***Trends In Using the Internet to Provide Help For Substance Use Problems

Treatment for people with addiction problems, particularly in a residential rehab, is notoriously expensive. The fees for such treatments often run into thousands of pounds or dollars a month. Unfortunately, most people who have addiction problems cannot afford such expensive treatments, and so have to go without this kind of help. Recent developments on the internet have brought a new range of treatments that are more within the price range of those who need them. This article will review some of the web-based services for alcohol problems and their costs.

The first use of the internet for addiction problems was primarily using the internet as an advertising medium. Treatment agencies would create a webpage advertising their services with contact details. Typically the treatment provider’s website would give contact details and treatment would continue to be provided as before, it could be residential or non-residential on either a face to face basis or through telephone counselling. The cost of residential treatments varies enormously, with figures of up to $20k (£10k) for a month at the most expensive end. Non-residential treatment is, of course, cheaper with cost of face to face treatment averaging around $100 (£50) and telephone counselling around $80 (£40), although these charges can be much higher. Using the internet in this way was a marketing decision and had little to do with innovative new therapies. All it did was make the same services available at the same price, but reduced the costs for advertising and gave the agencies a global customer base. Many treatment agencies have not progressed any further than this, although some now use their websites to give useful information and provide assessment tools.

The next feature of the Internet to be exploited was e-mail. Therapists can now use e-mails to communicate with their clients and provide treatment. Normal procedure consist of the client writing a long e-mail about his problems or her thoughts and concerns. The therapist then answers these e-mails, giving advice or suggesting a course of action for the client to pursue. Some therapists utilise chat rooms or instant messaging, to make the process more immediate and interactive and more resembling a counselling session. One criticism that might be made of this method is that it is reinventing telephone therapy, but in a much slower more cumbersome method. However it does allow the client to be anonymous and so may attract many clients who would be appalled at the thought of a face-to-face, or even a telephone, interview. The cost of e-mail therapy varies. Some therapists charge by the e-mail and some insist that you buy a minimum number of e-mail sessions. Average costs tend to be around $40 to $60 (£20 to £40) for an e-mail or $150 to $200 (£75 to £100) for a bundle of e-mails. Like most methods of therapy, e-mail therapy tends to be open ended, so the final cost to the client is difficult to predict.

Another method of using the web is a logical progression of the above. A website is created that offers assessment tools and feedback from these tools. The strength of this method is that drinkers can assess themselves using validated tools and find the answer to the question “Do I have a drink problem?”. Thus it makes drinking a live issue by providing assessments and brief advice, a positive step. However, the downside is that, in reality, the website is merely acting as a calculator by giving stock answers, albeit according to the drinkers score. Currently there are few of these initiatives around. The ones that do exist are mostly research projects, or are found on college internets as part of the health education package for students. However this initiative is set to become much more common as government organisations start to see this as a legitimate use for their health education budgets.
A more innovative method is the creation of a private network through teleconferencing. By providing some basic technology (webcam, microphone and software), group therapy can be offered over the net. Obvious benefits are that people can remain at home and do not need to physically attend the group, so they can retain their anonymity. Geography is not an issue, people in a remote area can receive treatment or alternately they could choose to attend a group with people from another area, to preserve their privacy. This is almost certainly set to be a growth area, as it removes some of the barriers to treatment initiation but retains the traditional familiar feel of what people expect treatment to consist of. In terms of cost, it is much cheaper than the cost of conventional treatment, especially residential treatment. However it is still not cheap. Typically, a course of treatment would cost $400 (£200) a month with a recommendation of three months minimum. However, even signing up for three months $1200 (£600)is a considerable saving on a residential rehab.
The most recent method takes a much less ‘medical’ approach than the others. Recent research shows that most people (around 80%) who recover from addiction problems, do so without the aid of treatment, including AA. Reasons commonly given for not seeking treatment are, stigma of being called an alcoholic, shame and not wanting to attend a doctor or AA. Given these reasons the internet becomes incredibly attractive. It allows privacy and anonymity and there is no requirement to attend. However what the treatment providers using the internet have not addressed is that this large group are changing without a medical input. They are gathering and using their own resources, something considered impossible until recently. This new approach recognises that the drinker has strengths, that their identity is not defined by their addiction. For example this approach states that instead of stating “I am an alcoholic” it suggests “I am John, Ann or whatever, I am many things, a husband, a father, a sister, a nurse, a friend AND I drink too much”. Thus their drinking is only a part of a whole person. This approach states that if we give you the tools you can change yourself. The internet is ideally suited for this approach as it allows the use of custom built genuinely interactive assessment tools, information on alcohol and how to change provided in a text, audio and video formats, evaluation tools and a journal to chart progress and the opportunity to interact, or not, with others. Currently there is only one site of this type, www.247helpyourself.com and it costs $79.95 (£39.95) month, $279.95 (£139.95) for 4 months.
There is little doubt that the internet is already important in our lives and is set to become more so. The opportunities to provide treatment, advice and support for many conditions, including addictive behaviours, are exciting. However, if they are going to be effective we need to take account of what people need or want. We also need to utilise the strengths of the internet to provide better types treatment, rather than just providing the same old treatment in a different environment.