May 4, 2013Presented byPaul Radkowski, MTS(PC), IAAOC, OACCPP, IAMFCFounder/President/Clinical Director, PsychotherapistMo...
Paul Radkowski, MTS(PC),OACCPP, IAAOC Psychotherapist, CEO, Life Recovery ProgramIn addition to his extensive work in Addi...
Overview1. What is a “Digital Future”?2. Gap Analysis3. Types of Web Based Modalities4. Pros & Cons of Online Intervention...
Myths- Assumptions of theInternet1. Who is using internet, e-counselling, an onlineforum for after care or support? i.e. t...
Being Current is the New Currency24/7Problem24/7Solutionwww.liferecoveryprogram.com
Centre of Addiction & MentalHealth “Digital Future”Alcohol and Drug Problems:A Practical Guide forCounsellors (CAMH Press)...
A web-based intervention is:A primarily self-guided intervention programthat is executed by means of a prescriptiveonline ...
Based on this definition, three broad web-basedintervention subtypes are identified:1. Educational Web-basedinterventions2...
Example: EducationalSAMHSA – Substance Abuse Mental Health ServiceAdministrationHttp://www.samhsa.gov/prevention/NIDA – Na...
Example: Self-guided1. MoodGYM – www.moodgym.anu.edu.au2. Internet Beating the Blues –http://www.beatingtheblues.co.ukBoth...
Example: Human Supported Structured behavioural change content i.e. e-lessons and includes partial human support via: E-...
Key Components for Web-basedInterventions1. Program Content2. Multi-media use/choices3. Provision of interactive online ac...
Not to be confused with:Internet Supported Interventions1. Online Counselling – email, chat, video-based2. Internet-operat...
Examples: the more interactivethe more the usageMulti-media programs Panic Center – www.paniccenter.net – primarily text-...
Gap AnalysisThe ratio of treated to untreated problemdrinkers is estimated to be anywherebetween 1 in 3 and 1 in 14, even ...
“National Co-morbidity ReplicationSurvey 2005” – U.S. & OntarioCan you guess how long it takes for the average personWith ...
What does this mean? 1/5 to 1/4 N. Americans will have a serious mentalillness or addiction $51 billion is the estimated...
Estimated World Prevalence ofConditions:Type ofConditionWorldPrevalenceUnited StatesPrevalenceNicotineAddiction1.4 Billion...
Global CostCost of Smoking, Drug Abuse andAlcohol Addiction WorldwideDrug Abuse- $900 billionSmoking- $400 billionAlcoh...
Access & Funding Regardless of Canada’s current access issues only one-third ofthose who need mental health services in C...
Stigma Just 50% of people would tell friends or coworkers that they have afamily member with a mental illness, compared t...
How Long is the Average Wait List?Privately Funded Beds?Publicly Funded Beds?www.liferecoveryprogram.com
Addictions, Trauma & Mental Health are hereto stay. The internet is also here to stay.www.liferecoveryprogram.comCanadians...
What Percentage of U.S. Adults Are Searching for Health-Related Information on the Internet?www.liferecoveryprogram.comhtt...
Percentage of Australians Who Are Searching for Health-Related Information on theInternethttp://www.pewinternet.org/Report...
Question....?What do you feel are some of thedownsides of web basedinterventions?www.liferecoveryprogram.com
Evidence-Informed Decision MakingInteragency ConnectionsCanadian Institutes of Health - www.cihr-irsc.gc.caMcMaster Univ...
PICO QuestionPopulationInterventionComparisonOutcomewww.liferecoveryprogram.com
LRP PICOIn adults seeking addiction treatment, how does on-line treatment and support (trauma informed, combinesMH & Addic...
Finding the Best Evidence - 5Swww.liferecoveryprogram.comEvolution of Services- Adapted from: Haynes, R. Brian. (2007). Of...
Summaries(E.B.Guidelines,Texts)Synopses ofSynthesesSyntheses (systematic reviews, meta-analysis)Synopses of Single Studies...
Main databases used: Pubmed Guidelines Clearing House Health-evidence.ca Cochranewww.liferecoveryprogram.com
Examples of Keywords Used Online treatment* Addiction* AND online treatment* Mental health* AND online treatment* Trau...
Findings- Systematic Reviews1. A meta-analysis of the effects of Internet and computer-basedcognitive-behavioral treatment...
Findings Continued1. Computer-delivered interventions for alcohol and tobacco use: a meta-analysis S.Rooke, E. Thorsteinss...
Findings Summarized1. In general, computerized or IBIs for depression and anxiety areyielding effect sizes that are compar...
