Aftercare Goes High-Tech

Treatment professionals today face a variety of challenges. These include but are not limited to: less time for treatment, budget restraints, cut backs on staffing, heavy client loads, and restrictions placed on them by payers and it is easy to see why frustrations frequently are high.

Many counseling professionals would like to provide a higher quality of care involving longer stays in treatment and more efficient post treatment follow-up. Yet counselors and patients alike often find they do not have the resources to make this possible. According to Alan Goodstat, LCSW, “In order to decrease the chances of relapse among our patients, the most important thing we as professionals can do is provide a sound continuing and aftercare plan that would enable us to maintain a higher level of communication with our clients after they leave the daily supervision of our center”.

This, however, involves counselors doing follow up calls when they already have a full caseload and limited time – they are expected to keep, maintain, and record outcome studies. These studies include statistics, demographical date, successes, as well as failures. With today’s transient population, simply trying to keep up with a current phone number is a task within itself. Many treatment centers are turning to alumni groups to help their patients after they return home. This has helped reduce some of the aftercare concerns, although there cannot be an alumni group in every city throughout the world.

The answer to several of these problems may lie in emerging information and communication technology – both of which promise to usher in a wealth of innovative solutions for healthcare, including quality, access, and cost. Gradually, treatment centers are turning to technology for help. The ease of access and affordability of the Internet makes it the logical next step in helping centers and individual counseling professionals perform their duties more efficiently. Online companies have established virtual a la carte menus, providing counselors and patients with the following:
- Secure client data collection starting the day the patient arrives for treatment. The information is forwarded electronically without violating the patient’s right to privacy or the Health Insurance Portability and Accountability Act (HIPPA).

• Acquiring times and locations of 12-steps meetings for existing patients so they leave treatment with a clear game plan. Thanks to the Internet, gone are the days of calling inter-group offices and running the risk of no answer, not being given the choice of all meetings, or getting lost in an unfamiliar area.
•  Increased levels of accreditation compliance through more complete discharge planning, patient participation, management of information, and professional development.
• Web sites allow counselors to maintain contact with patients after they leave treatment via online aftercare, center sponsored online private support meetings, progress reports, and surveys – all generated with one mouse click.

An example of one such Internet company is Florida-based CyberSober.com, Inc. (www.cybersober.com) - a private organization whose mission it is to provide economical assistance and support to both professionals and those recovering. In an effort to assist all parties involved in the recovery process, CyberSober and other web companies, such About.com and SAMHSA.gov, provide the quality support that patients and counselors desperately need. About.com has a health section that includes extensive information pertaining to substance abuse. The official web site for the Substance Abuse and Mental Health Services Administration is SAMHSA.gov. In addition to information about substance abuse, this web site has a treatment facility finder. Along with other services, CyberSober.com displays maps and directions to over 200,000 support group meeting around the world as well as resources for treatment professionals and those in recovery.

The blending of technology and treatment is simply the next logical step. With the use of Internet, treatment centers can increase their visibility, counselors can save valuable time, and the quality of care will be increased. Patients will be able to leave treatment more informed as to their next step and families will feel more comfortable with knowing everything is being done to insure success for their loved ones.

The mission of alcohol and drug abuse treatment is to treat the whole person with education and prevention, group therapy, and intensive one-on-one counseling – the latter being the greatest challenge counselors face as they are expected to perform so many duties. This problem affects their main mission, lasting sobriety and recovery. It is time to move forward and face the fact that the old way is not working and we must explore new methods of support through technology.
 

It's no secret that discharge planning is a top trouble spot for behavioral health organizations trying to comply with Joint Commission standards. Surveyors often fault facilities whose discharge plans are too glib or too generic. Instead, the accreditor looks for plans that will help ensure the client continues treatment or gets the support he or she needs to stay healthy.

But organizations trying to form good discharge plans often have high hurdles to clear. Finding resources for clients to tap into after discharge, and ensuring that the client actually takes advantage of what's offered, can prove time-consuming for staff who are already overwhelmed.

One facility found an answer to its discharge planning dilemma in cyberspace by using a Web-based tool geared toward drug and alcohol rehabilitation programs. Known as Cybersober.com, the site, which has been online for about a year and a half, has freed up hours of staff time, an administrator says.

"It meets most JCAHO compliance [standards] involving treatment planning," says Alan Goodstat, LCSW, administrator of Focus Healthcare of Florida, a 62 bed facility that treats addiction disorders on both an inpatient and outpatient basis in Cooper City, FL. "It's a neat way of providing excellent care."

