Friday, August 21, 2009

Can we get our recovery online?

The world is changing - rapidly. Our use of electronic devices and media are increasing at a dizzying pace. People all over the world are connecting with each other via regular email, Facebook, Skype, and now Twitter. There are literally millions of videos to find on YouTube. Students are studying and completing degrees at on-line universities. Physicians are routinely providing care to their patients via emails.

And recently a study in this year’s Journal of Substance Abuse Treatment explores the effectiveness of providing intensified substance abuse counseling using an Internet based videoconferencing platform. Dr Van King and his colleagues at Johns Hopkins University studied patients at a local Methadone Treatment program who had been failing at treatment and were having positive urine drug screens. The patients were being moved up to a more intense treatment, consisting of their usual weekly individual therapy session, plus two additional relapse prevention therapy sessions. Half of them received their extra therapy via “on-site’ counseling and the other half received their more intense counseling via a video link. In the video counseling, the participants could see the therapist but not the other participants. The therapist could see all the participants.

The results were impressive. The outcomes were the same in each group – marked reductions in drug use, and good attendance rates at the therapy sessions. The video therapy group reported a greater satisfaction with their therapy, because of the extra convenience.

However, this was the first study of this type and it was a small study consisting of only 37 patients. It was also a study of patients on methadone maintenance who had regular face to face time with their treatment providers. They had to show up to the clinic every day to receive their medication. They were also still having face to face sessions with a therapist every week. So it is hard to know how these results would generalize to other substance abuse situations. Could video counseling work with a regular Intensive Outpatient Program (IOP)?

These new ways of doing things challenge us to grow and learn more. Sometimes the road less travelled really does work better. Sometimes of course it leads to a dead end. More often, the road less travelled works well for some people but not for others.

As I see it, new electronic and internet systems can be quite helpful in a number of situations, but in most situations these systems shouldn’t replace face to face medicine or counseling. For me, practicing medicine is almost always best done face to face and in real time. The personal interaction with a patient is very important to me and I think this interaction is invaluable in terms of fully assessing a situation, making a diagnosis, communicating that to a patient, and getting agreement and commitment from the patient. This is even more important when it comes to substance abuse medicine, and especially important in an individual or group therapy situation.

I know that some alcoholics are getting their recovery at Alcoholics Anonymous chat rooms, but I just can’t believe that this works as well as a live meeting. There is something about going to the effort to get out of your house, meeting up with other recovering people, hearing a live discussion, and feeling real emotions. At a live meeting there is also the opportunity to help out and chat with other people after the meeting.

On the other hand, we have patients who live in very remote parts of the country or have such overwhelming commitments to family that they really can’t get to live therapy or meetings. For these people chat rooms or video therapy can be a useful adjunct. There are other people who really enjoy interacting over the internet, and get a lot out of this interaction. I think that for these people, internet chat rooms can be quite helpful, but I still think they need to complement this with live interactions.

We believe that these online, internet base interactions can be a useful adjunct to our patient’s recoveries. We are even in the process of setting up some chat rooms for our patients and their families. We believe that while this can be a useful aid to recovery, it should not replace actual therapy or live support groups.

I would love to hear your opinions on this timely issue. Please visit our chat room and let me know your opinion.—insert address and ? password here.

Peter Coleman MD

1 comment:

  1. is one organization that offers online therapy for addicts in recovery- also there are several examples of aftercare counseling being done in virtual worlds like second life.