Question...?What are some of the upsides ofweb based interventions?www.liferecoveryprogram.com
24/7 Problems Require 24/7Solutions https://www.liferecoveryprogram.com/AboutLRP/Media/0/0/0Mary Ann & Corey- Saving Lives...
SAMHSA Announces A Working Definition of "Recovery" FromMental Disorders And Substance Use Disorders“A process of change t...
CAMH- Strong Evidence for Web BasedInterventions“One of the primary challenges in health behaviour change is to Promoteacc...
Q & A1. What is a “Digital Future”?2. Gap Analysis3. Types of Web Based Modalities4. Pros & Cons of Online Interventions5....
A summary article on today’spresentation http://www.drugfree.org/join-together/addiction/internet-changing-addiction-trea...
Please join our community andshare your voice… https://www.facebook.com/LifeRecoveryProgram# https://twitter.com/paulrad...
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“Digital Future- How the Internet is Changing the Landscape of Addiction & Mental Health Services- 24/7 Problems require 24/7 Solutions”

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Although not a replacement to traditional treatment or counseling, web-based programs are proving to be an innovative and powerful approach to effectively reach those with addiction and mental health issues. A cost benefit analysis and overview of this trend as well as peer reviewed studies will be discussed.

Learning Objectives
- To provide current trends and research regarding online programs
- To explore ways of integrating online modalities with existing resources
- To discuss the advantages and limitations of web based programs

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“Digital Future- How the Internet is Changing the Landscape of Addiction & Mental Health Services- 24/7 Problems require 24/7 Solutions”

  1. 1. May 4, 2013Presented byPaul Radkowski, MTS(PC), IAAOC, OACCPP, IAMFCFounder/President/Clinical Director, PsychotherapistMonique Peats, MTS(PC), MSW, RSW, OACCPPCo-Founder/Director of Operational Services, Psychotherapistwww.liferecoveryprogram.cominfo@liferecoveryprogram.com
  2. 2. Paul Radkowski, MTS(PC),OACCPP, IAAOC Psychotherapist, CEO, Life Recovery ProgramIn addition to his extensive work in Addiction, he has consulted with numerous agencies, hospitals andtreatment settings working with groups, families and individuals as a Family and Marriage Therapist, CrisisCounselor and Trauma Specialist. Paul is the recipient of "Outstanding Addictions Professional Award"which was awarded by the International Association of Addiction & Offender Counselors and the very firstrecipient of the Ontario Association of Consultants, Counsellors, Psychometrists & Psychotherapists"Recognition Award for Outstanding Service and Contribution in the Field of Mental Health“Monique Peats, MTS(PC), OACCPP, MSW, RSW Psychotherapist/Clinical Manager , Life Recovery ProgramMonique, a Psychotherapist, has over fifteen years of clinical experience which includes private practice,hospital, university, community and agency settings. She is a trained crisis/trauma counsellor. Her broadscope of experience and training enables her to provide an expansive range of expertise,perspective and skill from a holistic paradigm. She is the co-founder of the internationally awardedonline wellness recovery program platform, the Life Recovery Programwww.liferecoveryprogram.com
  3. 3. Overview1. What is a “Digital Future”?2. Gap Analysis3. Types of Web Based Modalities4. Pros & Cons of Online Interventions5. Research Methods & Finding the “Best AvailableEvidence”6. P.I.C.O. Question & Databases Searched7. Research Findings8. Q & Awww.liferecoveryprogram.com
  4. 4. Myths- Assumptions of theInternet1. Who is using internet, e-counselling, an onlineforum for after care or support? i.e. texting withclients?2. What are assumptions on internet modalities?www.liferecoveryprogram.com
  5. 5. Being Current is the New Currency24/7Problem24/7Solutionwww.liferecoveryprogram.com
  6. 6. Centre of Addiction & MentalHealth “Digital Future”Alcohol and Drug Problems:A Practical Guide forCounsellors (CAMH Press)4th Edition “Digital Future”chapter• Has been used as a course textbook in bothgraduate and undergraduate educationsystemswww.liferecoveryprogram.com
