Therapeutic emails

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Abstract

Background

In this paper, we show how counselors and psychologists can use emails for online management of substance abusers, including the anatomy and content of emails that clinicians should send substance abusers. Some investigators have attempted to determine if providing mental health services online is an efficacious delivery of treatment. The question of efficacy is an empirical issue that cannot be settled unless we are explicitly clear about the content and nature of online treatment. We believe that it is not the communications via internet that matters, but the content of these communications. The purpose of this paper is to provide the content of our online counseling services so others can duplicate the work and investigate its efficacy.

Results

We have managed nearly 300 clients online for recovery from substance abuse. Treatment included individual counseling (motivational interviewing, cognitive-behavior therapy, relapse prevention assignments), participation in an electronic support group and the development of a recovery team. Our findings of success with these interventions are reported elsewhere. Our experience has led to development of a protocol of care that is described more fully in this paper. This protocol is based on stages of change and relapse prevention theories and follows a Motivational Interviewing method of counseling.

Conclusion

The use of electronic media in providing mental health treatment remains controversial due to concerns about confidentiality, security and legal considerations. More research is needed to validate and generalize the use of online treatment for mental health problems. If researchers have to build on each others work, it is paramount that we share our protocols of care, as we have done in this paper.

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Most cited references 43

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A telecommunications system for monitoring and counseling patients with hypertension. Impact on medication adherence and blood pressure control.

R. Friedman (1996)

This study was conducted to evaluate the effect of automated telephone patient monitoring and counseling on patient adherence to antihypertensive medications and on blood pressure control. A randomized controlled trial was conducted in 29 greater Boston communities. The study subjects were 267 patients recruited from community sites who were >or= 60 years of age, on antihypertensive medication, with a systolic blood pressure (SBP) of >or= 160 mm Hg and/or a diastolic blood pressure (DBP) of >or= 90 mm Hg. The study compared subjects who received usual medical care with those who used a computer-controlled telephone system in addition to their usual medical care during a period of 6 months. Weekly, subjects in the telephone group reported self-measured blood pressures, knowledge and adherence to antihypertensive medication regimens, and medication side-effects. This information was sent to their physicians regularly. The main study outcome measures were change in antihypertensive medication adherence, SBP and DBP during 6 months, satisfaction of patient users, perceived utility for physicians, and cost-effectiveness. The mean age of the study population was 76.0 years; 77% were women; 11% were black. Mean antihypertensive medication adherence improved 17.7% for telephone system users and 11.7% for controls (P = .03). Mean DBP decreased 5.2 mm Hg in users compared to 0.8 mm Hg in controls (P = .02). Among nonadherent subjects, mean DBP decreased 6.0 mm Hg for telephone users, but increased 2.8 mm Hg for controls (P = .01). For telephone system users, mean DBP decreased more if their medication adherence improved (P = .03). The majority of telephone system users were satisfied with the system. Most physicians integrated it into their practices. The system was cost-effective, especially for nonadherent patient users. Therefore, weekly use of an automated telephone system improved medication adherence and blood pressure control in hypertension patients. This system can be used to monitor patients with hypertension or with other chronic diseases, and is likely to improve health outcomes and reduce health services utilization and costs.

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Cognitive Therapy: Basics and Beyond

JS BECK, J Beck,, J. Beck … (1995)

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Motivational enhancement and other brief interventions for adolescent substance abuse: foundations, applications and evaluations.

Tracy O'Leary Tevyaw, Peter M Monti (2004)

To present a comprehensive review of the use of motivational enhancement and other brief interventions for substance use in adolescents. In this paper, we review the major theoretical foundations and influences of brief interventions (including motivational interviewing), consider developmental issues in its application for adolescents, discuss methodological issues in the design and implementation of brief interventions, including the assessment of treatment fidelity, evaluate and interpret the latest findings on brief interventions for adolescents and young people and discuss the issue of translating and exporting effective research into practice. Results from recent clinical trials using motivational interventions indicate that these approaches result in decreases in substance-related negative consequences and problems, decrements in substance use and increased treatment engagement, with results particularly strong for those with heavier substance use patterns and/or less motivation to change. While results are promising, more research is needed to examine the essential elements of motivational interventions, for whom they work best, and their impact on developmental transitions during adolescence.

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Author and article information

Journal

Journal ID (nlm-ta): Subst Abuse Treat Prev Policy

Title: Substance Abuse Treatment, Prevention, and Policy

Publisher: BioMed Central (London )

ISSN (Electronic): 1747-597X

Publication date Collection: 2007

Publication date (Electronic): 16 February 2007

Volume: 2

Page: 7

Affiliations

[1 ]Department of Health Administration and Policy, College of Health and Human Services, George Mason University, Northeast Module, 4400 University Drive, MS 1J3, Fairfax, VA, 22030, USA

[2 ]Chair and Professor, Department of Family and Community Health, School of Nursing, 655 W. Lombard St., Room 616, Baltimore, MD 21201, USA

[3 ]Associate Professor, University of Maryland, School of Nursing, 655 W. Lombard St., Baltimore, MD 21201, USA

[4 ]NYCHA Classic Center Director, 555 Mt. Prospect Avenue, #17H, Newark, NJ 07104, USA

[5 ]Department of Psychology, David King Hall, Rm. 2003, George Mason University, 4400 University Drive, MS 3F5, Fairfax, VA 22030, USA

[6 ]Department of Epidemiology and Biostatistics, Medical School, Case Western Reserve University, 10900 Euclid Ave., Cleveland, OH 44106, USA

Article

Publisher ID: 1747-597X-2-7

DOI: 10.1186/1747-597X-2-7

PMC ID: 1805747

PubMed ID: 17302991

SO-VID: 6a70a34f-cb22-413e-b17d-eb1e3c67666d

License:

This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Therapeutic emails

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Tobacco Prevention & Cessation

Most cited references 43

A telecommunications system for monitoring and counseling patients with hypertension. Impact on medication adherence and blood pressure control.

Cognitive Therapy: Basics and Beyond

Motivational enhancement and other brief interventions for adolescent substance abuse: foundations, applications and evaluations.

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