♪ meet cathy, who's lived most verywhere, from zanzibar to barclay square. but patty's only seen the sight, a girl can see from brooklyn heights, what a crazy pair! ♪ cathy: oh my, patty. did you find all your files? patty: finally! who knew it would be this much work when richard and i decided to retire! cathy: well, what are you going to do first? patty: we're heading down to brooklyn heights and start in on that social security paperwork. cathy: why would you do that?

patty: what do you mean? cathy: it's so much easier to log onto socialsecurity.gov and file online. patty: what if i need to know how much money i'll be getting? cathy: online. patty: what if our address changes? cathy: online. patty: what if i want medicare too? cathy: online. patty: so, how did you get so darn smart anyway? cathy: online! ♪ when cousins are two of a kind! ♪ [music] hello, i'm ivette torres.

welcome to another edition of the road to recovery. today we'll be talking about accessing prevention, treatment and recovery services online. joining us in our panel today are ginger bowler, content manager, the second road, charlottesville, virginia; cynthia reinbock, vice president, clinical services, crc health corporation, cupertino, california; eric hellmuth, director of technology and online communications, joined together, boston university school of public health, boston, massachusetts; dr. farrokh alemi, professor of health, systems administration, school of nursing and health studies, georgetown university, washington, d.c. about 23 million people throughout the country have a problem with alcohol or elicit drugs in the united states. only about 4 million of those have said

that they pursued treatment. so that leaves an incredible gap, dr. alemi. what can the online services bring to the need to provide more addiction treatment services? online services can do a great deal. they can reach people that are rural. they can reach people inside cities that have difficulty commuting. i know a lot of psychiatrists that see their patients on the phone. when we talk about online, we don't just think about computers. we think about both phone and computers. but what online services do is not just reach the person. they also change the content of counseling. counselors usually see patients periodically. online counselors see the patients everyday. so the content of what they say, how they say it changes entirely. the other aspect that changes is the type of counseling. usually you do counseling, cognitive counseling.

online counseling is much more oriented, better organized as motivational interviewing and relaxed prevention as opposed to cognitive counseling because motivational interviewing always ends with a question, and therefore you know if the other person has really understood you. and if you imagine that you have daily contact with the patient, then all of a sudden you are in a different ballpark, because if the patient relapses you can find the patient and bring them back in. eric, what is the history of online services? how long have they been around? they've been around really as long as the general public has had access to the online. and before the internet people were dialing up in bulletin boards and bbs services, and then services like compuserve and america online came along and you just dialed in with your modem and you were in that sort of closed off community, and joined together, for instance, had information services

and dial-up and aol health areas. and then when the internet came on strong in the mid 90s; then it really, we saw an explosion of a lot of groups realizing that this was the future and that more and more people were going to access information using convenient tools, but also something that's very different, and that is that they're anonymous. and there's the old saying that on the internet no one knows you're a dog. and you can be who you need to be, but it puts the burden on the individual to be honest; but it's at their own. that's for them to decide. and they can seek the information they need and get the help that they need, and they drive it. cynthia, we're going to go back to really, we've already, dr. alemi has talked about the counseling aspect of online services. what other services can we access online? well, we do counseling services directly.

we actually do the group therapy treatment with the folks who access our site. but there's a lot of research as eric was saying. one of the things that we do since ours is a worldwide site, we have patients from all over the world accessing us. our web site also gives people information about where they can find other resources, who they can call. we have an updated web page on our site that allows people to get the newest and the greatest information about not only resources but drug use as well. and your site is? let's just start mentioning it now: www.egetgoing.com is our adult services and www.teamgetgoing.com for our adolescent services. we're going to be talking a lot more about that in a second, but i want to get to ginger. samhsa has a facility locator where people can actually go online and get services or get transferred to services.

is that something that you think really people should be accessing, because i think that some of the members of the general public says well you know i really don't want to go online and it's something that is a little bit impersonal for me. well, the beauty about going online is, as eric said, is that you can set your own level of anonymity, and the secondroad.org, which is a non-profit platform for peers helping each other in recovery, is just that. and you can state your own level. you can state how personal you want it, how public you want it, and it gives you a freedom that one-on-one counseling or one-on-one treatment does not provide. you're a person in recovery yourself. talk to us a little bit about some of the services that you used before working where you're working now.