  7. 7. A web-based intervention is:A primarily self-guided intervention programthat is executed by means of a prescriptiveonline program operated through a websiteand used by consumers seeking health andmental-health related assistance.The intervention program itself attempts tocreate positive change and or improve/enhance knowledge, awareness, andunderstanding via the provision of soundhealth-related material and use of interactiveweb-based components.http://www.springerlink.com/content/374048n616233843/fulltext.pdfDefining Internet-Supported Therapeutic Interventions Azy Barak, Ph.D. & Britt Klein, D.Psych. (Clinical) &Judith G. Proudfoot, Ph.D. ann. behav. med. (2009) 38:4–17www.liferecoveryprogram.com
  8. 8. Based on this definition, three broad web-basedintervention subtypes are identified:1. Educational Web-basedinterventions2. Self-guided web-based therapeuticinterventions3. Human-supported web-basedtherapeutic interventionswww.liferecoveryprogram.com
  9. 9. Example: EducationalSAMHSA – Substance Abuse Mental Health ServiceAdministrationHttp://www.samhsa.gov/prevention/NIDA – National Institute on Drug Abusehttp://www.drugabuse.gov/www.liferecoveryprogram.com
  10. 10. Example: Self-guided1. MoodGYM – www.moodgym.anu.edu.au2. Internet Beating the Blues –http://www.beatingtheblues.co.ukBoth focus on folks who struggle with anxiety &depressionwww.liferecoveryprogram.com
  11. 11. Example: Human Supported Structured behavioural change content i.e. e-lessons and includes partial human support via: E-mail support Forums, Peer Support Forum, Face to face Video-based LionRock Recovery -http://www.lionrockrecovery.com/Provide live online group and individual therapy. Singlemonth – $1,840,www.liferecoveryprogram.com
  12. 12. Key Components for Web-basedInterventions1. Program Content2. Multi-media use/choices3. Provision of interactive online activities4. Provision of guidance & supportivefeedbackwww.liferecoveryprogram.com
  13. 13. Not to be confused with:Internet Supported Interventions1. Online Counselling – email, chat, video-based2. Internet-operated therapeutic software– robotic simulation, rule-based expert systems,gaming and 3D virtual environments3. Other online activities – Blogs, podcasts,online support groups and online assessmentswww.liferecoveryprogram.com
  14. 14. Examples: the more interactivethe more the usageMulti-media programs Panic Center – www.paniccenter.net – primarily text-basedCBT web-based program for panic disorders Sleep Healthy Using the Internet – www.shuti.net – forinsomnia - utilizes text, pictures, animation and audioInteractive programs Uses self monitoring exercises, assessments and tools oftenseen in weight loss sites – makes it more personalized =greater sense of ownership and connectedness to theprogram E.g. Down Your Drink – www.downyourdrink.org.ukwww.liferecoveryprogram.com
  15. 15. Gap AnalysisThe ratio of treated to untreated problemdrinkers is estimated to be anywherebetween 1 in 3 and 1 in 14, even whenattendance at Alcoholics Anonymous or abrief discussion with one’s family doctor iscounted as having received treatmentRoizen et al., 1978; Hasin, 1994; Burton and Williamson, 1995; Cunningham and Breslin, 2004www.liferecoveryprogram.com
  16. 16. “National Co-morbidity ReplicationSurvey 2005” – U.S. & OntarioCan you guess how long it takes for the average personWith a mental health challenge to access services? Delay from onset until treatment is 6 to 23 years 75% of all lifelong mental illnesses occur before the age of 24www.liferecoveryprogram.com
  17. 17. What does this mean? 1/5 to 1/4 N. Americans will have a serious mentalillness or addiction $51 billion is the estimated annual cost of mentalillness to the Canadian economy in terms of healthcare and lost productivity.(Minister’s Advisory Group on the 10-Year Mental Health and Addictions Strategy - December 2010)www.liferecoveryprogram.com
  18. 18. Estimated World Prevalence ofConditions:Type ofConditionWorldPrevalenceUnited StatesPrevalenceNicotineAddiction1.4 Billion 50 MillionAlcoholAddiction240 Million 23 MillionDrugAddiction100+ Million 13 Millionwww.liferecoveryprogram.comCentre for Disease Control and Prevention, World Health Organization, Kalorama Report, pg 16 (2007)
  19. 19. Global CostCost of Smoking, Drug Abuse andAlcohol Addiction WorldwideDrug Abuse- $900 billionSmoking- $400 billionAlcohol Addiction -$885 billionSource: Kalorama Information, World Health Organization – p2www.liferecoveryprogram.com
  20. 20. Access & Funding Regardless of Canada’s current access issues only one-third ofthose who need mental health services in Canada actuallyreceive them.xii While mental illnesses constitute more than 15% of the burdenof disease in Canada, these illnesses receive only 5.5% of healthcare dollars.xiv USA- In 1986 Mental health spending was 7.5 of all health carespending, 2003 6.2% and 2014 projected 5.9% Governments of less developed countries spend on average lessthan 1% of health care funds on mental health services.http://store.samhsa.gov/shin/content//SMA10-4590/SMA10-4590.pdf pg 52www.liferecoveryprogram.com
  21. 21. Stigma Just 50% of people would tell friends or coworkers that they have afamily member with a mental illness, compared to 72% who woulddiscuss diagnoses of cancer or 68% diabetes in the family.xv Only 12% of people said they would hire a lawyer who has a mentalillness, and only 49% said they would socialize with a friend who had aserious mental illness.xvi 46% of people use the term mental illness as an excuse for badbehaviour; and 27% are fearful of being around people who suffer fromserious mental illness.xviihttp://www.camh.ca/en/hospital/about_camh/newsroom/for_reporters/Pages/addictionmentalhealthstatistics.aspxwww.liferecoveryprogram.com
  22. 22. How Long is the Average Wait List?Privately Funded Beds?Publicly Funded Beds?www.liferecoveryprogram.com
  23. 23. Addictions, Trauma & Mental Health are hereto stay. The internet is also here to stay.www.liferecoveryprogram.comCanadiansage 18 andover searchedthe Internetfor medical orhealth relatedinformation
  24. 24. What Percentage of U.S. Adults Are Searching for Health-Related Information on the Internet?www.liferecoveryprogram.comhttp://www.ihealthbeat.org/data-points/2011/what-percentage-of-us-adults-are-searching-for-health-related-information-on-the-internet.aspx
  25. 25. Percentage of Australians Who Are Searching for Health-Related Information on theInternethttp://www.pewinternet.org/Reports/2010/Social-Media-and-Young-Adults/Part-4/1-Online-health-information.aspx?r=1www.liferecoveryprogram.com
  26. 26. Question....?What do you feel are some of thedownsides of web basedinterventions?www.liferecoveryprogram.com
  27. 27. Evidence-Informed Decision MakingInteragency ConnectionsCanadian Institutes of Health - www.cihr-irsc.gc.caMcMaster University: Dr. Maureen Dobbins- Principal Investigator - www.mcmaster.caConnections Canada-www.connectionscanada.caLife Recovery Program-www.liferecoveryprogram.comwww.liferecoveryprogram.com
  28. 28. PICO QuestionPopulationInterventionComparisonOutcomewww.liferecoveryprogram.com
  29. 29. LRP PICOIn adults seeking addiction treatment, how does on-line treatment and support (trauma informed, combinesMH & Addiction) compared with talk therapy (including e-counselling) affect treatment engagement and addictiontreatment outcomes (i.e. overall coping, substance use,stress, relationships, self-esteem, trauma symptoms)www.liferecoveryprogram.com
  30. 30. Finding the Best Evidence - 5Swww.liferecoveryprogram.comEvolution of Services- Adapted from: Haynes, R. Brian. (2007). Of studies, syntheses, synopses, summaries, andsystems: the “5S” evolution of information Services for evidence based-healthcare. Evidence Based Nursing. 10: 6-7.Services for evidence based-healthcare. Evidence Based Nursing. 10: 6-7.
  31. 31. Summaries(E.B.Guidelines,Texts)Synopses ofSynthesesSyntheses (systematic reviews, meta-analysis)Synopses of Single StudiesSingle Studieswww.liferecoveryprogram.com1. National Guideline Clearing House2. SAMHSA Treatment Improvement Protocols3. Health Canada Alcohol and Drug PreventionPublications4. National Institute for Health & ClinicalEvidence (NICE)5. European Monitoring Centre for Drugs andDrug Addiction6. Canadian Centre for Substance Abuse LibraryNote: Consider appraisingguidelines for strength ofevidence base using a tool suchas:Appraisal of Guidelines forResearch & Evaluation1. Health Evidence2. European MonitoringCentre for Drugs andDrug Addiction3. Cochrane Reviews1. Health Evidence2. Trip Database3. Cochrane Drug andAlcohol Group4. Cochrane Library5. CampbellCollaboration6. PubMed Reviews7. Psych Info Reviews
  32. 32. Main databases used: Pubmed Guidelines Clearing House Health-evidence.ca Cochranewww.liferecoveryprogram.com
  33. 33. Examples of Keywords Used Online treatment* Addiction* AND online treatment* Mental health* AND online treatment* Trauma* AND treatment*www.liferecoveryprogram.com
  34. 34. Findings- Systematic Reviews1. A meta-analysis of the effects of Internet and computer-basedcognitive-behavioral treatments for anxiety. Reger, M.A. et al. 2009 - 9(strong) ICT was superior to waitlist and placebo assignment acrossoutcome measures… The effects of ICT also were equal to therapist-delivered treatment across anxiety disorders.2. Computer therapy for the anxiety and depressive disorders is effective,acceptable and practical health care: A meta-analysis Andrews, G. et al.2010 - 9 (strong) Five studies comparing computerized CBT withtraditional face-to-face CBT were identified, and both modes oftreatment appeared equally beneficial.3. Online support for smoking cessation: A systematic review of theliterature Shahab,L. et al. 2009 - 7 (moderate)www.liferecoveryprogram.com
