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Today, more than ever, we live our lives online. From our banking, to paying the bills, to working from home and using social media, most of us will log online not once but several times a day. For some of you who are reading this right now, the entirety of your life happens online. And this is why it’s important, not just in business and education services but also health services, to keep up with research and consumer needs. Addiction treatment is no different.
For essentially the entire history of the addiction treatment field, the long-held standard in addiction has been residential treatment. This is the model everyone knows — an inpatient treatment facility that is usually expensive and requires 30-60 days (sometimes longer) of on-location commitment. The word rehab itself has essentially come to mean "a place you go away to for help with addiction." The outpatient treatment model, in which clients show up to receive treatment in an office setting and return home to sleep, has become substantially more prevalent than residential treatment clinically, but is still relatively obscure publicly. Unfortunately, the current model has been failing us and it's time for a new approach. Nowhere is this clearer, to me, than the most recent statistics regarding drug use and overdose deaths, all of which are continuing their trend of rising (see link to story HERE).
We need a more effective, cost-efficient and convenient treatment option for addiction help. And online addiction treatment may be just what we’re looking for.
Are traditional rehab facilities outdated?
Quite simply, the answer is “yes” and here’s why:
1. Most people don’t reach out for help at all. It is well known that only about 10 to 12 percent of people with alcohol or substance problems actually engage in treatment. This is a shocking statistic! For decades, addicts and their disease have been blamed for this, but it is my belief that it is more likely that the treatment system itself is partly to blame.
2. Rehab facilities require abstinence before you enter treatment. This means they require those who struggle with addiction to commit to the hardest thing for them to do before they can access actual support. Not only does this seem backwards, but my own research (LINK) suggests that this is one of the primary reasons for many people not accessing treatment at all.
3. The high dropout and low success rates are no surprise, given that most traditional rehab facilities are costly, time-intensive, isolating and shame-inducing. Numerous studies reveal long-term (1-5 year) success rates for residential treatment that are in the single digits when measuring abstinence and no better than spontaneous recovery (recovery with no treatment whatsoever). Given the fact that research has also revealed that many participants in these studies may be dishonest about their abstinence, the odds of success (as traditionally measured) in traditional treatment are dismal.
What prevents people from entering traditional treatment?
So, what keeps 90 percent of people from getting help for their addiction? The study I conducted at UCLA during my postgraduate work (HERE and HERE) revealed that about half of the respondents in the study did not want to abstain from alcohol or drugs and this was the reason they delayed or avoided treatment. The other major barriers were:
Shame: This is the number one underlying emotional disturbance experienced by people with addiction, either self-induced shame or shame projected onto them by others. I’ve previously talked about shame here and here, and so when it comes to traditional rehab facilities, it’s no wonder that people with addiction don’t want to come face to face with a professional, or stand up in meetings, or share their struggles in a group setting. These are torturous for someone experiencing immense shame about their addiction, and really, until the underlying shame is addressed, the addiction treatment is likely to fail.
Cost: It’s no secret that the healthcare system in the United States leaves much to be desired. There are endless people struggling to access affordable physical health treatment, and affordable psychiatric and addiction treatment is far more difficult to access. Not only that, but traditional rehab facilities are extremely expensive to manage and participate in. Even outpatient treatment is relatively expensive. I know this from personal experience – running a rehab is costly if you want to provide good care, so you end up having to charge clients a lot of money to do it AND insurance rarely pays a substantial portion.
Logistics: If you manage to get past the shame and expense of rehab, then you have to take off weeks or months (30-90 days in the case of residential rehab) of your life. Who can do that? Even outpatient therapy can take up to 10-15 hours per week. Getting time off from work and other commitments is a big ask for people who struggle with alcohol and drug addiction. Then there’s the traveling, parking, sitting around and waiting and then returning home. Only to come back and do it all over again the following week. For many people, the logistics themselves stand in the way of getting help.
The benefits of isolation:
People have believed that complete isolation is the only way for “addicts” to get better, but is this just a myth? When we tell people struggling with an alcohol or drug addiction that the only way they can get better is to remove themselves from their lives, pay an exorbitant amount of money and sit in a roomful of people with similar struggles, what message does this send? It tells them that they can’t be trusted and that they are incapable of functioning in their home setting. See my writing on the Pygmalion effect and the impact of this sort of expectation on those who struggle – it’s no wonder so many resent being sent away.
