In 55 percent of counties in the U.S., all rural, there exists no practicing psychiatrists, psychologists, or social workers according the 2013 SAMHSA Workforce Survey. Nationwide, Less than 10 percent of those in need of addiction treatment receive it, based on data from the annual National Survey on Drug Use and Health. While over half of the 1.6 million inmates in the U.S. sit behind bars with addiction problems, very few receive any kind of treatment. And our present military is overwhelmed with addiction and mental health problems, having too few resources to address the needs of active military and veterans, according to the Institute of Medicine report Substance Use Disorders in the U.S. Armed Forces.
Even more, in 2014 about 40 million more Americans will be able to seek out help for addiction problems due to changes in health insurance coverage under the Affordable Care Act. This means that our already crippled addiction treatment system will feel even more strain as limited resources get stretched even further.
While 90 percent of addiction care is delivered on an outpatient basis, most financial investors know that profits are more easily obtained by expanding residential care. But a review comparing residential to intensive outpatient treatment found no differences in outcomes for most people. So increased funding is not being spent wisely for the greater good.
What is the answer to meeting the needs of those who suffer with addiction given our thinly spread addiction treatment system?
The Online/Cloud-Based Solution
Presently, 85 percent of the U.S. population have access to the internet, and many through mobile devices such as tablets and smart phones. Even in tiny rural communities with one grocery store, folks have online connections. On a recent walk through a homeless community in Portland, Oregon, I was surprised by how many people sitting in tent shelters were glued to their smart phones or tablets.
At the same time, significant research has been accumulating that online addiction treatment interventions can produce positive outcomes on par with face-to-face treatment. In 2011, Warren Bickel and colleagues published A Review of Computer-Based Interventions Used in the Assessment, Treatment, and Research of Drug Addiction that concluded:
New technologies appear to produce better or similar results in detecting, informing, and educating individuals with substance use disorders relative to traditional counselor-facilitated methods. New hypotheses and therapies for drug addiction have grown from using these technologies, offering further solutions for drug-dependent individuals, their families, and society.
Yet despite the obvious answer – a National Online Addiction Treatment System where all who suffer can access free treatment – so far online interventions remain in their infancy, falling far short of what is possible.
Should you pay for online treatment?
If you are in need of addiction help and live in a community where no treatment services exist, then yes, engaging in an online program makes sense! If you have access to treatment services, then the answer is maybe. The reason is that currently the online programs available may not be any less expensive than engaging in outpatient care, and research on which ones actually produce solid outcomes is scarce or non-existent. So if you can access care from licensed clinicians, then that should be your first option. But if barriers including cost, access, or fears related to face-to-face therapy exist, then again, engaging in an online program may be very helpful.
But which online program do I choose?
You need to first understand that online treatment can mean many things.
Delivered by an actual person
On one end of the continuum of services are treatments delivered by an actual person via video-conferencing, email, phone, or a combination of communication methods. In such cases, who you work with makes a difference, so you would want to select someone in the same way you go about selecting someone in private practice. Such care often is charged by the minute or in set increments of time. In some cases you may be able to sign-up for a free consult to test drive the program, but be wary of sales pitches that sell you on a large outlay of money from the get go. The best option is the one that allows you to pay per session, and only for as long as it is working for you. Also, bear in mind that because you are engaging with an individual in a therapeutic relationships, it is worth understanding how their credentials (practice license) applies to online therapy legally and ethically – Does a Board regulate what they do?
Delivered solely by a computer
At the other end of the continuum are online programs that involve no individual human connection. They tend to include: self-addiction assessments, downloadable documents, videos, and opportunities for participating in chat rooms or online recovery groups. Many are packaged as apps, or have app components to them. Some are free, others can charge hundreds of dollars. Evaluating such programs as a consumer is not so easy, because often you have no idea what you are buying until you pay. Even when sites offer money-back guarantees, you should be cautious.
Delivered by person and computer
And of course there are all the programs that fall in-between the above two options. Some use recovery coaches in place of licensed clinicians to cut costs, others provide online therapy groups through conference calls. Some have you do online assessments and then have a clinician review them in a session. Others allow you to track your behavior and then check-in with a live person when necessary. The best advice I can give is be cautious of programs that promise too much. If you have spent time on this site, you know that addiction is a challenging problem to overcome, and that doing so requires a holistic approach such as the 5 Actions.
The Future of Online Help
I believe in the years ahead we will see a transformation of our addiction treatment system into one that utilizes online interventions as a first-line treatment for everyone. Ideally, the government would fund and manage a National Online Addiction Treatment System that gives all citizens access to evidence-based assessments, interventions, and options for pursing higher levels of care if necessary. The reasons why I believe such a system will eventually come to be are many, and include the fact that online care can: be delivered 24/7, work on many different devices, be free (or close to free), do a better job of assessing and tracking lots of information over time, identify powerful leverage points for change missed by therapists, better connect individuals to local community resources, and coordinate care among stakeholders more efficiently than our present system.
In addition, such a system does not negate the need for face-to-face counseling. In fact, it takes much of the burden off of our overwhelmed treatment system and allows clinicians to more judiciously work with those most in need. At the same time, it suggests that those who are delivering care will need to be graduate-level trained, licensed, and know how to interface with primary care systems. I am not the only one who is thinking this way. David Gustafson wrote a compelling article title Automating Addiction Treatment that provides another perspective on what we might see in the future.