E-health technologies and substance abuse
The rapid development of e-health technologies not only in developed but also in developing countries offers great opportunities for public health. The aim of this project is to develop, adapt, evaluate and disseminate internationally applicable e-health tools in the area of alcohol and substance abuse.
The initial focus is on helping developing countries to set up an e-health portal that provides national and international information on policies, epidemiological data, research findings and health services. This information will be relevant for, among others, policymakers, professionals in health and community services and experts in related areas. The portals shall also give access to computerized tools for professionals, such as a computerized version of the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST).
The general public and people with hazardous or harmful alcohol consumption can benefit from such a portal in their country as it provides relevant and understandable information on alcohol, a self screening test and online self help. The latter is an innovative method to create online access (via computers and mobile phone) to existing evidence-based mental health interventions, based on learning, cognitive/behavioural and problem-solving principles. The intervention contains self tests, customized feedback, monitoring and analysis of alcohol consumption, advice and exercises.
Online interventions are client friendly, allowing a person to use them anonymously, whenever or where-ever it suits them (24/7), without travel time or waiting time. They attract persons who in the past were physically not able to seek help or avoided help as they were afraid of stigma. Alcohol and drug use disorders typically commence before the age of 25 years, an age group that has been traditionally hard to reach. Yet, this age group uses the internet intensively. The care is usually free or inexpensive (no extra costs beyond the usual costs for access to the internet or mobile phone network).
The intervention is fully computerized, without the direct involvement of professionals, other than a moderator, if an online support forum is included in the portal, a function which can be fulfilled by trained volunteers. This means that online interventions impose a minimal burden on scarce health resources. The costs are mainly limited to the start-up costs of developing and making the intervention available.
A meta analysis commissioned by WHO has shown that online interventions for hazardous and harmful alcohol use are as effective as conventional evidence-based psychological treatments administered by clinicians (Riper et al: Effectiveness of e-health interventions for curbing adult problem drinking: a meta-analysis; submitted).There are also indications of their cost-effectiveness.
The online self help intervention developed for this project is based on an effective intervention originally developed and evaluated in the Netherlands. The role of e-health tools in overall prevention and treatment systems for substance use disorders is still to be assessed and evaluated in different cultural and health care system contexts. A model for assessing cost-effectiveness of e-interventions has also been developed.
Initially the project will focus on alcohol, followed by other psychoactive substances, and after successful implementation may expand to selected mental and behavioural disorders.
If evaluated favourably, the capacity to scale up e-interventions would be excellent, reaching many more people, as internet penetration and the use of cell-phones are rapidly improving throughout the world.
The project has started with the development of a generic portal on alcohol and health by WHO together with experts from a WHO collaborating center (Trimbos Institute) and leading institutes in four pilot countries (Belarus, Brazil, India and Mexico). The deployment in the pilot countries is foreseen before summer 2011, after which the testing can start.