well, before i became involved in this organization, my only, i was in outpatient treatment when i first got sober, and then i'm very involved in 12 step programs and individual therapy for many years. so i was able to take advantage of those things, but a lot of people aren't able to take advantage of those things. so before i became involved in the second road it was just what i could access in my geographical location. there are chat rooms. there are teleconferences that people are accessing online. there are web casts that people are accessing online. there's pod casting and, probably, there's going to be a lot more of consumer driven information in there. how do we sort this all out, eric? i think that it's important to understand who

your target audience is, because you can't reach everybody equally well and you have to understand where they are. i think that people who are targeting youth right now need to understand the impact of social networking web sites, like myspace and facebook, and find innovative strategies that are probably peer driven, in my opinion, to exploit the particular strength of that environment. that said, the web is not dead and email is not dead. so i really think that paying attention, close attention, to the audience and making the investment to understand where they are is key. one way to think about all these technologies is to put away the technology and say what the patient experiences. and if there are some technologies that provide information, and there are other technologies that allow the patient to have peer support, and there is a third set of technologies that allow counseling to occur. so these are three different ways of organizing things,

and you can go on different sites and have information, peer support, or counseling. and those will have different implications of what works and what impact it will have. cynthia and i were just talking before the taping. this disease being an equal opportunity killer will present itself anytime, any place, anywhere. and we were just talking about our web sites and how she's had to scale down hers because there's so many things one can do on a web site. when we started ours, we were trying to get the general population, and it's moved into a youth-oriented direction. i was in an aa meeting the other day with senior citizens that said this is an amazing site for senior citizens because we're web savvy. one person was deaf and he said this is a great venue. so all of a sudden i'm think, "oh we have to get something for deaf people, something for senior citizens, something for veterans."

so there's so much more work to be done. you have to limit yourself rather than expanding yourself. that's a real challenge for someone who's thinking about providing web services for recovery and prevention treatment, and dr. alemi's point i think is really salient to understand the purpose of what you're doing. and it's tempting when you have a medium that is so universal and so many people; limitless audiences can reach it in increasingly limitless ways, on a cell phone and on a modem. then it's tempting to try to think, "well, we can just do it all," and your point, your experience is that that's a mistake. and the way to do it, it has to be... i mean if you're going to segment population, certain populations, whether it is in terms of age or gender or other categories, you really, when you're dealing with issues of treatment, you really have to tailor sometimes the service to that particular. but let's start, dr. alemi made a very good point, and my notes went along those lines.

the first point of entry, let's start so that the audience can basically understand. the very first thing that if i'm in trouble and i recognize that i'm in trouble, or let's say that i'm not in trouble. i go in and i'm drinking too much and i go, let me go in and see if i can find a service. is there a service where i can go in and assess whether i have a problem or not, eric? there is, join together built alcoholscreening.org in 2001, and this year we will have our one millionth visitor complete online screen. it uses the audit, which is a standardized assessment instrument, 13 questions. people get very simple feedback about their probable level of risk for the drinking, whether it's likely to be healthy with caveats, or risky for future problems, or probably dependent and then can choose referral to samhsa's treatment locator or other resources as needed. and we have found that people do come in great numbers, but

they also come because they are concerned about their drinking. on the audit, the cut-off score for hazardous drinking is 8, and the average score for alcoholscreening.org is 13. so people do seem to be coming there. we published some research that found that the higher person's score was on the test the more likely they were to click "find help" and to look for a treatment facility. i was going to ask that. i mean i think one of the things that we should not forget is that whoever is looking for help and whoever has a site really has the responsibility to make sure that the person has access to getting that help. and how does the site get the person? in other words, one thing is getting me there. another thing is convincing me that i need to push that button for help. how does that site handle that? well when you first visit the site, it asks a number of typical questions. how much is too much? and how do i know if i have a drinking problem?

so it tries to get into the head of the average person who's asking. and it doesn't gender or differentiate? right. and so the feedback you get is for your age and for your gender, and you get normative feedback about. you find out that 75 percent of the population actually drinks less than you do and that's the kind of preliminary information. it is no substitute for even for online counseling like e get going does. but it's the first, it can be a first stage to find out in a private anonymous setting what really may be going on with your drinking and what you might want to do. very good. when we come back we're going to be talking about more on the youth subject and i want each one of you to describe your particular program so that the audience gets a chance to understand what you do. we'll be right back. [music]

i think there are a number of people who are reaching out to the larger community especially young adults, which, that's an age category. eighteen to twenty five constitutes our the largest proportion-wise area, a group of individuals who are using or misusing alcohol and drugs. so the internet offers that opportunity. it allows us to deal with underserved populations including those in remote geographic areas. now, will it give us a better advantage in the long run? we don't know yet. it's new. but there's tremendous amount of hope. veterans organizations are using online supports. clinical groups are using it. people are using the internet for followup. i know several prominent treatment programs that have geographically dispersed. clients are using the internet so that people can, do follow up so that it's not just 28 days and see ya.

