At the Interface of Clinical Services and Information Technology
by Tom Horvath, Ph.D., ABPP
Benefits of Software in Addiction Treatment
For about a year Practical Recovery has included the Checkup & Choices website (www.checkupandchoices.com) in our work. By referring clients to the site we reduce the amount of time they spend with clinicians, thereby lowering their fees. We also increase the accuracy of both assessment and psycho-education. Psycho-education is that part of psychotherapy in which the clinician delivers basic information about a common topic (e.g., how to cope with craving).
Software does not have memory lapses. Unlike the more variable clinician, software asks the same questions and delivers the same information each time (barring the occasional hardware or software problems). Of course, to eliminate memory problems during assessment clinicians have been using printed tests and forms for probably a century. In psycho-education we can also use workbooks or similar materials to ensure that information is conveyed completely and consistently.
However, although paper versions of assessment and psycho-education are readily available, software has some advantages. It can be accessed at the clinician’s office but also elsewhere. It is easily updated. It can be interactive (in ways which are just beginning to show their promise). It appeals to a portion of the population who might not sit down with paper and pencil. The digital responses it records are much easier to read and search than answers that might be scrawled on paper.
A Closer Look at Checkup & Choices
Anybody can draw up a list of questions for assessment, or concepts for psycho-education, and publish it. A responsible clinician would be wary of such products. The research behind www.checkupandchoices.com is impressive. Dr. Reid Hester, the principal investigator, and his colleagues have been conducting research on online assessment and treatment of problematic addictive behavior for 20 years. They have been funded by the National Institutes of Health to conduct six clinical trials of their work. These clinical trials are published in peer-reviewed scientific journals. No other software in this field appears to come close to that level of investigation and publication. The software is based on established cognitive-behavioral, motivational enhancement, and behavior tracking techniques, and on published norms for addictive behavior (which are used to generate participant feedback).
The screener for alcohol is brief. Screenings for other substances are in development. The Checkup (the assessment) requires approximately 30-45 minutes. Upon completion the participant has the option of choosing an abstinence approach (for alcohol, marijuana, opioids, stimulants, or compulsive gambling) or moderation for alcohol. All these modules can be completed by the same participant if desired. Once the participant begins a module, the software offers customized exercises, behavior tracking, and reminders. Other interactive features are under development.
Checkup & Choices has been developed for all devices, including smartphones. If the site is offered via an organization (such as Practical Recovery), there is also the option of aggregate data being provided to the organization. However, the confidentiality of individual participants is fully protected. Customization for the specific organizational setting is also available.
Does Software Have a Role in Addiction Treatment?
As a clinician who has been focused on developing a strong working relationship with clients, I have been skeptical about whether software would be of any additional benefit in my work. I now believe that software has a role to play. In my initial sessions, for instance, I can move quickly from assessment to treatment planning and intervention. The client can complete a comprehensive online assessment later, and elect to send me the results (or not). The motivational value of a comprehensive assessment is thus not lost, but in the first session I have also not lost the opportunity to begin treatment interventions. If the client can come out of that first session with something to do, while they are in a motivated state, the change process is off to a better start.
All of us adopt change at our own pace. I understand that some of my colleagues are a long way from incorporating software into their work. For those who are ready, I believe Checkup & Choices merits consideration. I also expect that, just as in other software applications, we will see enormous improvements in the years ahead. I expect that in a few years practicing without adjunctive software will be obsolete.