Holding patients accountable

Focus Healthcare began using Cybersober.com about six months ago as a pilot facility. The site is designed so that patients from participating organizations can log in and get directions to meetings such as Alcoholics or Narcotics Anonymous, as well as ancillary programs such as Al-Anon or Alateen. They also get access to other treatment providers online.

Patients get instructions on using the site as part of the discharge planning process. if they don't have Internet access at home, they can still access the site through public Internet stations at libraries and community centers.

Traditionally, treatment programs such as Focus Healthcare give patients information about meetings as part of their discharge plans. But attendance of these programs-considered crucial to maintaining sobriety-suffers when patients have trouble finding them, Goodstat says. The Web site eliminates that problem by providing instant, updated directions and times to appropriate meetings.

"It's a way of holding the patient accountable," he says. "The biggest excuse we get at discharge is they say, 'Well, I couldn't find it.’

Ultimately, Goodstat says Focus Healthcare will try to use the site for program alumni by allowing them to communicate with other treatment facilities.

“It’s just helped us a lot. It adds a lot of credibility to our program. It allows us to have the patient active in the discharge planning process," he says. "It allows us to demonstrate that we are following the patient through the treatment and the discharge process."

Genesis of a Web site

When the joint Commission dislikes a discharge plan, it often criticizes an organization's failure to focus on the patient. Cybersober.com president and chief executive officer Robert Morgan knows about that problem firsthand-he has been in addiction recovery for six years, having gone through seven rounds of treatment before he finally got sober for good.

Prior to his recovery, Morgan says the longest he had been able to stay sober was 60 days. A former insurance underwriter and travel industry worker, he often had trouble finding Alcoholics Anonymous group meetings because he would call an outdated telephone number and get no answer. If he could reach someone, he would sometimes get lost going to meetings in strange cities because the directions were unclear.

"That started the wheels spinning," Morgan says.

Web site

In May 1999, he formed Cybersober.com in Ft. Lauderdale, FL. A month later, he licensed with MapQuest, a popular site devoted to providing directions to Web users. After a year, Cybersober.com had compiled a list of more than 125,000 12?step meetings. The company is now marketing to treatment centers for use as part of an after-care package, as well as court systems, corporations needing the service as part of employee benefits packages, and universities. Today, it provides information about 190,000 meetings in 52 countries.

As part of his research, Morgan says he has looked into patient compliance challenges that providers face.

"Treatment centers don't have much choice besides saying, 'Here are the meetings we have, here's the intergroup number, and good luck,’ “Morgan says. "I think we've created a better mousetrap- [clients] can go home with something tangible in their hands."

Treatment centers can also use the site to build a lot of good will with patients families by going the extra mile to provide such details as maps to meetings, Morgan says.

Patient participation is important to the joint Commission, and Morgan says his site helps clients participate in their own aftercare.

"If 1 was the center, I would want to know that I did everything possible and I exhausted every tool possible to give the person guidance and direction when they leave here," he says.

Performance improvement

Eventually, Cybersober.com hopes to design a page that will provide online aftercare for patients if they want it, Morgan says. Treatment centers would be

able to maintain relationships with their clients by providing care without tying up their resources as much as they would with in-person meetings.

The Joint Commission recently has placed a lot of emphasis on performance improvement and use of statistics to demonstrate such improvement through projects. Morgan says his site plans to help those initiatives by tracking statistics of its users and conducting surveys, such as asking users how long they have stayed sober after leaving a program. Because the user is identified through his or her ID and password, Cybersober.com can funnel the information back to the facility to use the statistics in identifying areas that need improvement.

Likewise, treatment centers-which are often strapped for resources-can get rid of a lot of paperwork by switching to computerized discharge plans, which theoretically makes survey preparation easier, Morgan says.

Goodstat says Focus Healthcare has found the site meets JCAHC standards for information management, continuum of care, and discharge planning, though he acknowledges that a joint Commission surveyor won't evaluate the organization's use of the program until February 2001.

However, he says the staff has saved time by avoiding phone calls and voice-mail tag trying to get information about meetings for discharge plans. That is particularly helpful when trying to piece together information for clients who live in remote areas in other parts of the country, Goodstat says.

The site "allows us to find meetings in an area where I know someone would have to spend an hour and a half on the phone trying to find the meeting," he adds. "We have found it to be a really user-friendly product that has allowed us to automate some of our systems."

Morgan believes the Joint Commission will give the program its stamp of approval.

"I'm not saying we are the cure-all," Morgan cautions, though he adds, "I think we're the beginning. This disease is baffling to so many people."