there is an opportunity to interact with providers. and you can also with the internet do your followup over a much longer period of time. you don't have to fly back and forth. you don't have to drop out of work for a day. you can talk to somebody. it's not a substitute for a one-on-one. it's an augmented supplement, and in some cases where there is no opportunity for a one-on-one interaction it offers you some assistance when you need it. people who suffer from drug or alcohol addiction sometimes say hurtful things. they drive the people who love them most away. if you know someone who suffers from drug or alcohol addiction, listen. try to hear what they are really saying. know that there is hope and help them find their voice again. for drug or alcohol treatment referral for you or someone you know, call 1-800-662-help.

brought to you by the u.s. department of health and human services. people trapped by drug or alcohol addiction often feel like there's no hope, no way out. but for every lock there's a key. and if you have a problem it's good to know there are real solutions to help you get free. for drug or alcohol treatment referral for you or someone you know, call 1-800-662-help. brought to you by the u.s. department of health and human services. [music] well, kentucky river community care we serve a rural, eight-county region in southeastern kentucky, and

often times our offices and our resources are spread throughout a wide geographical region. so logistically this makes it difficult often times for our clients to travel to access the services they need. our system consists of a video camera attached to a personal computer, which then sends the video signal over a secure internet connection. we also use a digital voice phone system, which greatly enhances the sound quality of the conversation between the provider and the client. now when we first start you on this medicine, we had a little bit of nervousness and maybe a little bit of depression. has that been affected by the medicine at all? yeah, actually it has. i was, before i started taking it, i was anxious all day and always... by using this system our clients are able to travel shorter distances and access to services or providers they

are in need of, and they do not have to wait for a particular person to travel to that area to see them. [music] you know when i was arrested and i was put in jail, i thought my life as i know it is dead and my life as i knew it was dead because i was still in active addiction then. i was still stealing pills from people's bathroom and just in active addiction. and so what i didn't realize was that my life as i knew it was dead. and now i have a whole new life and an identity that is real and honest that i can tell you about without shame or guilt.

and i've been introduced by the grace of god to this wonderful thing called recovery. and it has changed... it's given me my life. that's a phrase that you hear over and over and over again, and it seems very trite but it's very true. it gave me not my life back but it gave me my life. ginger, talk to us about the second road. if i were just to go on the site, what would i find? you would find an amazing web site that is run by people in recovery for people in recovery. it's a platform. it's just a platform where people in recovery can dialog with, connect with people who wonder if they have a drinking or alcohol or substance abuse problem, are in recovery or are clean and are at the point where, okay i'm clean and sober, now what do i do next. how do i maintain this? we also have a friends and family site for people who have loved ones, friends addicted.

when you go to the site, it looks like a drive in movie theater. it's not typical blocks. it's just adorable. and we have videos that rotate constantly. we have 100 stories of people's journey through addiction and recovery, and you can click on any one that you want and get a five minute segment. we've edited them all. there are options to read. we have people like william cope moyers, the author of broken logs, for us. we have martha woodruff who's an npr reporter. dr. alan berger writes a column. and then, we have chat rooms and we encourage... our drive right now is to encourage people to design their own chat rooms for their own group so they can have... we have teens, texas teens. teens in recovery has a chat room. so you can invite anyone to your chat room. there's an open forum for chats on the front page. there is an experts exchange where you can get this kind of

information, where you can just get educational information. but mostly this is a social networking interactive site for people in recovery helping others. and is it free? it's totally free. very good. it's totally free. we're on a major marketing drive right now to get sponsorship and membership levels, but it is totally free. excellent. and cynthia, talk to us about e get going and teen get going. either site if we start with teen get going, if you were a parent and you had some questions about, well, i found something in my son or daughter's room. let me see what this is. you can go on the teen get going site and there's a parent's page that you can sign up for. you can go on. it's all information about what a drug looks like, what are some of the signs and symptoms that the individual is using that particular substance and what you might want to do about it. there are different things for the adolescents who visit our site, the youth that visit our site. there is games. we have a drunk driving game, like how to drive a car when you're under the influence, two, three, four drinks.

