1. Farrokh Alemi, Ph.D. Video Introduction

2. 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

3. 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.

4. No Shame Patients are more likely to report controversial issues to a computer than to a human being

5. Real Feelings Online counselors have more contact and lasting relationship with their clients 56% of messages had emotional content.

6. 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

7. 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

8. Component 4 of online treatment: Laboratory Tests n Routine n Not punitive

9. Component 5 of online treatment: Office Visits n Available on demand n Initiated by clinician or patient n Limited in number

10. Coming Up Does it work?

11. 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

12. 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.

13. 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.

14. 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.

15. Online Services to Homeless Patients

16. Study of Impact Patients asked in 4 States 79 Signed Consent 39 Usual Care + Computer 40 Online Care + Computer 17 Completed Exit Interview 26 Completed Exit Interview

17. 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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