Farrokh Alemi, Ph'D'

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Farrokh Alemi, Ph.D. Angela Harge
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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 isdifferent from others
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• Not replacement but two different modalities
• Different content, different methods, pursuing
  same outcomes

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Population Served

• Poor
• Low education
• Dual diagnosed
• Homeless
• Court involved
• On probation
• Addicted to illegal drugs

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Delivery Mode

• 1990s studies Computer services delivered
  through Interactive Voice Response
• 2000s studies Free net appliance installed in
  patients homes

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Peer Support Reduced Visits

• 53 recovering parents of infants
• Randomly assigned
• Less attrition online
• Real emotions
• Reduced use of service over 4 months
• Same health status

Alemi F, Mosavel M, Stephens RC, Ghadiri A,
Krishnaswamy J, Thakkar H. Electronic self-help
and support groups. Med Care. 1996 Oct34(10
Suppl)OS32-44.
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Reminders Increased Visits

• 213 mothers of infants
• Urban clinic
• Reminders
• to keep appointment
• reschedule missed appointments

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 Oct34(10 Suppl)OS45-51.
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Online Relapse Prevention

• Recovering drug users contacted weekly
• Prospective not after the fact
• Asked to call in, otherwise called by computer
• Asked 25 questions, including Have you visited
  a place where you used before?
• Client reaction at end of program You have
  mothered us for months. How dare you stop?

Alemi F, Stephens R, Parran T, Llorens S, Bhatt
P, Ghadiri A, Eisenstein E. Automated
monitoring of outcomes application to treatment
of drug abuse. Med Decis Making. 1994
Apr-Jun14(2)180-7.
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Different Population Reached

• 240 TARGET city patients
• Referred to both face to face online services
• Online reaches clients not available for face to
  face

Mosavel M. The Role of Technology in Mediating
Drug Abuse Treatment. Journal of Social Work
Practice in the Addictions, Vol 4 (2) 2004, p
65-83
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More Online, More in Treatment

• 82 pregnant substance abusing patients
• 1.5 times more likely to be in treatment
• 1.7 times more likely to use self care

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 Oct34(10
Suppl)OS10-20.
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What did not work?

• Simultaneous group therapy on telephone lines
• Too many crisis
• Too few kept time
• Too much noise in background

Alemi F, Jackson M, Parren T, Williams L, Cavor
B, Llorens S, Mosavel M. Participation in
teleconference support groups application to
drug-using pregnant patients. J Med Syst. 1997
Apr21(2)119-25.
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Impact of Online Therapy

• 81 clients randomly assigned
• Net appliances not sold
• Variations in effectiveness (differences not
  significant)

Alemi F, Haack M, Nemes S, Harge A, Baghi H.
Online Substance Abuse Treatment a Pilot Study
of Effectiveness. In review, 2005
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Panel Size of Counselors

• Online 300 patients
• Unpublished data that needs to be duplicated
• Face to face 20 patients

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What We Know?

• Patients want computer services feel entitled
  to it, once available
• It is possible to deliver online treatment to
  under privileged populations
• Online treatment affects use of services
• Attrition is lower in online treatment
• Outcomes maybe better or worst
• More studies are needed.
• Costs are drastically lower

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Careers in Online Therapy

• Entrepreneurs needed
• Not for risk averse individuals
• Hangout around universities
• Grant funded activities
• Marketing Savvy is needed
• 80 of costs