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

May 4, 2013
Presented by
Paul Radkowski, MTS(PC), IAAOC, OACCPP, IAMFC
Founder/President/Clinical Director, Psychotherapist
Monique Peats, MTS(PC), MSW, RSW, OACCPP
Co-Founder/Director of Operational Services, Psychotherapist
www.liferecoveryprogram.com
info@liferecoveryprogram.com

Paul Radkowski, MTS(PC),OACCPP, IAAOC Psychotherapist, CEO, Life Recovery Program
In addition to his extensive work in Addiction, he has consulted with numerous agencies, hospitals and
treatment settings working with groups, families and individuals as a Family and Marriage Therapist, Crisis
Counselor 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 first
recipient 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 Program
Monique, 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 broad
scope 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 awarded
online wellness recovery program platform, the Life Recovery Program

Overview
1. What is a “Digital Future”?
2. Gap Analysis
3. Types of Web Based Modalities
4. Pros & Cons of Online Interventions
5. Research Methods & Finding the “Best Available
Evidence”
6. P.I.C.O. Question & Databases Searched
7. Research Findings
8. Q & A

Myths- Assumptions of the
Internet
1. Who is using internet, e-counselling, an online
forum for after care or support? i.e. texting with
clients?
2. What are assumptions on internet modalities?

Being Current is the New Currency
24/7
Problem
24/7
Solution

Centre of Addiction & Mental
Health “Digital Future”
Alcohol and Drug Problems:
A Practical Guide for
Counsellors (CAMH Press)
4th Edition “Digital Future”
chapter
• Has been used as a course textbook in both
graduate and undergraduate education
systems

A web-based intervention is:
A primarily self-guided intervention program
that is executed by means of a prescriptive
online program operated through a website
and used by consumers seeking health and
mental-health related assistance.
The intervention program itself attempts to
create positive change and or improve/
enhance knowledge, awareness, and
understanding via the provision of sound
health-related material and use of interactive
web-based components.
http://www.springerlink.com/content/374048n616233843/fulltext.pdf
Defining Internet-Supported Therapeutic Interventions Azy Barak, Ph.D. & Britt Klein, D.Psych. (Clinical) &
Judith G. Proudfoot, Ph.D. ann. behav. med. (2009) 38:4–17

Based on this definition, three broad web-based
intervention subtypes are identified:
1. Educational Web-based
interventions
2. Self-guided web-based therapeutic
interventions
3. Human-supported web-based
therapeutic interventions

Example: Educational
SAMHSA – Substance Abuse Mental Health Service
Administration
Http://www.samhsa.gov/prevention/
NIDA – National Institute on Drug Abuse
http://www.drugabuse.gov/

Example: Self-guided
1. MoodGYM – www.moodgym.anu.edu.au
2. Internet Beating the Blues –
http://www.beatingtheblues.co.uk
Both focus on folks who struggle with anxiety &
depression

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. Single
month – $1,840,

Key Components for Web-based
Interventions
1. Program Content
2. Multi-media use/choices
3. Provision of interactive online activities
4. Provision of guidance & supportive
feedback

Not to be confused with:
Internet Supported Interventions
1. Online Counselling – email, chat, video-based
2. Internet-operated therapeutic software
– robotic simulation, rule-based expert systems,
gaming and 3D virtual environments
3. Other online activities – Blogs, podcasts,
online support groups and online assessments

Examples: the more interactive
the more the usage
Multi-media programs
 Panic Center – www.paniccenter.net – primarily text-based
CBT web-based program for panic disorders
 Sleep Healthy Using the Internet – www.shuti.net – for
insomnia - utilizes text, pictures, animation and audio
Interactive programs
 Uses self monitoring exercises, assessments and tools often
seen in weight loss sites – makes it more personalized =
greater sense of ownership and connectedness to the
program
 E.g. Down Your Drink – www.downyourdrink.org.uk

Gap Analysis
The ratio of treated to untreated problem
drinkers is estimated to be anywhere
between 1 in 3 and 1 in 14, even when
attendance at Alcoholics Anonymous or a
brief discussion with one’s family doctor is
counted as having received treatment
Roizen et al., 1978; Hasin, 1994; Burton and Williamson, 1995; Cunningham and Breslin, 2004

“National Co-morbidity Replication
Survey 2005” – U.S. & Ontario
Can you guess how long it takes for the average person
With 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 24

