The following is a conversation between Fred Muench, President of the Center on Addiction, and Denver Frederick, Host of The Business of Giving on AM 970 The Answer WNYM in New York City.
Denver: There are many challenges that currently face this country. Gun violence is certainly at the top of everyone’s mind, but so, too, is drug addiction and the opioid crisis. Over 120 people die each and every day from an opioid overdose. An organization that is on a mission to transform how this nation addresses this crisis is the Center on Addiction, and it’s a pleasure to have with us tonight their President, Fred Muench.
Good evening, Fred, and welcome to The Business of Giving!
Fred: Denver, thanks so much for having me on the show and for doing this show.
Denver: Give us a little bit of a history on the Center on Addiction, including the recent merger with the Partnership for Drug-Free Kids.
Fred: I was the president and CEO of the Partnership for Drug-Free Kids, and we merged with the Center on Addiction, which recently rebranded from the National Center on Addiction and Substance Abuse. The Partnership for Drug-Free Kids (formerly known as the Partnership for Drug-Free America) was founded in the ‘80s. It was founded in collaboration with the Ted Bates Advertising Agency, but really brought to life by the American Association of Advertising Agencies – the 4A’s – where they got together and they said essentially, “Hey, if we can sell Doritos, we can also unsell drugs.”
That was in the time of the crack epidemic, so people were very frightened for their children’s future, and the iconic ad came out of that campaign, which was This is Your Brain on Drugs, which both had positive and negative reactions from people over time, but memorable. Known as one of the top 100 ads of all time. Certainly, a memorable ad. What grew out of that was there is an appetite to change attitudes around public health, and specifically around drug-taking behavior in adolescents, in particular substance misuse.
And so, the partnership grew out of grants through the Robert Wood Johnson Foundation. They worked with ONDCP, which is the national federal organization that handles drug policy, and started creating ads. Actually, over 3,000 ads were created over the 30-year span of the partnership. What started to happen though, across the spectrum of media and marketing, was things began to change in terms of direct consumer advertising. Over the last 10 years, there’s been a real evolution from media campaigns that were targeting traditional advertising like TV ads, to social media to digital media to engaging people. Because once you try to change an attitude, what people want to do is: So, what do I do next? I want to do something, but what do I do?
So, the next evolution of the partnership came with their web resources. People would come to the website, and then what we learned over time in all behavior change is that PDF isn’t enough all the time; we need more. Actually, I was brought into the partnership in 2011 to help start their helpline. So, not only did people have an ad to think about changing their attitudes and a call to action to the website, they now had a call to action to a helpline to get support from someone, and that started growing as well.
What changed over time as well was the digital revolution. I left the partnership and was fortunate enough to be recruited back in because of my work on digital health to build out the digital health capacity of the partnership: to keep people engaged through text messaging, Facebook, chat, email… to really start the conversation with family members. And so, what we evolved into was a media and service organization. So, change attitudes through media; engage people; bring them in, and then offer them support and guidance because they’re not getting it from outside. Our particular focus is on parents and caregivers.
So, that’s the history of the partnership. We’ve been fortunate enough to merge with the National Center on Addiction and Substance Abuse, which is now known as Center on Addiction, and we’re all known as Center on Addiction. This was January 1 of this year.
CASA’s history is amazing in itself, started by Joe Califano. He wanted a policy think-tank.
Denver: He was a former secretary of HHS.
Fred: That’s correct, and a powerhouse in really changing the culture around smoking. He was the one who championed laws throughout of smoke-free workplaces. Joe is a force of nature. He’s still on the board. He’s still involved.
Joe wanted to start a policy think-tank. He wanted to say, “We can make some changes here, but we need a think-tank. We need to do research. We need to pour all our efforts into this.” Because if you look at the personal and public health cost of addiction in America, it’s more than heart disease. It’s amazing. And that’s not even taking the intangibles of relationships – troubled relationships, domestic violence, you name it. And in terms of our criminal justice system, people are being arrested or were being arrested, for having an ounce of pot on them, and it was ruining their lives with a felony offense. So Joe really wanted to change that, and he also wanted to empower families at the same time.
What we found was we were the services and media group; they were the policy and research group. We were these two organizations. We started chatting, and we started saying, “How do we collaborate? Do you want to do more services? You have a great crew of credible researchers. We want to do more evaluation and monitoring, and outcomes monitoring.” They want to do more media; we want to do more policy because we’re doing advocacy. The conversation just got started, we said, “Hey, why don’t we merge?”
…looking for organization where there’s complementary strengths, and complementary strengths not only in mission but in personnel, I think was really helpful.
Denver: Well, you complement each other very, very nicely; a lot of organizations do, but they don’t merge, particularly in this sector. What was it about this relationship? What are the keys to a successful merger? Because I think everybody out there listening would say, “This sector would be more effective if more organizations did what they have done.”
Fred: Yes. There are a few reasons for merging. One is, like what you’ve said, we have a very similar mission and goal. But we also have different strengths, and each complements each other in a way that we felt we could never do alone. As they looked at our strategic plan and we looked at theirs, we realized we could help each other.
But mergers don’t happen mainly because of ego, and what we had to do was sit down. I was very fortunate that our boards, as well as their Chief Executive, Creighton Drury, (who is the CEO and I’m the president) sat down, and we essentially said: How do we complement each other? How can we make sure to continue the mission of this organization? How do we let go of some of the ego? Each. Individually. And we threw it on the table.
And even with that, it’s hard. Being the president and CEO to just being the president means my role has shifted dramatically. And so, when I was going through this is to say to myself “I have to be a servant leader. The only way we can combat addiction is if we merge and come together, and I have to let go of my ego.” Creighton said the same thing.
We have a collaborative decision-making process. We disagree on certain things. As the CEO, he has more say than I do; and that’s okay because we are respectful of each other, and we listen. The other thing that worked is we know we each have different strengths. I think if we were both more on the marketing and ad side, or both on the service side, we’d be colliding. So, looking for organization where there’s complementary strengths, and complementary strengths not only in mission but in personnel, I think was really helpful.
Opioids are an analgesic pain reliever that hits on the opioid receptors in the brain. What it does is really two things: it creates a euphoric effect as well as reducing pain sensitivity.
Denver: It’s funny what you say about ego, too, Fred, because ego exists in the corporate world, but it is actually less of a problem in the corporate world because you have shareholders. And the shareholders don’t really care about the ego; they care about their stock and the share price. So, market forces will make those mergers happen. But we do not have that in the nonprofit sector, so the ego can be the ultimate roadblock.
So, with this new organization, Fred, you have four pillars that it is based upon. Can you tell us what those are?
Fred. Those four pillars are the two organizations’ primary missions merged.
One is to empower families and make sure that families get what they need from prevention to recovery. The second is to advance health care and advance care for those people struggling, and that includes: helping healthcare systems implement new addiction treatments, evidence-based addiction treatments; technical assistance to those organizations; data analysis and data mining to do predictive modeling to make sure we can identify people; and research, and cutting-edge research, to make sure we’re doing the right treatments and developing the right treatments.
We also focus on media, and making sure we’re changing culture. So that’s media and culture. And lastly, we focus on policy and advocacy. And those are the four pillars of the merged organizations.
Denver: Well, let’s turn our attention to the opioid crisis, and if I can start really with a basic question: What are opioids?
Fred: Opioids are an analgesic pain reliever that hits on the opioid receptors in the brain. What it does is really two things: it creates a euphoric effect as well as reducing pain sensitivity. That combination has been used to treat pain for many years. It’s also been used to create a euphoric feeling in heroin, morphine, Methadone, OxyContin, Percocet… a whole class of substances that act on those receptors.
And so what happened in terms of opioids is there was a mass marketing effort to put them out to treat chronic pain, and this is where we are now. I don’t want to go too far into this. Lead the conversation, but essentially that is what happened.
The CDC study was alarming because what it found was a seven-day prescription, and some of the studies say five days prescription increases your likelihood of becoming opioid-dependent significantly. And so, what that means is just getting a taste of how those opioids feel will increase your chances later.
Denver: The last numbers I saw, I think that were 11.7 billion pills prescribed last year; that’s 36 pills per person, which is pretty insane. How quickly can you get addicted to opioids?
Fred: So, the CDC has done some amazing studies as well as some longer-term studies. There is a misconception that taking opioids after X number of days will get you addicted. People react very differently to opioids. The CDC study was alarming because what it found was a seven-day prescription, and some of the studies say five days prescription increases your likelihood of becoming opioid-dependent significantly. And so, what that means is just getting a taste of how those opioids feel will increase your chances later.
Now, if you’re taking opioids for 30 days, you’re going to develop physiological dependence; that doesn’t mean you will become addicted. But what we’re seeing now is people who take opioids even for a few days, particularly younger people, which is they get that feeling, then they stop, and maybe there’s something going on like, “I did this. I was okay. It wasn’t a big deal,” and then they try it again. And then they start to develop some physiological dependence: It makes you feel good; There’s no immediate consequences to it; There are usually only benefits.
The people who throw up for the five days of taking it, don’t take it again.
Denver: They’re lucky.
Fred: You’re absolutely right. They’re lucky.
And so, what we’re finding is the flooding of opioids into particularly the Appalachian Trail completely created a generation who were addicted to opioids and the range of opioid-related substances. And whether it’s from the pharmaceutical manufacturers, Purdue and the such; the distributors who pushed it out, who didn’t put the gates up; the MDs who were prescribing and prescribing…as people say, there’s plenty of blame to go around, and we have to focus on solutions right now.
Denver: And it sounds like, from what you’re saying, that if you are taking opioids for pain, let’s say after surgery, and the pain has gone away… and you have some pills left, probably the best thing to do is get rid of those pills.
Fred: There is no question. It’s get rid of those pills immediately. There are drug take-back sites. We worked with Google on Drug Take-Back Day, but also you can drop them off at a local pharmacy. 60% of people – and it could be even a little bit more – who started using got it from a friend or family member in terms of having extra opioids. So, getting rid of those opioids is key because you’re going to have a teenager who comes in, takes it for pain, and then they start taking it more and more. It’s unsupervised.
But what we’re seeing now is if you really look at the data, you don’t have to take opioids for acute pain. The data is very clear: Ibuprofen or sodium naproxen work just as well. So, there’s been a marketing effort to make sure that people are taking opioids when they don’t have to. And if our first line was taking Advil or something, whatever it is, and then go back to your doctor…We have to shift the perception that people need opioids first, and we’re starting to do that…and then we’ll be able to tackle some of that overprescribing.
Denver: So there are a lot of alternatives to pain relief other than opioids, although some of them are not fully reimbursed by Medicare.
Fred: That is a big problem. So when you look at some of the medical devices out there, when you look at some of the local anesthetic shots, for example, that are out there that last a few days, not all of them are reimbursed. And until that happens, doctors don’t know what to do for their patients. They want to help their patients. Doctors have the best intentions for the most part. They want to help their patients; they don’t know what to do. And often saying “Take an Advil,” they don’t feel comfortable saying that. They want to give them something.
So, I think we have to do some re-education but also provide more reimbursement for alternative pain treatments.
And that data saying just taking an opioid a couple times increases your likelihood and risk, it’s so crucial for us to understand that we should have a zero tolerance in at least acute, non-chronic pain for young people in terms of opioids.
Denver: By and large, how do teens first get their hands on opioids?
Fred: It’s typically either they’ve been prescribed opioids, but more likely than not, they’re getting it from a friend or family member from the medicine cabinet. And so, this is why getting rid of those pills is so crucial and so important. And that data saying just taking an opioid a couple times increases your likelihood and risk, it’s so crucial for us to understand that we should have a zero tolerance in at least acute, non-chronic pain for young people in terms of opioids.
I think of my own history in recovery from heroin addiction. I tried pills as a kid. I was not one of these people who were prescribed opioids and then right then became addicted. I was a kid. I partied. It was something I did. I tried certain things; People said I would get addicted, and I didn’t. And then later, it just spun out of control because I thought I could handle it. And that’s what we’re seeing with kids, is that they think they can handle things because they don’t have those immediate consequences, and then things spin out of control.
Denver: Right. And sometimes you can handle it one day, but the exact same intake the next day is a completely different result and outcome, and kids can’t believe that it could be the case.
One of our core missions at Center on Addiction is to delay, delay, delay.
We need to make sure to remind ourselves that it’s not benign, and to remind our young people and support our young people to delay, delay, delay…until they’re old enough to make a decision on their own.
Denver: Well, for those who are addicted to drugs or alcohol or cigarettes for that matter, how many of those people started before they were age 18?
Fred: About 90%. One of our core missions at Center on Addiction is to delay, delay, delay. The brains are still growing. And so, we have a number of programs directed at parents and family members to teach them to delay as much as possible. With recreational marijuana laws changing, there’s going to be more availability. There’s availability of alcohol. We need to make sure to remind ourselves that it’s not benign, and to remind our young people and support our young people to delay, delay, delay…until they’re old enough to make a decision on their own.
We know that parents who get drunk in front of their kids are much more likely to have kids who have problems with alcohol later.
We often hope that things are going to be okay because the majority of people who try a substance don’t become addicted. So, you think your kid is going to fall into that, but the problem is those who do try have a much higher likelihood of becoming addicted.
Denver: What can parents do to protect their children and loved ones before they start?
Fred: There are many things family members can do… parents and caregivers can do. The first is proper modeling. Being a good model in terms of – there’s the recent emergence of mommy juice: mommy needs a drink, and daddy needs his beer…saying you need something to get out of yourself – shifting that language that if you are going to drink, to drink moderately; not to say you’re using it as a coping mechanism, and not to normalize it, to empower our kids that they can be resilient without drugs and alcohol. So, that modeling is crucial. We know that parents who get drunk in front of their kids are much more likely to have kids who have problems with alcohol later. So that’s one.
The other is communication. Communicating with your kids. We often hope that things are going to be okay because the majority of people who try a substance don’t become addicted. So, you think your kid is going to fall into that, but the problem is those who do try have a much higher likelihood of becoming addicted. So, communicating, talking about it.
And then the other is boundary setting and monitoring. It’s being aware, being there. I have a 16-year-old. I am awake when they come home. I have a conversation with them. I talk to them. I know where they’re going before they go. And they’re going to lie to me; that’s going to happen. Teenagers do that. But we have open communication about it, and I set expectations of not using. If they break those expectations, that’s something I have to deal with, but setting those expectations we know will reduce teen alcohol and drug use.
Denver: So, Fred, let’s say things have gone a little bit off the track, and it has become time to intervene, to have “the conversation” with your child. How should you approach it? What does a parent need to know and be mindful of?
Fred: So being open, being loving, not being accusatory. This is not a moral failing. This is something that makes sense. When you look at why teenagers use, they use to socialize; they use because they’re bored; they use to just see what it feels like; they use because their peers are using; it makes them feel more comfortable…all these immediate effects, just like with opioids, right? There are some good immediate effects that they see; they don’t see the longer term.
So that’s the first… is being non-judgmental and open. Learning how to communicate and listen is one of the most important. Getting their point of view, not lecturing; understanding why they’re using, what they’re doing; understanding what they want; understanding what they want from life.
But then once you start to think about is setting those proper boundaries. So a lot of the prevention you can use when someone’s already started using: making sure you’re scheduling alternate activities because what happens is: very often kids start to surround themselves with peers who are also using, so making sure they have a heterogeneous peer group. And then I highly recommend getting some sort of individual counseling. They don’t have to go to a treatment center, but some sort of individual counseling and empowerment.
We’re building resilience. We want kids to be above that influence. How do we build healthy, resilient kids? And focusing on the positive and not just taking away something?
Denver: I also imagine it’s important that mom and dad are on the same page and have a unified front.
Fred: Unified front is crucial. Thank you so much for bringing that up because we do see parents with mixed – I did it as a kid. I’m fine. What’s the problem?
Denver: I bring it up because I played my mom off my dad. This is a game we play as a kid.
Fred: That’s right, and kids do that; kids are masters at it. And so, having a unified front even if you disagree, finding that middle ground. And at the Partnership and Center website, we have lots of resources for parents and families to have those conversations with your kids. But it is crucial to be on the same page.
We know that teens that start vaping are more likely to start combustible cigarettes when they don’t have nicotine. We also know that their brains are forever changed once they start adding nicotine into that. They’re getting this immediate reward. They’re getting a surge of dopamine. And so, what they’re doing is, instead of focusing on their friends or playing an instrument, their mind shifts, and it becomes salient.
Denver: How concerned are you about e-cigarettes?
Fred: Very concerned. We saw it brewing for the last five or six years. It was billed as: It’s going to help you quit! it was billed as harm reduction. We knew it was not harm reduction. If it was harm reduction, it should be behind the counter at a pharmacy, and it’s not. It’s at a local candy store.