The individual time in rehab and the social connection with others has been seen as THE most important aspect of rehab treatment (see project MATCH findings). It has been thought that addicts couldn’t get help remotely, or at least that’s the message that has been clearly delivered. The behavioral tools used in traditional rehab are themselves sometimes reported as being secondary to the individual connection (the “therapeutic relationship”), which was believed to only happen in face-to-face settings.
So the catch-22 was this: It’s expensive to have experienced professionals deliver effective treatment and logistically difficult to be able to do it and commit to long enough periods of treatment. It’s also shameful to stand in a room full of people and admit to your failures, and people simply did not want to engage, but that seems to be the only way to get better.
Or is it?
The good news is that more and more evidence suggests technology is catching up and could deliver exactly what is needed in the fight against addiction.
Are online treatment programs effective?
Absolutely. A study recently published by a group at Yale assessed 137 people struggling with alcohol or drug addiction. The participants were split into three treatment groups: weekly group outpatient counseling, individual cognitive-behavioral therapy sessions, and a web-based program called CBT4CBT, which featured interactive multimedia and cognitive-behavioral therapy.
The study found exactly what I would have expected given my research on treatment barriers – the participants in the web-based group were less likely to drop out while showing higher success rates (with 67 percent no longer meeting diagnostic criteria for substance abuse, compared to 43-52 percent for individual and group counseling).
There were similar findings identified in another study published in The American Journal of Psychiatry (2014), where 255 adults took part in a web-based program called the Therapeutic Education System (TES) and another 255 people were enrolled in a standard outpatient treatment for addiction. This study also found that the web-based program reduced alcohol and substance use, and that web-based participants were also more likely to remain engaged in face-to-face therapies when online treatment was used as a supplement.
These studies suggest that not only are online treatments effective in addiction treatment, but they can also be used as a gateway into face-to-face (or residential) treatments down the line, if needed. Online treatment can easily become incorporated as THE starting point for many individuals who need help, with higher levels of care available when appropriate.
What treatment options are available online?
Online treatment programs provide people with convenient, affordable and time-efficient addiction treatment options without the hassle of attending a traditional rehab facility. That, and the concepts behind The Abstinence Myth, were the main driving factors for my own internet-based addiction treatment program, IGNTD recovery.
It is time we move addiction treatment forward using technology and the lessons we have learned from research about what does and doesn’t work in addiction treatment.
Let’s look at the pros and cons of online addiction treatment programs:
Advantages: First, you don’t have to put your life on hold. You don’t have to take time out of work, inform your employer and risk job loss, and the treatment can fit around your life. Don’t get me wrong, it still requires a level of commitment, but it certainly reduces the barriers to accessing help. Not only is it time-effective, but it’s also cost-effective, you have more autonomy over your treatment, you can do it at your own pace, and you can address some of the underlying issues that prevent you from accessing more traditional therapies if you wish to do this down the track. Additionally, since much of the treatment is standardized, we can actually be MORE certain of the quality of the care being delivered online. For instance, in IGNTD recovery, I deliver all of the lessons (with fun bonus sessions from other experts), the schedule is flexible, the cost is low, and you don’t have to quit alcohol or drugs before you access treatment.
Disadvantages: On the other hand, online treatment programs tend to rely less on the social contentedness of a traditional rehab facility. For some people, the social support is very effective in addiction treatment. Some online offerings (including IGNTD) feature online methods for connecting through private groups, online chat, and more, but being in person with someone is certainly not the same as speaking to them in a video conference (and it’s also less shaming).
What is the best option for me?
There’s no simple answer to this question. Any treatment can be effective when it is tailored to your individual needs and desires, and no specific treatment approach has been found to be effective in all cases (although some of the most noted addiction researchers in the field ranked evidence-based approaches in order of overall research support – see HERE). For some people, taking time out from their life to undergo intensive rehab treatment is the best option, and medical supervision is sometimes necessary. For others this is simply unrealistic.
What’s more important are the benefits of continued advances in treatment to provide people struggling with addictions suitable options. It’s best to research what approach might work best for you in terms of your life, budget, and time constraints. This means you can make an informed decision, a genuine commitment and really give yourself a red hot go at recovering from an addiction.
