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Web based substance abuse interventions for offenders


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An overview of how substance abuse professionals and researchers are using information technology to deliver substance abuse interventions to justice-invovled person who live in rural and underserved areas.

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Web based substance abuse interventions for offenders

  1. 1.
  2. 2. Agenda Part 1: Overview of the past and current use of technology-based interventions for substance-use disorders. Part 2: Description of how computers and web-based interventions have been used to deliver services to rural and underserved offenders—by Tom Wilson Counseling Center, Boise, Idaho.
  3. 3. Why Rural Offenders?
  4. 4. Approximately one quarter of the U.S. population (62 million people) lives in frontier/rural areas 16–20% of those individuals experience substance dependence, mental illness, or both conditions (NRHA, 2008)
  5. 5. Individuals residing in remote areas have  higher mortality rates,  higher suicide rates, and  more severe alcohol/drug problems (Baca et al., 2007; Goldsmith et al., 2002)
  6. 6. They have more personal, social, and geographic barriers to accessing services. There may be a stigma associated with treatment. (Finfgeld-Connett & Madsen, 2008; Oser et al., 2012)
  7. 7. 3.3% 19.3 million people needed but did not receive treatment for illicit drug or alcohol use Did not feel they needed treatment (NSDUH, 2011) In 2011, 20.6 million people aged 12 or older met the criteria for substance-use disorders Felt they needed treatment—Did not make an effort Felt they needed treatment—Did make an effort
  8. 8. Barriers to Treatment
  9. 9. Barriers include • Travel Costs • Transportation access • Time Away From Work • Child Care • Lack of Service Providers
  10. 10. Privacy and Confidentiality (Moyer & Finney, 2004/2005)
  11. 11. The lowest concentration of mental health professionals was found in frontier/rural areas (counties with less than 10,000 people) (Ellis et al., 2009; HRSA, 2011)
  12. 12. How could addiction treatment or other behavioral health providers expand their reach and overcome barriers to serve these populations? (Kazdin & Blase, 2011; Perle & Neirenburg, 2013)
  13. 13. One Answer… Telehealth Technologies
  14. 14. Telehealth Definition: The use of telecommunications and information technologies to provide access to health information and services across a geographical distance. Technologies included in telehealth are: • Videoconferencing • Telephones (smart and dumb) • Email and texting • Web-delivered programs • Apps (Institute of Medicine (IOM), 2012)
  15. 15. 1879 TELEHEALTH is not new (Aronson, 1977; Backhaus et al., 2012; IOM, 2012; Wittson et al., 1961; Wittson & Benschoter, 1972)
  16. 16. Why Use Telehealth Technologies? Reason #1 Most telehealth research supports that outcomes are as good or better than in- person strategies for behavioral health services (mental health and substance abuse). (IOM, 2012)
  17. 17. Largest provider of telemental health services using videoconferencing (Godleski et al., 2008; Darkins et al., 2008; IOM, 2012; Deen et al., 2012; Godleski et al., 2012)
  18. 18. VA Services  146 hospitals provided 55,000 community-based outpatient clinic patients with 140,000 telemental health visits  6,700 patients received home-based telemental health services  25% decrease in hospitalization for receiving telemental health services between 2006-2010  30% reduction in admissions during the first 6 months of care in 2011 (Darkins et al., 2008; IOM, 2012)
  19. 19. Indian Health Services (IHS)  Serves 2 million American Indians and Alaska Natives representing 566 federally recognized tribes  Includes 600 hospitals, clinics, and health stations under tribal governance  Implemented mobile telemedicine services in the 1970s  Alaska Federal Health Care Access Network utilizes telehealth (IOM, 2012)
  20. 20. University of Virginia’s telehealth program has documented the avoidance of 7.2 million miles of travel (Rheuban, 2012)
  21. 21. Annually, 10 million patients receive telemedicine services (IOM, 2012)
  22. 22. Why Use Telehealth Technologies? Reason #2: Access to technology is widespread. • Access to the Internet has increased dramatically • 90% of individuals worldwide have access to mobile phone services. • Smartphone access is expected to triple by 2019 • Internet and mobile access is growing among traditionally underserved populations Marsch, 2014
  23. 23. (Pew Report, 2012)
  25. 25. 80%send and receive text messages (Pew Report, 2012)
  26. 26. Over HALF have gathered health information on their phones Almost 20% have a health app (Pew Report, 2012)
  27. 27. Skype and other videochat platforms are free or low cost
  28. 28. Videoconferencing Is Mainstream
  29. 29. Why Use Telehealth Technology? Reason #3: High Customer Acceptability .
