farrokh alemi, ph.d. video introduction. online substance abuse treatment 1. motivational counseling...
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Farrokh Alemi, Ph.D.
Video Introduction
Online Substance Abuse Treatment1. Motivational counseling
2. Relapse prevention
3. Peer to peer support group
4. Routine urine or hair tests
5. Limited clinic visits
Component 1 of online treatment:
Motivational Counseling Short, near daily Individualized auto-prompts 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.
No Shame
Patients are more likely to report controversial issues to a computer than to a human being
Real FeelingsOnline counselors have more contact and lasting relationship with their clients
56% of messages had
emotional content.
Component 2 of online treatment: Relapse Prevention Weekly risk assessment Automated analysis
Phone call Family re-engagement Change in treatment modality
Component 3 of online treatment:
Online or On-Phone Support Peer to peer Confidential 8 times more attendance Group norm & solidarity
Component 4 of online treatment:
Laboratory Tests Routine Not punitive
Component 5 of online treatment:
Office Visits Available on demand Initiated by clinician or patient Limited in number
Coming Up
Does it work?
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.
82 pregnant patients with cocaine addiction
Peer to Peer SupportReduces Utilization
53 recovering parents of infants Randomly assigned 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.
Patients PreferOnline Counseling
~300 recovering patients Central intake, referred to both 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.
Reminders Change Patients’ Behavior
213 mothers of infants
Urban clinic 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.
Online Services to Homeless Patients
Study of ImpactPatients asked
in 4 States
79 Signed Consent
39 Usual Care + Computer
40 Online Care + Computer
17 Completed Exit Interview
26 Completed Exit Interview
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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