what does the car do? and their reaction time is taken into consideration and they see it right away. there's different blogs that they can get on. there's also all of the information regarding different youth and drug services. what's happening right now in the drug services world? how could they get help. what's actually, what's the new research say about cocaine in the youth's brain, brain development, things like that. so it's all there and it's all oriented toward the individual. e get going is the same way. you go onto the e get going site. you have questions. i have a friend who might be in trouble. i'm a family member. again, there is information about drugs, specific drugs of choice, what the consequences of use may be. both of the sites have free assessments that they can take, and something eric said, too, is about we've kind of looked at folks how many times they come back to the site because in order to use the site they can either do it anonymously or they can use their own name, a name that they make up.

and what we found is some folks will come back two, three, four, five times to take that assessment one more time just to be sure they're seeing the right thing. and they're remarkably truthful, which was something else i have always found fascinating. they're truthful about what their use is and their results are pretty much the same. those are all free services. they can also say if they want to talk to an individual; they're thinking maybe now is the time. there's a toll free number they can call and actually talk to one of our national resource center folks, too. so that's another way to do it. and i know for a fact that you are a for-profit corporation. so where does the for-profit side come into the equation? excellent question. when a person decides that they would like to join a group, first they're assessed and screened by my intake people, my intake counselors. if they choose to participate, it's $1200. that's basically for 2 sessions a week plus treatment planning sessions, plus one-to-one sessions with their counselor

over a 3 month period or 24 sessions, 2 times a week, same counselor, same time every week, and any of the ancillary needs like court letters. and how does that work? does the person actually get to see the counselor if they have one of the little cameras on the computer, or is it via phone? how does the session work? another great question. when you come into our group, you actually log into a private home page. we are a secured site. so they have a security link in order to get in, with a user name and password. their home page allows them literally to push a button and drop into a group. the group that they see, this is a virtual group, so everybody's online at the same time. they see their counselor on their computer screen. and i don't mean to stick with you but one more question and then we'll move on. sure. do you deal with co-occurring conditions? yes, we do. and i will tell you if there's a co-occurring disorder and an individual is perhaps on medication for that disorder, we have a release of information to

the physician who is prescribing. so if my counselors see or hear anything, they're immediately on the phone with this individual to make sure that they are also aware of changes that we're hearing and dialog. well, cynthia, i'm going to come back to you. but now i want to go to dr. alemi. how does the sid work? have we done any research to figure out whether this system of getting services and information and blogging does work or not? that's a very complex question to answer because early on we were asking the same kinds of questions, does it work? but later on as the research got more mature, the question became for whom does it work, not whether it works or not. and what kind of intervention works? for example, i know e get going has done studies that shows that it works. we did our own study on telephone conferencing groups in synchronous time and it didn't work. so that seems to work.

this doesn't seem to work. a lot of people are doing assessment. assessment seems to work. people are truthful in their assessments on the computer. in fact, they are more likely to be truthful now. about 30 years of research shows that they are more likely to be truthful on the computer than with a human being, with their own clinician. now does treatment itself work, not information exchange, but treatment itself work. that's even more complex because it requires a relationship. and do we establish relationships online. the answer is unquestionably. if you have frequent contact, you do establish a relationship, even if you're anonymous. so your counselor knows you. you know your counselor. every day, you have exchanges or nearly daily exchanges, then yes, it absolutely works if that's the frequency.

less frequency, no, it doesn't work. there is no relationship. eric, you were saying that boston university has also done some research through join together in terms of some of the services that you offer. what have you found? we extended alcoholscreening.org for a study with boston university freshman, and we were able to get 55 percent of the class one year to participate in going to an extended version of that site that added some brief motivational interviewing feedback specific to college students. so we would tell them how many sticks of butter and calories their drinking would be. and we found that 30 percent of them did have drinking that was hazardous, and 85 percent came for a 1 month followup and found that there were some modest but real and statistically significant reductions in the self reports of hazardous drinking, particularly with the females. so that was early evidence that if you add an automated brief motivational interviewing for people who are in the early side of the continuum.

this is not treatment. on the road to recovery might start with identification; but if you're starting early, it provided some interesting, tantalizing evidence that you might be able to change some behavior early, before it gets worse. well, when we come back i want to go into the whole issue of prevention, because i think there's a big role for online services to play in that area, and we'll talk about the parents' role and how the youth are connecting. we'll be right back. [music] mornings used to be the toughest. before i got treatment for my addiction, it was the little things that were hardest to bear. but now that i'm free of drugs and alcohol, it's the little things that give me the most joy.