Denver: Right. Tangerine-flavored, or whatever they call it.
Fred: Tangerine flavors. The line that it’s safer than smoking, combustible cigarettes…there is no evidence right now because we don’t have the data. And the data that’s coming in is not great. The Bubblegum lungs… and what’s coming in, we have no clue.
What scares me is that teenagers and family members somehow think there’s less risk associated with this. We know that teens that start vaping are more likely to start combustible cigarettes when they don’t have nicotine. We also know that their brains are forever changed once they start adding nicotine into that. They’re getting this immediate reward. They’re getting a surge of dopamine. And so, what they’re doing is, instead of focusing on their friends or playing an instrument, their mind shifts, and it becomes salient. That addiction becomes salient. They’re looking for nicotine. We do not want our kids…we do not want anyone to be focusing on drug seeking. And this is what kids are doing.
So, we have a new guide. We have parents who are calling us now to help them. We’re very focused on working with other organizations who are focused on this issue, and we see this as one of the most important public health emergencies that we should be focusing on at the current time.
So, what we want to do is be there. We want to be a salient presence in the lives of family members because it’s so easy to ignore it. It’s so easy to hope it gets better. And what we want to make sure is that people are vigilant about this; and digital technology and the mobile phone has changed all of that.
Denver: That’s great. Absolutely. You know, you alluded to this before, but you’ve been a leader in leveraging digital platforms to deal with substance abuse disorders. What are some of the latest tools out there that are available?
Fred: I’ve been very fortunate to have done this for my career as a psychologist, both in academia and the startup world, and now with Center on Addiction. When we look at both prevention, intervention and recovery, there’s a few key components to engaging people. What we want to do is keep something salient. We want to do it in the most effortless way possible, and we want to adapt it and give it to people at the right time and tailor it to their personal needs.
And so, I’ll give you an example of what we’re doing at Center on Addiction and then talk about a few others. At Center on Addiction, what we do is we focus on the family; we focus on parents and caregivers. Why do we do that in particular? Because there’s no reimbursement really. There’s limited reimbursement for family members, and we know that when family members are empowered and trained, that they can have the most impactful outcome on both prevention and intervention. The research is clear.
But what we also know is that there’s not a lot of urgency. There’s no treatment center for a parent. They’re not going, and if they’re going, it’s just a collateral visit as part of it. So, we know that parents aren’t going to go and seek out care also because they’re like, “Oh, my kids go into treatment. Everything’s great.” What we do is we lower the burden. So, we allow people to come in via SMS; we engage people via Facebook Messenger, via e-mail, via chat, via phone line. They can schedule. So we start the process of engaging people with their preferred communication medium.
So, what we’re doing is if they’re on SMS, they can just text us so there’s no effort. But then digital has the amazing capacity to tailor. So what we do is we ask people a few questions, and based on that, we give them automated feedback. And we can give them feedback for 90 days; we can give them feedback for two years, but they’re having those ongoing salient reminders of what they should do – remind to ask questions; to communicate; to set boundaries; to tell your kid you love them.
And what we do is we tailor it to the needs state. So if there’s a prevention parent, they get very different messages from a kid who’s already using, from a kid who’s in treatment and needs recovery. And then ongoing, what we do is we make sure we can adapt it. So, let’s say someone’s an early intervention parent, and what happens is they’re talking to their kids, and it turns out their kid’s a little further along, and they need treatment. They can simply type into their text message feed “treatment” and the whole intervention shifts. And then if they want to talk to a treatment specialist, they can type in “chat” and within 24 hours, a specialist will get back to them and give them and help them navigate the treatment system.
So, what we want to do is be there. We want to be a salient presence in the lives of family members because it’s so easy to ignore it. It’s so easy to hope it gets better. And what we want to make sure is that people are vigilant about this; and digital technology and the mobile phone has changed all of that.
Denver: That’s for sure. That’s an easy thing to say: “I’ll tackle this tomorrow.” But when you customize it like that, and you have those kinds of reminders, it just puts it in front of your face and you say, “Maybe I better do it now.”
What are policymakers doing and not doing to address this crisis?
Fred: The opioid crisis has put more of a spotlight on policymakers, and some good things are happening… I would say aside from…we need way more money. I mean, $6 billion. The money is going to states. There are great things happening. The money that is going to National Institute on Drug Abuse, NIH, CDC and FDA…that’s just a drop in the bucket, and people are doing good stuff with that. But we need a few things.