Copyright 2000 C&R Publications

When Is Drinking a Problem?
For people who are alcohol dependent — commonly called alcoholics — addiction experts agree abstinence is the only treatment. But according to the American Psychiatric Association, there are different degrees of addiction to alcohol. And defining abusers vs. full-fledged alcoholics is a thorny question, and key to the debate.
An abuser, according to the APA, is someone who continues to drink although it is the source of social, physical or work problems and leads to an inability to fulfill school or home obligations.
A dependence diagnosis is more severe and requires that a person meet criteria such as increased tolerance to alcohol, withdrawal syndrome, persistent desire to drink or failed efforts to control drinking and reduced activities in favor of drinking.
The Department of Health and Human Services defines moderate drinkers, or those who do not have a problem with alcohol, as those who consume no more than two drinks a day, for men 65 years old and younger, and one drink a day, for men over 65 and women of all ages.
Individuals who abuse or become dependent on alcohol often don’t realize how serious their problem is.
“Identifying the fine line between the two diagnoses can be difficult in clinical settings and is impossible for most drinking alcoholics,” says National Institute on Alcohol Abuse and Alcoholism spokeswoman Ann Bradley.
Denial is widely considered to be an element of alcoholism, blurring a fine line even further.
“But people do not go on and off the wagon and spend time trying to change their drinking if they are not alcoholic,” says Rob Morgan, president and CEO of Cybersober.com, who has abstained for more than five years. “One of the biggest problems with alcoholism is denial and moderation allows that to stay alive.”

Two Sides, Many Views
Moderation Management board member Marc Kern says drinking problems, like other behavior disorders, lie on a continuum and people who identify their problem early on should be offered an alternative to abstinence. “To tell everyone one size fits all is absolutely absurd,” he says. “We’re going to chase people away.”
But Fulton Crews, director of the Center for Alcohol Studies at the University of North Carolina at Chapel Hill, says Kern’s argument is flawed. He believes moderation groups do problem drinkers a disservice because they offer the wrong motivation, luring them with the very drug to which they are addicted.
Yet dangling a “drug carrot” — such as methadone for heroin addicts — is a common harm-reduction treatment approach for illicit drug addicts, points out William Miller, director of research at the Center on Alcoholism, Substance Abuse, and Addictions at the University of New Mexico.
“Alcohol abuse and dependence comes in degrees. It’s continuous — like hypertension,” says Miller. Treatment, he says, should be done in relation to the severity of the problem, as well as a patient’s willingness to work on it.

Walking the Tightrope
According to the NIAAA, there are four times as many alcohol abusers as dependents in the United States. But federally funded research has found that 93 percent of American treatment programs are abstinence-based 12-step programs.
Most American 12-step programs are modeled on Alcoholics Anonymous, a spiritual self-help group founded by Bill W. in 1935. As well as committing to abstinence, AA members admit they are powerless over alcohol. But moderation groups say they aim to help early-stage problem drinkers, who want to learn to control their alcohol intake before they become powerless or “hit bottom.”
Even problem drinkers may be powerless to set limits, however. Miller, the University of New Mexico researcher, discovered that many find staying within moderate drinking limits “a tightrope walk,” and ultimately decide to quit drinking altogether.

Moderation as Prevention
Genetics may also weigh in on the side of the abstinence theory. Many believe that alcoholism is an irreversible, progressive genetic disease, best treated with abstinence. Studies from the 1970s documented that alcoholism does run in families, but did not resolve whether a child learns to abuse alcohol from the home environment, or inherits that tendency, or both.
But moderate drinker and founder of Drink/Link programs Donna Cornett says the genetics argument is “a misconception” that limits and labels people. “Prevention is the cornerstone of medicine,” Cornett says, adding that moderation programs may help people gain control before they are trapped in a devastating cycle of alcohol abuse.
In summing up 10 years of research on moderation programs, Miller says only 15 percent of people who seek help succeed in limiting their drinking in the long run.
Rather than lay blame or make accusations, Kern urges, it may be more fruitful for Americans to rethink the role alcohol plays in society overall.

From the South Florida Business Journal

CyberSober.com takes shot on the Web

Fort Lauderdale-based CyberSober.com's for-profit Web site is, well, unusual. The mega-directory contains the dates, times, locations and directions to more than 155,000 meetings and 14,000 treatment centers for a variety of recovering addicts.

It's the brainchild of recovering alcoholic and CyberSober CEO Rob Morgan.

"I didn't start it to make money," said Morgan, anticipating everyone's first question. "I was in Dallas a few years ago and tried without success to find an Alcoholics Anonymous meeting after 5 p.m. The AA office was closed and I couldn't locate a local meeting to attend."

As with most 12-step recovery programs, regular follow-up attendance at meetings is required to boost or reinforce recovery. The trick when traveling or on vacation is finding where they are and what times they are held.

