ALCOHOLISM & DRUG ABUSE WEEKLY
MONDAY, OCTOBER 6, 2003
Front page story
Washington State Provider Agencies Add Online Element to Services
San Jose, Calif.-based CRC Health Corporation, which operates the country’s only accredited Internet-based treatment system for addiction, last month announced partnerships with several organizations in Washington state that have begun to integrate its online treatment program into their substance abuse service mix.
Along with its rapid acquisition of freestanding addiction treatment facilities in recent years, the for-profit CRC is known for launching eGetgoing, an Internet-based, interactive addiction treatment and counseling program for adults. Both eGetgoing and the adolescent program teenGetgoing offer interactive group counseling through live audio and video (see ADAW, Nov. 18, 2002).
CRC officials announced that Washington state’s treatment community is the first to widely adopt online substance abuse programs as part of a comprehensive treatment approach that also includes traditional facility-based services and medically assisted opiate addiction services.
Also last month, CRC officials announced its first set of national data for its much-discussed online treatment program, citing client satisfaction, retention and completion rates and other indications of online treatment effectiveness (see box).
CRC owns 71 facilities across 16 states and employs more than 1,700 people. The privately held company has three divisions — Residential Outpatient Facilities, Opiate Treatment Programs, and eGetgoing. CRC this year expanded its presence on the East Coast with its acquisition of Comprehensive Addiction Programs (CAPS) Inc. (see ADAW, March 3).
"I am delighted and proud that leaders in Washington state, where I have long had a strong family and personal association, are making this state the most progressive in the nation for drug and alcohol prevention and treatment," Gen. Barry R. McCaffrey, former director of the White House Office of National Drug Control Policy (ONDCP) and principal adviser to eGetgoing, said in a statement.
CRC officials have consistently said that the online program is not a substitute for traditional addiction treatment, but rather an important addition to the continuum of care. "We’re very excited; we certainly expect to see online treatment growing very rapidly," Barry Karlin, founder and chief executive of CRC Health and eGetgoing, told ADAW. "In time, online treatment will become routine."
Karlin added, "Washington has taken the lead and been very supportive in integrating all modalities of treatment, including residential from detox to inpatient to outpatient aftercare. It’s not about one or the other. If you’re a person with an addiction problem, it’s about evaluating and determining the best course of treatment."
eGetgoing involves a 12-week, two-session-per week online treatment program in groups of 10 or fewer led by an experienced counselor. The program costs $1,200, as compared to about $3,000 for a traditional outpatient course of treatment, Karlin said.
Seattle-based Schick Shadel Hospital, noted for having a unique aversion therapy treatment program, is one of eight organizations in the state now using eGetgoing. The hospital uses the program as part of its outpatient treatment services, says Dick Andrews, Psy.D., director of treatment services.
"My interest in [eGetgoing] is as an adjunct to treatment for our inpatient graduates," Andrews told ADAW.
The facility has used the online product since mid-August, Andrews said. "We saw the potential. It’s cutting- edge material." The hospital also was finding in the past that many patients proved unable to continue with outpatient treatment after leaving the hospital.
"We ordinarily do two years of follow-up [treatment]," said Andrews. The online program for graduates no matter where they live, as long as they have computer access, is "pretty convenient. Someone who has been treated in Seattle can take part in an outpatient group with nine other people in the same stage of recovery anywhere in the world."
CRC’s online treatment program is also being looked at to benefit participants in the Tacoma area’s family court program, according to Terree Schmidt-Whelan, executive director of the Pierce County Alliance, the primary treatment provider for the county’s offender population. Schmidt-Whelan said her organization began using eGetgoing last week.
The program will not replace existing counseling staff, Schmidt- Whelan told ADAW. "We’re looking at it as something new and different."
Tacoma ranks second in the nation in per-capita methamphetamine use. Schmidt-Whelan said the Pierce County Alliance will use the CRC online program in conjunction with its Methamphetamine Family Services program, a family drug court structure.
State officials’ perspective
While some organizations in the state have quickly embraced online addiction treatment, some state officials believe the modality may not be suited to some public-sector populations.
"Online treatment is not a smart idea for the clients that [we] deal with through the public system," Kenneth Stark, director of the state Division of Alcohol and Substance Abuse (DASA), told ADAW. "There has to be lots more research and marketing to convince someone like me."
Stark did say that he sees the program as potentially being "a great adjunct to regular treatment." Still, he is concerned that online treatment may not work well with clients who are in denial over substance abuse problems. "The [online treatment program] would work with a client who is highly motivated — a client who has a strong support network."
Stark likens the situation to that of a student involved with an online education program. "A student who is very focused is motivated to learn something," he said. An adult with substance abuse problems who is not self-directed may not be inclined to read the material via an online education class, he said.
"eGetgoing is not in the public sector yet," Doug Allen, chief of policy and planning at DASA, told ADAW. "There are still a couple of issues — they have not yet applied for certification."
Allen, who attended a news conference held by CRC last month, said that the organizations in the state that are using the online program "use it as an adjunct to treatment like any other education service online."
Allen said he recently spoke to someone in the criminal justice community who indicated that because of the program’s need for access to computers, the online effort may present challenges to the offender population.
Karlin said CRC has worked with appropriate state licensing agencies to explore how it can offer online treatment at the public-sector level. He added that CRC is involved in such discussions with Washington state officials.
Appealing for youth services
School districts using teen- Getgoing, such as the Sunnyside School District in Washington State, are very pleased, Karlin said. The teenGetgoing Discover program is a live counseling program, and the teenGetgoing Aware program is a self-paced learning program.
"It’s the first time they actually have a weapon to deal with the issue in a real economic way," Karlin said of school districts.
According to CRC, the Alaska Department of Labor and Canada’s Department of Health both plan to adopt eGetgoing for youth populations.
In short, eGetgoing’s momentum appears to continue to grow. "We’ve already had discussions with 25 states at this point," Karlin said.
According to CRC Health Corporation’s first national results of online addiction treatment services for adults and teens, released last month, its programs are showing encouraging results in treatment satisfaction, completion and substance use outcomes.
CRC’s one-year study involved 602 clients in more than 15,000 sessions using eGetgoing’s live videostream counseling. According to the study, 80 percent of clients completed the eGetgoing online outpatient treatment program, compared to a completion rate of about 41 percent for traditional outpatient treatment (as reported last January by the Substance Abuse and Mental Health Services Administration in the Drug and Alcohol Services Information System report).
"Studies nationwide report the importance of program completion to more favorable outcomes as compared to those who begin, but who do not complete treatment," Gen. Barry R. McCaffrey, former director of the White House Office of National Drug Control Policy (ONDCP) and principal adviser to eGetgoing, said in a statement.
"Clients state the privacy and convenience of treatment through online technology is a major inducement for completing the full treatment program — leading to a completion rate that is double that found in traditional outpatient programs," said CRC founder and chief executive Barry Karlin.
The study also found that 20 percent of clients reported relapsing over the nine months following completion of eGetgoing outpatient treatment. This compares to a range from 50 percent of clients resuming heavy use to 90 percent having a brief lapse, as reported nationally, researchers said.
In the client satisfaction rating, the study found that 100 percent of clients reported "Excellent" to "Very Good" overall satisfaction following their eGetgoing online treatment experience. According to the research, all clients studied would recommend the program to someone else.
Nearly all eGetgoing clients rated their overall quality of life as improved following their online treatment program experience, measured at one week, three months, six months and nine months post-treatment, the study stated. The study also found that individual health was also rated as improved at all intervals for 90 percent or more of eGetgoing online clients.