Online Substance Abuse Treatment 1. Motivational counseling 2. Relapse prevention 3. Peer to peer support group 4. Routine urine or hair tests 5. Limited clinic visits
Component 1 of online treatment: Motivational Counseling n Short, near daily n Individualized auto-prompts n Leading to self insight Alemi F, Haack MR, Nemes S, Aughburns R, Sinkule J, Neuhauser D. Therapeutic emails. Subst Abuse Treat Prev Policy. 2007 Feb 16;2:7.
No Shame Patients are more likely to report controversial issues to a computer than to a human being
Real Feelings Online counselors have more contact and lasting relationship with their clients 56% of messages had emotional content.
Component 2 of online treatment: Relapse Prevention n Weekly risk assessment n Automated analysis u Phone call u Family re-engagement u Change in treatment modality
Component 3 of online treatment: Online or On- Phone Support n Peer to peer n Confidential n 8 times more attendance n Group norm & solidarity
Component 4 of online treatment: Laboratory Tests n Routine n Not punitive
Component 5 of online treatment: Office Visits n Available on demand n Initiated by clinician or patient n Limited in number
Online Services Improve Retention in Treatment Alemi F, Stephens RC, Javalghi RG, Dyches H, Butts J, Ghadiri A. A randomized trial of a telecommunications network for pregnant women who use cocaine. Med Care. 1996 Oct;34(10 Suppl):OS10-20. n 82 pregnant patients with cocaine addiction
Peer to Peer Support Reduces Utilization n 53 recovering parents of infants n Randomly assigned n Changes in utilization over 4 months Alemi F, Mosavel M, Stephens RC, Ghadiri A, Krishnaswamy J, Thakkar H. Electronic self-help and support groups. Med Care. 1996 Oct;34(10 Suppl):OS32-44.
Patients Prefer Online Counseling n ~300 recovering patients n Central intake, referred to both n Online counseling included support group, home monitoring, average of 3 contacts per week Mosavel M. The use of a telephone-based communication tool by low-income substance abusers. J Health Commun. 2005 Jul-Aug;10(5):451-63.
Reminders Change Patients Behavior n 213 mothers of infants n Urban clinic n Computer call before each scheduled appointment Alemi F, Alemagno SA, Goldhagen J, Ash L, Finkelstein B, Lavin A, Butts J, Ghadiri A. Computer reminders improve on-time immunization rates. Med Care. 1996 Oct;34(10 Suppl):OS45-51.