Post on 03-Jan-2016
Farrokh Alemi, Ph.D., Mary Haack, Ph.D., Susie Nemes, Ph.D., Angela Harge, M.Ed., Heibatollah Baghi, Ph.D. This research was supported by a grant from Robert Wood Johnson Foundation’s Substance Abuse Policy Research Program
Unmet Demand13 to 16 million people in the US need
treatment3 million receive careOnline counseling as a low cost
compliment of face to face therapy
Unmet Demand13 to 16 million people in the US need
treatment3 million receive careOnline counseling as a low cost
replacementreplacement of face to face therapy
Experience with Online SUD ServicesOnline services retention in face to face
treatmentOnline self-help groups healthcare
utilizationGiven a choice, most patients maintain
online and not face to face contact
Experience with Online SUD ServicesOnline services retentionOnline self-help groups healthcare
utilizationGiven a choice, most patients maintain
online and not face to face contact
What Is Online Counseling? Daily email/phone contact
Motivational Interviewing
Weekly relapse prevention assessment On demand peer-to-peer anonymous support Within 24 hours answers to questions Bi-weekly urine tests On demand visits This definition is
different from others
Online counseling Face to face counselingFrequency Near daily Less frequentAvailability On demand By appointmentInitiated by Mostly by provider PatientMethod Motivational interviewing VariesContent Today & tomorrow Varies
No need to duplicate features of face to face therapy. Two different modalities.Different contentDifferent methodsSame outcomes
Delivery ModeFree net appliance installed in patients homesProvided to both experimental and control groupOnly experimental group received 4 months of online counseling
Population ServedEagle Butte
SDNewark
NJ Alexandria
VA Washington
DC
Number of cases 10 30 17 22
Number of experimental cases 5 15 9 10
Referral source Indian Reservation
clinic
Halfway house & drug court
Probation agency
Substance abuse & mental
health clinic
Percent White (not Hispanic origin) 0% 13% 6% 18%
Percent Black (not Hispanic origin) 0% 83% 88% 59%
Percent Hispanic 0% 3% 6% 14%
Percent American Indian 100% 0% 0% 9%
Percent male 40% 10% 71% 50%
Average years of education 12.0 11.9 12.6 12.6
Percent days worked in last 30 days 26% 12% 39% 48%
Percent currently on probation/parole 30% 20% 100% 27%
Percent medicated 10% 20% 12% 32%
Population Served 1. Poor2. Under-educated3. Unemployed4. Psychiatric
problems5. Involved with
criminal justice system
Population Served 1. Poor2. Under-educated3. Unemployed4. Psychiatric
problems5. Involved with
criminal justice system
Random assignmentwithin each
site
No difference in ASI components at baseline
Participation in Face to Face Treatment
Experimental Control
Percent of days in treatment 30 days prior to exit 45% 43%
Percent of clients in controlled environment 30 days prior to exit
21% 21%
No difference in face to face treatment
Study AttritionUrine tests available
on 62% of subjects
Maybe biased
Study AttritionUrine tests available on 62% of subjectsExit surveys available
on 54% of the subjects
Maybe biased
Study AttritionUrine tests on 62% of subjectsExit surveys on 54% of the subjects Either self report or urine test results
75% of subjects
Measurement of Drug Use
TestsLastFirstbetweenDaysofNumber
DaysUseDrugofNumberPu &
30
30 daysLastinUseofDaysP
S
Drug Tests
Self Report
PC =
Pu If only urine tests was available
Ps If only self report was available
(Pu+Ps)/2 If both urine & self report were available
Missing if neither urine or self report was available
Combined
Drug Use
Experimental Control
Daily probability
of useNumber of cases
Daily probability
of use
Number of
cases
Drug Use
Urine tests 8.95% 13 25.35% 14
Self-reported drug use 6.94% 24 7.01% 19
Both 7.65% 29 14.79% 26
Self-reported alcohol use 2.36% 24 1.75% 19
Drug Use
Experimental Control
Daily probability
of useNumber of cases
Daily probability
of use
Number of
cases
Drug Use
Urine tests 8.95% 13 25.35% 14
Self-reported drug use 6.94% 24 7.01% 19
Both 7.65% 29 14.79% 26
Self-reported alcohol use 2.36% 24 1.75% 19
Wide Variations in Results at Different Sites
ConclusionsPatients want computer services & feel
entitled to it, once availableIt is possible to deliver online treatment
to under privileged populationsThere is wide variation in delivery of
online services by different clinicians
Reduces Drug Use