What does this mean?
 1/5 to 1/4 N. Americans will have a serious mental
illness or addiction
 $51 billion is the estimated annual cost of mental
illness to the Canadian economy in terms of health
care and lost productivity.
(Minister’s Advisory Group on the 10-Year Mental Health and Addictions Strategy - December 2010)

Estimated World Prevalence of
Conditions:
Type of
Condition
World
Prevalence
United States
Prevalence
Nicotine
Addiction
1.4 Billion 50 Million
Alcohol
Addiction
240 Million 23 Million
Drug
Addiction
100+ Million 13 Million
Centre for Disease Control and Prevention, World Health Organization, Kalorama Report, pg 16 (2007)

Global Cost
Cost of Smoking, Drug Abuse and
Alcohol Addiction Worldwide
Drug Abuse- $900 billion
Smoking- $400 billion
Alcohol Addiction -$885 billion
Source: Kalorama Information, World Health Organization – p2

Access & Funding
 Regardless of Canada’s current access issues only one-third of
those who need mental health services in Canada actually
receive them.xii
 While mental illnesses constitute more than 15% of the burden
of disease in Canada, these illnesses receive only 5.5% of health
care dollars.xiv
 USA- In 1986 Mental health spending was 7.5 of all health care
spending, 2003 6.2% and 2014 projected 5.9%
 Governments of less developed countries spend on average less
than 1% of health care funds on mental health services.
http://store.samhsa.gov/shin/content//SMA10-4590/SMA10-4590.pdf pg 52

Stigma
 Just 50% of people would tell friends or coworkers that they have a
family member with a mental illness, compared to 72% who would
discuss diagnoses of cancer or 68% diabetes in the family.xv
 Only 12% of people said they would hire a lawyer who has a mental
illness, and only 49% said they would socialize with a friend who had a
serious mental illness.xvi
 46% of people use the term mental illness as an excuse for bad
behaviour; and 27% are fearful of being around people who suffer from
serious mental illness.xvii
http://www.camh.ca/en/hospital/about_camh/newsroom/for_reporters/Pages/addictionmentalhealthstatistic
s.aspx

How Long is the Average Wait List?
Privately Funded Beds?
Publicly Funded Beds?

Addictions, Trauma & Mental Health are here
to stay. The internet is also here to stay.
Canadians
age 18 and
over searched
the Internet
for medical or
health related
information

What Percentage of U.S. Adults Are Searching for Health-
Related Information on the Internet?
http://www.ihealthbeat.org/data-points/2011/what-percentage-of-us-adults-are-searching-for-
health-related-information-on-the-internet.aspx

Percentage of Australians Who Are Searching for Health-Related Information on the
Internet
http://www.pewinternet.org/Reports/2010/Social-Media-and-Young-Adults/Part-4/1-Online-health-
information.aspx?r=1

Question....?
What do you feel are some of the
downsides of web based
interventions?

Evidence-Informed Decision Making
Interagency 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.com

PICO Question
Population
Intervention
Comparison
Outcome

LRP PICO
In adults seeking addiction treatment, how does on-
line treatment and support (trauma informed, combines
MH & Addiction) compared with talk therapy (including e-
counselling) affect treatment engagement and addiction
treatment outcomes (i.e. overall coping, substance use,
stress, relationships, self-esteem, trauma symptoms)

Finding the Best Evidence - 5S
Evolution of Services- Adapted from: Haynes, R. Brian. (2007). Of studies, syntheses, synopses, summaries, and
systems: 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.

Summaries
(E.B.Guidelines,
Texts)
Synopses of
Syntheses
Syntheses (systematic reviews, meta-
analysis)
Synopses of Single Studies
Single Studies
1. National Guideline Clearing House
2. SAMHSA Treatment Improvement Protocols
3. Health Canada Alcohol and Drug Prevention
Publications
4. National Institute for Health & Clinical
Evidence (NICE)
5. European Monitoring Centre for Drugs and
Drug Addiction
6. Canadian Centre for Substance Abuse Library
Note: Consider appraising
guidelines for strength of
evidence base using a tool such
as:
Appraisal of Guidelines for
Research & Evaluation
1. Health Evidence
2. European Monitoring
Centre for Drugs and
Drug Addiction
3. Cochrane Reviews
1. Health Evidence
2. Trip Database
3. Cochrane Drug and
Alcohol Group
4. Cochrane Library
5. Campbell
Collaboration
6. PubMed Reviews
7. Psych Info Reviews