  35. 35. Findings Continued1. Computer-delivered interventions for alcohol and tobacco use: a meta-analysis S.Rooke, E. Thorsteinsson - 2010 - Conclusion Findings of the meta-analysis suggestthat minimal contact computer-delivered treatments that can be accessed via theinternet may represent a cost-effective means of treating uncomplicated substanceuse and related problems.2. Computer-delivered interventions to reduce college student drinking: a meta-analysis Kate B. Carey, L. Scott-Sheldon - 2009 - Conclusions CDIs reduce thequantity and frequency of drinking among college students. CDIs are generallyequivalent to alternative alcohol-related comparison interventions.3. Twelve-Month Follow-up Results from a Randomized Controlled Trial of a BriefPersonalized Feedback Intervention for Problem Drinkers John A. Cunningham, T.Cameron Wild - 2010 - 75 research trials to-date of computer-based interventionsfor different health behaviours and concluded that such interventions hadsignificant evidence for their efficacywww.liferecoveryprogram.com
  36. 36. Findings Summarized1. In general, computerized or IBIs for depression and anxiety areyielding effect sizes that are comparable to traditionalpsychosocial treatment.2. Overall, the web-based interventions evaluated wereconsidered to be acceptable and user satisfaction was generallyhigh.3. Interactive, web-based interventions for smoking cessation canbe effective in aiding cessation.4. Both therapist-led as well as self-directed online therapiesindicate significant alleviation of disorder-relatedsymptomatology.www.liferecoveryprogram.com
  37. 37. Question...?What are some of the upsides ofweb based interventions?www.liferecoveryprogram.com
  38. 38. 24/7 Problems Require 24/7Solutions https://www.liferecoveryprogram.com/AboutLRP/Media/0/0/0Mary Ann & Corey- Saving Lives & Families 24/7www.liferecoveryprogram.com
  39. 39. SAMHSA Announces A Working Definition of "Recovery" FromMental Disorders And Substance Use Disorders“A process of change through whichindividuals improve their health andwellness, live a self-directed life, andstrive to reach their full potential.”http://www.medicalnewstoday.com/releases/239713.phpwww.liferecoveryprogram.com
  40. 40. CAMH- Strong Evidence for Web BasedInterventions“One of the primary challenges in health behaviour change is to Promoteaccessibility of efficacious tools and services that promote reductions inrisk behaviours… the Internet is one promising option …recent reviewidentified 75 research trials to-date of computer-based interventions fordifferent health behaviours and concluded that such interventions hadsignificant evidence for their efficacy.”“There are many advantages to the Internet as a modality to promoteaccess to efficacious health behaviour change interventions.”“Other more intensive Internet-based interventions or interventions viaother modalities may enhance this positive outcome..”http://alcalc.oxfordjournals.org/content/early/2010/02/10/alcalc.agq009.fullwww.liferecoveryprogram.com
  41. 41. Q & A1. What is a “Digital Future”?2. Gap Analysis3. Types of Web Based Modalities4. Pros & Cons of Online Interventions5. Research Methods & Finding the “Best AvailableEvidence”6. P.I.C.O. Question & Databases Searched7. Research Findings8. Q & Awww.liferecoveryprogram.com
  42. 42. A summary article on today’spresentation http://www.drugfree.org/join-together/addiction/internet-changing-addiction-treatment-expert-sayswww.liferecoveryprogram.com
  43. 43. Please join our community andshare your voice… https://www.facebook.com/LifeRecoveryProgram# https://twitter.com/paulradkowski https://liferecoveryprogram.com/The Life Recovery Program is an evidence based, peer reviewed andinternationally awarded online wellness platform. Using technologicalinnovations, the Life Recovery Program provides systemic, holisticsupport to those challenged by addictions, trauma, depression, anxiety,stress, and/or other impulse control behaviours.It includes supportive and informative downloads, e-mails, groundingtechniques, ebooks and an interactive clinician-moderated peer-supportforum to help you or the one you care about achieve optimal health.www.liferecoveryprogram.com

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