The prospect that computerised interventions could make help for problem substance use readily available to more people and for less money – with the promise of greater feasibility as internet access expands and becomes more convenient – has driven studies to test whether such approaches can retain the effectiveness of in-person interventions. If effectiveness is sacrificed, casting the net wider may not be worthwhile. Moreover, the idea that an automated response driven by a computer could help addicted patients overcome often desperate situations doesn’t quite sit right with everyone. Where is the humanity without the human-to-human contact? And where is the ‘therapy’ without the familiar cues of patient and practitioner? This reaction is in itself a reason why they might not work, because such therapies would fail to meet a basic criterion for effective psychosocial treatment, that it’s about what you do in that culture to get better – that to the patient, it looks like ‘treatment’. 

Nobody is yet suggesting that computers can replace therapists for typical treatment populations, but further down the severity and complexity scale, there is growing evidence that computers and other forms of digital technology may add substance use reduction to its more familiar competencies. As web services permeate more of life including social and health-related activities such as dating, networking and distance learning, they too may take their place among culturally-accepted routes to overcoming unhealthy substance use.