Main databases used:
 Pubmed
 Guidelines Clearing House
 Health-evidence.ca
 Cochrane

Examples of Keywords Used
 Online treatment*
 Addiction* AND online treatment*
 Mental health* AND online treatment*
 Trauma* AND treatment*

Findings- Systematic Reviews
1. A meta-analysis of the effects of Internet and computer-based
cognitive-behavioral treatments for anxiety. Reger, M.A. et al. 2009 - 9
(strong) ICT was superior to waitlist and placebo assignment across
outcome 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 with
traditional face-to-face CBT were identified, and both modes of
treatment appeared equally beneficial.
3. Online support for smoking cessation: A systematic review of the
literature Shahab,L. et al. 2009 - 7 (moderate)

Findings Continued
1. Computer-delivered interventions for alcohol and tobacco use: a meta-analysis S.
Rooke, E. Thorsteinsson - 2010 - Conclusion Findings of the meta-analysis suggest
that minimal contact computer-delivered treatments that can be accessed via the
internet may represent a cost-effective means of treating uncomplicated substance
use 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 the
quantity and frequency of drinking among college students. CDIs are generally
equivalent to alternative alcohol-related comparison interventions.
3. Twelve-Month Follow-up Results from a Randomized Controlled Trial of a Brief
Personalized Feedback Intervention for Problem Drinkers John A. Cunningham, T.
Cameron Wild - 2010 - 75 research trials to-date of computer-based interventions
for different health behaviours and concluded that such interventions had
significant evidence for their efficacy

Findings Summarized
1. In general, computerized or IBIs for depression and anxiety are
yielding effect sizes that are comparable to traditional
psychosocial treatment.
2. Overall, the web-based interventions evaluated were
considered to be acceptable and user satisfaction was generally
high.
3. Interactive, web-based interventions for smoking cessation can
be effective in aiding cessation.
4. Both therapist-led as well as self-directed online therapies
indicate significant alleviation of disorder-related
symptomatology.

Question...?
What are some of the upsides of
web based interventions?

24/7 Problems Require 24/7
Solutions https://www.liferecoveryprogram.com/AboutLRP/Media/0/0/0
Mary Ann & Corey- Saving Lives & Families 24/7

SAMHSA Announces A Working Definition of "Recovery" From
Mental Disorders And Substance Use Disorders
“A process of change through which
individuals improve their health and
wellness, live a self-directed life, and
strive to reach their full potential.”
http://www.medicalnewstoday.com/releases/239713.php

CAMH- Strong Evidence for Web Based
Interventions
“One of the primary challenges in health behaviour change is to Promote
accessibility of efficacious tools and services that promote reductions in
risk behaviours… the Internet is one promising option …recent review
identified 75 research trials to-date of computer-based interventions for
different health behaviours and concluded that such interventions had
significant evidence for their efficacy.”
“There are many advantages to the Internet as a modality to promote
access to efficacious health behaviour change interventions.”
“Other more intensive Internet-based interventions or interventions via
other modalities may enhance this positive outcome..”
http://alcalc.oxfordjournals.org/content/early/2010/02/10/alcalc.agq009.full

Q & A
1. What is a “Digital Future”?
2. Gap Analysis
3. Types of Web Based Modalities
4. Pros & Cons of Online Interventions
5. Research Methods & Finding the “Best Available
Evidence”
6. P.I.C.O. Question & Databases Searched
7. Research Findings
8. Q & A

A summary article on today’s
presentation
 http://www.drugfree.org/join-
together/addiction/internet-changing-addiction-
treatment-expert-says

Please join our community and
share your voice…
 https://www.facebook.com/LifeRecoveryProgram#
 https://twitter.com/paulradkowski
 https://liferecoveryprogram.com/
The Life Recovery Program is an evidence based, peer reviewed and
internationally awarded online wellness platform. Using technological
innovations, the Life Recovery Program provides systemic, holistic
support to those challenged by addictions, trauma, depression, anxiety,
stress, and/or other impulse control behaviours.
It includes supportive and informative downloads, e-mails, grounding
techniques, ebooks and an interactive clinician-moderated peer-support
forum to help you or the one you care about achieve optimal health.

“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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