  30. 30. Lack of Adoption by Professions There are few published works on the use of telehealth technologies to provide or enhance substance-abuse services in rural areas. (Balas & Boren, 2000; Benavides-Vaello et al., 2013; Ryan & Gross, 1943)
  31. 31. The Promise of Technology Several research studies demonstrate that technology-based behavioral health tools:  Can be useful and acceptable to diverse populations  Have an impact on health behavior and outcomes  Can produce outcomes comparable to (and some cases better) than providers. (Marsch, 2014) Dartmouth Center for Technology and Behavioral Health
  32. 32. The Promise of Technology Technology-based behavioral health tools…  Increase quality, reach, and responsivity of care  Can be more cost effective than in person services  Can increase service capacity of organizations  Can be responsive to individual's behavioral need trajectory over time (Marsch, 2014) Dartmouth Center for Technology and Behavioral Health
  33. 33. Examples of Technology for Substance-Use Disorders Decision Support Systems - e.g., Let’s Talk About Smoking (Brunette) Assessment - ASI-MV (Butler) - CHAT (Comprehensive Health Assessment Tool for Teens) (Lord) Brief Intervention - Drinker’s Check-up (Hester)
  34. 34. Examples of Technology for Substance-Use Disorders • Treatments/Psychoeducation Therapeutic Education System [“TES”] (Marsch, Bickel) Cognitive Behavior Therapy CBT4CBT (Carroll) SHADE (Kay-Lambkin) • Recovery Support Addiction–Comprehensive Health Enhancement Support System [“A-CHESS” ] (Gustafson)
  35. 35. Web-Based Screeners
  36. 36. Web-Based Support Groups
  37. 37. Web-Based Support Psychoeducational Self-Help Mutual Support
  38. 38. Virtual Reality
  39. 39. Use of computers to deliver some aspects of psychotherapy or behavioral treatment directly to patients through interaction with a computer program (located on a device or virtual learning environment [the cloud)]. (Carroll & Rounsaville, 2010) Computer-Based Treatments
  40. 40. Using Web-Based, Substance-Abuse Interventions With Rural and Underserved Offenders © 2012 Tom Wilson Counseling Center
  41. 41. Rural Nature of Idaho Thirty-five of Idaho’s forty-four counties are rural or frontier and many areas have limited access to specialty care. While rural Idaho continues to face challenges recruiting and retaining medical and behavioral professionals, telehealth and telemedicine are playing an increasingly important role. (Idaho Telehealth Alliance, 2015)
  42. 42. Objectives of Web-Based Services To expand the reach of substance-use services to our remote, rural, or challenged clients through technology To help clients overcome personal, social, and geographical barriers to substance- use disorder services To deliver substance-use services guided by evidence-based practices and principles
  43. 43. The Aim of Prevention The aim of prevention is to: • Deter the onset of alcohol or other drug abuse • Provide individuals with the information and skills necessary to prevent the problem.
  44. 44. Importance of Early Prevention “…It is easier to build strong children than to repair broken men...” —Frederick Douglass
  45. 45. Theory of Prevention Drug abuse can be prevented if:  Risk factors in a population are identified and reduced  Protective factors are identified and strengthened
  46. 46. ABOUT OUR PROGRAM Tom Wilson Counseling Center specializes in providing alcohol and drug-abuse prevention education services for forensic (court– ordered) clients. Most of our clients are low-risk offenders charged with substance-abuse- related offenses and are on diversion or bench probation.
