believe in that. I believe that it's making a difference in our community. So we try to look at ourselves as like the Tesla of the addiction space. Like if there's something that we're doing that's trendy, trendy and and it's helping and you're able to get reimbursed for it, like I'm a I'm an open book and I have no problem, you know, educating people because honestly, it's it's an honor to, like, be able to say, hey, you're coming to us to learn how you can give back to your community better. And so I would say that, you know, with Matty focusing on the mental health side of it is something that we've we've always done. And, you know, we're seeing other centers that are now starting to go that route. And we're we're really happy. And one of the things I will say, this is just hot off the press. One of the things that we're actually now going to do is we're developing a very robust outcomes, educational, white, bipolar studies on our patients. And so we're going to now start presenting our outcomes data to the community at large. We want other treatment centers to see it because I want the consumer to be better educated about what is considered good because again, there's a lot of centers that do great work, not questioning, but a lot of centers do great work, and they're only measuring qualitative aspects. So they're saying, did you like the center? Did you like the bells and whistles? Did you get massage? Was the food good? And while those things are important, that's not what recovery is. You know, we want to monitor clinically how they're improving what was the, you know, addiction severity index scores, What's the you know, the the depression, anxiety, PTSD symptoms, how do we manage it? So we're actually going to start releasing that data, make it public, make it public for the consumers, because we want them to look at our data and then go to the next center and say, well, I want to see how you are performing, because I think that's the next way that we start to look at what is quality. And by us exposing that, it puts us on the, you know, put us out there. And I told my team I was like, That means we got to do good. You know, we have to be able to stand up to what the, you know, the data showing. But I'm really excited about that. 

Wendy Beck 48:44
That's something we'll be releasing. Up until now, there really hasn't been any data. And so there's we're learning. Yeah, we're learning like people that have, you know, issues with getting health care, you know, has a there's a lot of factors and there's you know, it's age or economics or race or all of these things. And I just literally was on a call last week with the state of Maryland because our houses are certified. So they'll do like a presentation and they'll like keep us up to date on certain things. And and and the young woman who did this presentation was exactly on this topic. And, you know, and the reason that we are not able to care for them the way that they need to be is because we do not have that data, do they? And so now, you know, in the recovery house world, like I said, okay, we need to start tracking this. Did they come in with a car? Did they come in with the job? How many kids do they have? Like, you know, are they doing IAP? Are they going to therapy? Like all of these things? You know, once we have enough data to be able to say, okay, 90% of people that come in to a recovery house after treatment, guess what? They don't have a car. So how are they going to succeed? Because we're in a semi-rural area, which maybe is like, you know, you said. So the person who lives, you know, in this area now, they need to get a job and they need to go to the grocery store, because even though we're a level two and the house is monitored with the house manager, you know, they don't have all the resources they need just because they went to treatment. So having that desire is, I think, really what's going to throw everybody up until the next level to be like, hey, you know, recovery houses need transportation. You know, and what. 

Manny Nsien 50:30
What does that look like? How do we make that? Yeah, yeah, absolutely. 

Wendy Beck 50:34
Absolutely. Yeah. I commend you on that because the data is what's going to drive us bigger successes. 

Manny Nsien 50:42
I agree. And so that's where we're really happy about, you know, getting that together. I've already seen all the data in the presentation and it's impressive. You know, we've been able to, you know, monitor the tracking over years and we have a really I think it's like 300, you know, people within the study that went through and, you know, monitored. So it is really interesting data. It's going to be something that we're going to, you know, really talk to the consumer and say, hey, you should ask for this. Like this is something you need to know because number one is expensive for treatment. I mean, let's let's just, you know, call it what it is. It's an investment, you know, to be able to do this. And it's unfortunate. And if you want to protect that investment, you need to make sure that you know where you're going and that you know the place you know, that you're going to. It's important for them to know if they're doing well or not. And so that's that's something that we want to bring into the market as a conversation, because, again, there's a lot of people that get into this space with with a passion and they are genuinely passionate and they want to do a good job, but we have to make sure that they are doing a good job and that we're not causing undue burden to the you know, to the family members that are honestly in a very vulnerable state and don't really know what's good and what's bad, because all they care about is their loved one getting better. And that's and we want to make sure that people are informed when they make a decision. 

Rich Bennett 52:06
So the very important tell everybody the website and how they can get in touch with you. 

Manny Nsien 52:12
Yeah. So to reach out to us we are at WW W dot Ripple Ranch dot com and outpatient center it is continuum outpatient dot com. So that's our two locations that we have ripples in our pristine beautiful rural beautiful area And then continuum outpatient center is our outpatient center in northwest San Antonio. 

Rich Bennett 52:39
And the donee button is on Walgreens.com right? 

Manny Nsien 52:42
Yes sir. Yeah. 

Rich Bennett 52:44
So look for that. B Well, that's important. 

Manny Nsien 52:46
Yeah, I guess I'll say that. Yeah. If you, if you want to get back and you just. Yeah, sorry I, I, my, my, my PR team is going to be like, why don't you say that? Yeah, but if you ever want to give back we do have a donate button and again it goes to just ensuring that people don't have the stressors, all the stressors for the, you know, the barriers to access care, try to make it affordable so your money will be going directly towards that. 

Wendy Beck 53:11
And when they're there, they don't want to feel like they're they're less than a person because I know like treatment, like you said, you know, can be it can be stressful in itself. You're away from your family, you're away from your home. And when you leave, you're going to have all of these things that you're going to have to think about. So while you're there, having the best care is probably the best leverage for the next step. 

Manny Nsien 53:35
Absolutely. Yeah, absolutely. 

Wendy Beck 53:38
It was a pleasure. 

Rich Bennett 53:39
A Yeah, I have one more question for you. Unless he's got a question for you. 

Wendy Beck 53:44
Go ahead. Maybe I'll have one after you, but go ahead. 

Rich Bennett 53:47
Oh, after this question. I'm sure you will, because I got into an argument about this the other night. 

When it comes to addiction, 

is it a disease or is it a choice? 

Manny Nsien 54:04
I can answer it first is most certainly a disease. It is most certainly a disease. It is a 

it is a disease that has to be managed. Other chronic diseases. Um, you know, it's a lifelong disease in our opinion, and it's something that there is ongoing maintenance. And, and again, I always try to compare it to like type two diabetes is always the best comparison because right now we spend a quarter of every dollar that spent on health care is spent towards diabetes maintenance. So it's a significant amount of money we spend every year. The average costs annualized for managing someone with type two diabetes in the US is around like $19,000 a year that you're spending. And it's very comparable to substance use, which is around $15,000. Obviously we spend significantly more money on diabetes, which is why we focus more on it. But It's still, you know, it's up there, you know, and, you know, but I do think that substance use is a disease. And we if if in the best way to frame it is that if you don't look at it as a disease, then and you only treat it as only an acute current occurrence, then we won't we won't do all the necessary work for these individuals if we're only addressing it as, oh, there currently on drugs or they're currently, you know, experiencing withdrawal symptoms. Let's address that, let's bandaid that and then kick them out. You would no immediate lead that. That's not sufficient. You know, if you don't do the clinical work, if you don't do looking at their socioeconomics, looking at the resources downstream that they need, following up with them, continued counseling, the medication that supports them to help with cravings. All of these things are, you know, something that would be tied to a chronic lifelong disease, which is like type two diabetes. And so there's a lot of parallels between substance use and other very well known and respected chronic use disorders. And if we don't look at it that way, it's a huge disservice because these individuals will continue to go through triggers that can essentially just collapse the castle that they are they're trying to work on, which is looked at as like days of sobriety. Right. So we have to look at it as a chronic illness, that we have to build a network of support system that helps them on for the long term. That's my view. 

Wendy Beck 56:48
Yeah. No, I think it's great. I think you you hit the nail on the head. 

Rich Bennett 56:53
Yeah, exactly. Yeah. Because. Yeah, yeah. I said the same thing. It's a disease. And the rebuttal was, well, they chose to do two drugs, so they should be able to choose to quit. Which. Yeah. 

Wendy Beck 57:06
Well they've never. 

Manny Nsien 57:07
Let me add one. 

Wendy Beck 57:08
Struggle. 

Manny Nsien 57:08
Yeah, right, right. Let me, let me add another just last minute thing about that, too, because and that's why, you know, when you look at substance use, there are there are you know, there are some people that believe that they have not experienced a loved one going through it, our friend or family member. And they look at it as a moral flaw, like it's a personal decision, a choice that they're making. And what we've found actually is when we started to look at the substance use as maybe a secondary issue and focus on mental health, people look at it differently. So if you're if you save it and if they truly have depression, like and we say that they've been struggling with depression for a long time, they've been struggling with anxiety for a long time, they've had some trauma. That's for a long time. People are more receptive to that. And I think that's been a helpful tool educating the community at large, because to your point, there are people that are like just stop doing drugs. But if you say that this person was abused when they were a child and you start to understand their story and they've been high functioning, they went to college, they they'd have failed failed relationships, though, but they're working well and they're just stressed and they've never been able to address this issue. And then they're like, you know what? I'm just going to take some opiates to just numb that pain. You know, when you start to look at it's like, well, did they take the opiates because they just recreationally wanted to take opiates or is that noise of that underlying trauma so loud and so intense and so debilitating that that it's that that it's really consuming who they are and it's preventing them from living a life. 

Wendy Beck 58:55
And I don't think that a perfectly healthy individual is going to wake up today and say, you know, I'm going to drink this entire bottle of wine. Right? I'm going. 

Manny Nsien 59:04
Exactly. 

Wendy Beck 59:05
Take opiates. I'm going to do exactly. It's a progression. And, you know, not everyone that's an alcoholic 

has trauma. There's also that's has like a genetic disposition as well in their body. But, you know, we're not saying, hey, you're 21, don't get a drink because or whatever, whatever you decide, because we don't know how that road is going to look for you, because we're not we're not teaching on that level. People are this is what we do. And this is, you know, I'm going out with my friends and they're smoking weed and they're drinking alcohol. And just because, you know, this person over here can still get up and go to work and even 20 years later, they're okay, that other person is not. So we have there's no crystal ball to know what's who's going to be affected or who not who's not going to be affected. And that's why it's not going to go away. And we just have to get better. And I love what you guys are doing because I thank you so much. Is the next that is the next level of care that we have been desperately waiting for. 

Rich Bennett 1:00:15
Yes. 

Manny Nsien 1:00:16
Thank you so much. I'm proud of our team and everything that they do every day. 

Wendy Beck 1:00:21
I love it. 

Rich Bennett 1:00:22
Many thanks a lot. And thank you for everything you are doing in the mental health and the addiction recovery world. It is truly appreciated. So thank you. 

Manny Nsien 1:00:34
Thank you, sir. And thank you, Wendy. It's been a pleasure to have this conversation this morning.