Home > Telehealth in substance abuse and addiction: review of the literature on smoking, alcohol, drug abuse and gambling.

Ohinmaa, Arto and Chatterley, Patricia and Nguyen, Thanh and Jacobs, Philip (2010) Telehealth in substance abuse and addiction: review of the literature on smoking, alcohol, drug abuse and gambling. Alberta, Canada: Institute of Health Economics.

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Telemedicine and telehealth are defined as sending electronic health/health care information (e.g. data, audio, images) over distances between two or more individuals or sites. The scope of telehealth is somewhat wider than telemedicine since it includes areas such as self-help activities where people look for health related material that may impact their health or health behavior. Many conventional interventions in addictions have been shown to be effective; however, the widespread use of those interventions have often been limited due to a limited number of personal services provided by professionals and the stigma associated with seeking and accessing available services. Telehealth can potentially overcome many of these challenges by offering services over distances and providing these services to large populations at the same time. The aim of the study was to do a systematic review of telehealth studies in addiction/substance abuse and study the effectiveness and/or cost-effectiveness of the different telehealth applications in different addiction problems.

From the 1521 references identified in the search, 151 publications (9.9% of all abstracts) were ordered for closer review and 145 were received for detailed review. Most of the articles came from the smoking cessation area (78) followed by alcohol (39), illicit drug use (10), and gambling (3). Of the studies, 15 were review articles, mainly from the smoking cessation (10). Through the telehealth activity, the studies were distributed to 64 applications via telephone, 39 via the Internet, 37 via computer/CD-rom and three via videoconferencing. Internet applications were relatively common in alcohol- and smoking-related programs. Internet applications for students had relatively good outcomes, especially if the intervention is directed to those who used alcohol or smoked. The results of primary prevention studies of starting alcohol use or smoking are not promising. The general population applications seem to be more effective, especially for alcohol problems.

Getting more individualized programs based on the personal characteristics and increasing the length and frequency of the sessions improve outcomes. Adding the Internet application to other treatments, either simultaneously or after, can be beneficial. A large majority of the studies were large scale randomized controlled trials (RCTs), which indicates that these results are relatively reliable.

Similar to the Internet applications, many of the computer-based application programs were directed towards adolescents and college or university students. Most of these programs seem to be beneficial and the effectiveness was better in programs where students already used substances rather than in primary prevention type of programs. Some of the first programs did not use interactive and personalized information and, in general, they were not as effective compared to more theory-based intervention programs published at a later date. Overall, a majority of stand-alone computer applications had positive outcomes or were equivalent to face-to-face outcomes. The greatest uncertainty from the benefits can be seen in the smoking cessation studies where studies did not show clear positive outcome, especially student-based studies. Out of 13 telephone-based applications in alcohol and smoking, 12 showed positive or outcomes that were equivalent to conventional methods. Half of these studies were based on reviews and meta-analysis in telephone applications in smoking cessation where we included only review studies. Most of the applications involved the conventional use of telephone for mediating advice and therapy by distance. The use of cellular phones for text messaging has increased during the last few years; however, there are only a few studies in this category.

The results of this review indicate that the Internet, computer, and telephone applications in alcohol and smoking addictions are at least as effective as conventional services, especially when we review more recently published applications that utilize personalized, interactive modular settings. There was some evidence from telehealth in the area of illicit drugs applications, but the number of studies was still relatively small (eight studies). There is a need for further studies which use telehealth for gambling addiction. Although telehealth applications are expected to be less expensive than individual face-to-face therapies, there is no good quality literature in the cost-effectiveness of telehealth applications in the studied addictions.

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