One is we need to change our parity laws. We need coverage for substance abuse and mental health, just like any medical condition. When you look at the state level, when you look at insurers, we need pressure to get insurers to pay for care. We need more money in the prevention space going directly to communities. We need more money overall in terms of the recovery space.
So, people want to fund treatment because there’s a reimbursement stream, so they’ll do that, even though not everybody is reimbursing addiction treatment. But the recovery space is when real change happens. So, when someone leaves treatment, they’re out in the open. And so funding recovery, funding communities, and funding the family…we know that when a family member is empowered, outcomes are significantly better.
They’ve done studies where they’ve trained family members on something called community reinforcement and family training. And what they do is they essentially empower family members to essentially be therapists in the house. They teach them self-care. They also teach them how to communicate. When that’s done, you have significantly higher recovery rates. Because the family members are the first, second, and third responders.
The other thing we can do with family members is give them naloxone. Train them on how to avoid overdose. If everyone had naloxone, we would reduce the overdose rates vastly significantly, but we do not have that. It should be free. The federal government should be paying for naloxone to be out there.
So, there’s a lot they can do. It’s usually about money, but it’s also about acknowledging that addiction should be treated like every other medical condition.
I think that addiction is part of the conversation, and it hasn’t been. It’s gone from a moral failing and a criminal justice issue to a disease: a condition. That people see people they knew as kids who get taken in by the grips of addiction, and they understand this is not a moral failing.
Denver: Let me close with this, Fred. This is mighty tough work, but I know you approach it with tremendous energy and optimism. What makes you most optimistic right now that we’re going to turn the corner on this and find our way?
Fred: I think that addiction is part of the conversation and it hasn’t been. It’s gone from a moral failing and a criminal justice issue to a disease: a condition. That people see people they knew as kids who get taken in by the grips of addiction, and they understand this is not a moral failing.
Addiction has a lot of negative side effects. Very often, people will steal to feed their addiction. That is not the person. And what I’m most optimistic about is people see that recovery is possible. People see people speaking out: I want people to know I’m in recovery from heroin addiction; I want people to know that I was down a dark path; I went to many treatment centers; I thought of ending my life. After even being out of a treatment center and in recovery for a month, I ended up in a jail cell… That things happen, but recovery is possible, and I do think that people are starting to see that, and the recovery movement is growing. Family members are becoming empowered to say, “No. We demand treatment. We can change.”
The other thing is that I think people are also recognizing that there’s a real drive towards wellness. I don’t think it’s with everyone, but I think there’s a little bit of a groundswell happening of: We don’t need substances to be better; We can be resilient; We can enjoy life without substances; We can enjoy it more. There’s nothing more interesting than going to a club and not drinking and seeing what that’s like. It’s a bizarre feeling. It’s empowering. You feel alive.
Denver: And you remember it the next morning.
Fred: And you remember it the next morning, whether you want to or not. But I’m empowered that there’s such great people in this field, and they’re passionate, and I think we’re making a difference.
Denver: Well, Fred Muench, the President of the Center on Addiction, I want to thank you so much for being here this evening. Tell us about your website and what visitors will find there.
Fred: We have two websites right now. The merger is not complete.
I’ll start with www.drugfree.org. That’s the Partnership’s legacy site. We’re merging Center on Addiction and Partnership.
But the Partnership’s site has all the resources for families. And those resources are: How to talk to your kid at any age about substance use? How to navigate the treatment system? What about vaping? And also, do you need to speak to someone? We’re there for you. Do you need to speak with someone with lived experience? We have 400 parent-coaches who have lived experience who will speak with you.
So those resources are there if you come to the website. Please don’t hesitate to reach out directly to our helpline specialists or just get the information you need or bring it to your community.
Denver: Well, thanks Fred. It was a real pleasure to have you on the show.
Fred: Thank You, Denver. I appreciate it.
Denver: I’ll be back with more The Business of Giving right after this.
The Business of Giving can be heard every Sunday evening between 6:00 p.m. and 7:00 p.m. Eastern on AM 970 The Answer in New York and on iHeartRadio. You can follow us @bizofgive on Twitter, @bizofgive on Instagram and at www.facebook.com/businessofgiving.