  47. 47. Challenges of In-Person Classes Traditional in-person classes are difficult for offenders who: • Travel for work • Have a suspended license • Live in rural areas • Have child/family obligations • Experience communication problems • Have no local SUD provider
  48. 48. Information technology is now an effective way to deliver health information/content Cost has dropped significantly due to open source movement, cloud technology, etc. Access to well-designed applications has increased dramatically
  49. 49. Advantages of Online Learning Self-paced learning can take place anywhere, anytime. Accessible to virtually all learners—regardless of disability, location, or learning schedule. Providers can use creative methods and delivery modalities.
  50. 50. Requires computer or mobile device and Internet access, and some computer literacy. Some participants uncomfortable with or distrustful of technology Does not work well for some learning styles or activities that require group interaction
  51. 51. Program Design Target Behavior: Harmful alcohol use Objective: Change attitudes toward drinking Target Population: Underage Drinkers Delivery Medium: Web-based education
  52. 52. Evidence-Based Components Motivation- Enhancement Techniques Stages of Change Activities Cognitive Behavioral Skills Web-Based Programs Include:
  53. 53. Motivational Enhancement Therapy  Non-confrontational intervention  Begins with self-assessment  Personalized feedback report on pattern of use  Feedback includes normative comparison of results
  54. 54.  Introduce the Stages of Change  Identify stage-specific thoughts and beliefs  Identify activities that help an individual move from one stage to the next
  55. 55.  What stage am I in?  Readiness to change example  Decisional Balance—Benefits vs. costs of change
  56. 56. Sample Lesson Process Read content and answer review questions Receive feedback If correct, continue or retry questions
  57. 57. Feedback Example Your Response:  You told us you drink 8– 14 drinks per week on average when you drink.  Based on your response, you drink more than 81% of all males and 94% of all females.
  58. 58. Example of Calculation Exercise Your typical blood alcohol content is the amount of alcohol in your blood on a typical day when you drink. To calculate your typical BAC (blood alcohol content), use the online BAC calculator provided. Online BAC Calculator
  59. 59. Feedback for Typical Drinking BACs Your response: You calculated your BACs for a typical drinking occasion as falling between .06 to .10. At BAC Levels of .06 to .10, you will have impairment of muscle coordination and a slower reaction time, and disregard for personal safety.
  60. 60. Sample Lesson Page Binge Drinking • Is defined as 5 or more drinks on the same occasion at least once in the past 30 days. • Health, social, and academic problems occur when men drink 5 or more drinks per occasion, and women drink 4 or more per occasion. • Binge drinking is the most common pattern among underage drinkers. • Less than 25% of persons aged 12 or older participated in binge drinking Click for Review Question
  61. 61. Using Text Messaging as an Intervention “In a recent study, Text Messaging to Emergency Patients Reduced Their Alcohol Consumption”  12-week trial of receiving automated text messaging asking about drinking  Men who had 5 + drinks and women who had 4+ drinks received text messaging of concern about level of use  Asked if they would cut down.
  62. 62. Other Mediums of Delivery 2. Online Assessment and Feedback with “E-checkup to Go” for university freshmen 3. Online Assessment and Feedback with “Brief Assessment and Intervention for College Students”
  63. 63. Conclusions The tools of information and computer technology are successfully being implemented to remotely treat and prevent substance abuse. The tools of technology can increase accessibility of behavioral health services to rural offenders through web-based delivery. Technology-assisted services will help offenders improve compliance—reducing the burden on diversion and community supervision services.
  64. 64. Current Research on Outcomes
  65. 65. Recidivism Rates of Online DUI Classes Conducted at Tom Wilson Counseling for 2010–2013 • Participants—557 (68% male, 32 % female) • Mean age of participants: 35 • Completed DUI classes in 2010–2013 (study 4/2015) • Cognitive-behavioral curriculum like DWC • TWCC Recidivism rate (7.5%) • CDBH 2008 Study of in-person DUI Program Completers Recidivism rate (7.8%) Preliminary Study Results 4/30/15 (Raissa Miller, Ph.D. Boise State University) (Gender, age, and prior arrests are not predictors of subsequent arrests)
  66. 66. Tom Wilson, LCPC, CPC 514 S. Orchard Street, Suite 101 Boise, ID 83705 Office: 208.368.9909 email: