Farrokh Alemi, Ph.D. Video Introduction. Online Substance Abuse Treatment 1. Motivational counseling 2. Relapse prevention 3. Peer to peer support group.

Farrokh Alemi, Ph.D.

Video Introduction

Online Substance Abuse Treatment1. 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 Short, near daily Individualized auto-prompts 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 FeelingsOnline counselors have more contact and lasting relationship with their clients

56% of messages had

emotional content.

Component 2 of online treatment: Relapse Prevention Weekly risk assessment Automated analysis

Phone call Family re-engagement Change in treatment modality

Component 3 of online treatment:

Online or On-Phone Support Peer to peer Confidential 8 times more attendance Group norm & solidarity

Component 4 of online treatment:

Laboratory Tests Routine Not punitive

Component 5 of online treatment:

Office Visits Available on demand Initiated by clinician or patient Limited in number

Coming Up

Does it work?

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.

82 pregnant patients with cocaine addiction

Peer to Peer SupportReduces Utilization

53 recovering parents of infants Randomly assigned 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 PreferOnline Counseling

~300 recovering patients Central intake, referred to both 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

213 mothers of infants

Urban clinic 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.

Online Services to Homeless Patients

Study of ImpactPatients asked

in 4 States

79 Signed Consent

39 Usual Care + Computer

40 Online Care + Computer

17 Completed Exit Interview

26 Completed Exit Interview

Online Counseling May Reduce Positive Urines

Alemi F, Haack M, Nemes S, Harge A, Baghi H. Impact of online counseling on drug use: a pilot study. Qual Manag Health Care. 2010 Jan-Mar;19(1):62-9.

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