"A few months later, nearly the same thing happened in Cincinnati," Morgan said. "That time I did get someone on the phone but I got no choice of meetings and poor directions to find the one that I did get. There had to be a better way."

The better way, to Morgan's thinking, was CyberSober.com, incorporated in February. The site now lists meetings nationwide for a number of 12-step programs. They include Alcoholics Anonymous, Al-Anon, Al-Teen, Co-Dependencey Anon, Narcotics Anony-mous, Cocaine Anon, Gamblers Anon and one called Arts Anon for artists who fear rejection.

Organizations do not pay for inclusion, nor do they endorse the CyberSober.com site.

The site had more than 235,000 visitors between February and June. It gets more than 5,000 hits a day and climbing, according to company records. A 30-day, $7,400 advertising program on Yahoo! has nearly doubled daily traffic since it started a week ago.

Last week, CyberSober had two booths at the National Association of Alcohol and Drug Counselors and received "a lot of interest," Morgan said.

The world of the dot.com is none too secure on today's Wall Street. The fashion Web site Boo.com went out of business a couple of weeks ago after burning through $130 million of capital in six months. Amazon.com under Jeff Bezos has lost more than $500 million since inception, has never made a penny of profit-and is running out of capital. How can obscure CyberSober survive in this tough environment?

For Morgan, who loves swimming, golf and collectible cigars, the answer is both optimistic and realistic.

"I'm no saint," he said. "I just want to help where I can. The money will follow if we are successful in offering a service that people appreciate and need."

Morgan's dot.com foray hasn't been cheap ­ and the true believer has done it all with his own money.

"I've put in $690,000 so far and counting, with another $310,000 earmarked for the project," he said.

The CyberSober burn rate is $40,000 a month including salaries for 10 employees. That's modest by most dot.com standards, but will flame the entire capital pool within seven months if income sources are not developed or additional capital secured.

The company is housed in the Palace Blue Inn at the Beach, a motel owned by another Morgan corporation. The executive office is upstairs and overlooks a swimming pool with an overgrown garden.

Downstairs, young tekkies in a spacious suite input the latest content updates and tweak impressive site servers and network peripherals. The beach is two blocks away, the Intracoastal Waterway three.

The membership-only site costs $19.95 a year to join. There are 240 paying members already signed with thousands of others visiting gratis during CyberSober's introductory phase. Morgan points out there are also daily trial memberships available, and there is no limit on the number of trial memberships an individual can have.

Recent upgrades to the site include MapQuest, which costs CyberSober $14,000 a year. It enables members to print out color maps and directions to meetings at no charge.

What does the recovery industry think about the five-month-old CyberSober? For the most part, it's news to them.

"Sounds like it could be helpful," said Marc Goldberg, intake coordinator at Boca Raton's Watershed Treatment Program. He had heard about the site, but hadn't seen it.

"We offer a free 800 nationwide help line and service by phone, but don't offer it online or with maps," he said.

Alcoholics Anonymous offers a Web site (http://www.aa.org) but it has no master list of meetings and locations. It does have a state-by-state list of local help and meeting referral organizations, called intergroups.

Locally, there are intergroups in West Palm Beach, Delray Beach, Fort Lauderdale, a French-speaking group in Hollywood, plus two in Miami, one Spanish-speaking. The AA Web site makes it clear that Alcoholics Anonymous does not endorse or recommend any treatment center or outside service.

A woman on the telephone at the AA intergroup in Delray Beach, (members request anonymity), said she was unfamiliar with the CyberSober site, but would check it out.

Goldberg wondered how CyberSober would make money, but said he was supportive of anything that would help recovering patients succeed.

Morgan's firm is developing revenue sources. Since CyberSober will not release members' names or contact information, it is somewhat limited in the more lucrative advertising options and tie-ins.

Banner ads will come

"Banner ads are a no-brainer when we hit critical mass," Morgan said. "But they have dimmed in popularity over the last year or so."

The firm plans to offer treatment center rehab packages to corporate human resource departments, collecting a commission from treatment centers.

The relapse rate for recovering addicts from all treatment centers is high, according to industry statistics. Morgan plans to license CyberSober to clinics for $1,500 a year to aid them in improving their reputations and results for patient after-care with insurance companies.

The treatment centers, in turn, may introduce and recommend CyberSober to all their patients as a continuing recovery resource.

In the immediate future, CyberSober has plans to apply for a federal grant.

Further out are plans for expansion to Canada, Europe and other large international markets. Supervised chat rooms and online meetings also have been started.

E-Mail Staff Technology Writer Ed Duggan at EDuggan@bizjournals.com