1. For more information contact Alemi at 703-993 4226 falemi@gmu.edu

2. Coming Up n How to care for patients online? n Does it work? n Why management matters?

3. How to Treat Substance Abuse Online n Motivational counseling n Relapse prevention and monitoring n Peer to peer support group n Routine urine or hair tests n Limited clinic visits Return to Index

4. Component 1 of online treatment: Motivational Counseling n Short, 3-4 times a week n Message broadcast to patients in same stage of illness n Individualized conversation aimed at self insight n Patients who progress are moved to new stages We have developed and tested detailed protocols of care

5. No Shame Patients are more likely to report controversial issues such as substance abuse, sexual abuse, suicidal thoughts, sexual dysfunction, etc. to a computer than to a human being

6. Real Feelings Online counselors have more contact and longer lasting relationship with their clients than face to face counselors. In discussion groups, 56% of messages had emotional content.

7. Component 2 of online treatment: Relapse Prevention n Weekly risk assessment n Automated analysis n Counselor actions: u Face to face visit u Family re-engagement u Increased contact u Change in treatment modality

8. Component 3 of online treatment: Electronic Support Groups n Peer to peer n Confidential n 8 times more likely to be attended n Group norm & solidarity n Participation affects behavior

9. Component 4 of online treatment: Laboratory Tests n Routine and part of “one day at a time” philosophy n Not punitive n Data plotted and provided back to patients n Used in counseling to enhance motivational interviews

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

11. Coming Up Patients’ reactions to online treatment and results of clinical studies

12. Online Services Improve Compliance n 82 pregnant substance abusing patients n 1.5 times more likely to be in treatment n 1.7 times more likely to use self care

13. Peer to Peer Support Reduces Utilization n 53 recovering parents of infants n Randomly assigned n Changes in utilization over 4 months

14. 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

15. Reminders Change Patients’ Behavior n 213 mothers of infants n Urban clinic n Computer call before each scheduled appointment

16. Ongoing 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. ASI Values at Baseline n No difference in any of the following indices u Alcohol use u Drug use u Family problems u Legal problems u Employment problems u Medical problems u Psychiatric problems

18. Change from Baseline to Follow-up

19. Coming Up Management matters: how online treatment requires new business and clinical processes

20. Care and Technology Are Linked n Technology leads to new care processes. n Technology changes the objectives of the care You can’t take a care for a walk You have to take it to new destinations

21. Key Practice Differences

22. More Key Practice Differences

27. Summary of Changes n New gatekeepers n Focus on one disease n Out of sight is not out of mind n Subcontractor to existing HMOs n Low capital costs n Small numbers can be profitable n Patient expectations and behavior will change