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Alcoholic avatars and penny pinching insurance companies - a match made in heaven.

None of us would complain about less time spent wasted in doctor's waiting rooms, or better and more affordable healthcare! Emerging internet based interactive platforms promise to increase our access to health information and healthcare participation, while allowing a finite number of doctors to treat as many patients - more comprehensively and effectively.

We are not the same group of patients we were 15 years ago. Who goes to the doctor now before taking a self diagnostic tour of internet medical sites? We often scare ourselves with misdiagnoses of terrible diseases, but we endeavor to get informed and by doing so we participate better in the healthcare process - and at its best, healthcare is not passive, but interactive.

The potential for positive change is great - but will the pendulum swing too far? As interactive net based communication between patient and provider improves, will financial pressures compel the e-sourcing of things that just don't make sense? Will we soon see virtual drug rehabs?

The Good - Where E-Care Makes Sense

www.reliefinsite.com is great. Not too fancy, no bells and whistles, just a simple and effective way for pain patients to communicate their symptoms in real time, and longitudinally, to their doctors. Pain patients can create what is essentially an online pain diary - and as they experience pain on a day-to-day basis, they can record information about their symptoms in their diary.

It's collaborative too. Doctor's can log on, and given permission, access a patient's diary, see what's really happening, and even write notes to the patient in their diary - on a day-to-day basis. Great stuff - It just makes sense. No need to try and explain a history of pain in a 15 minute office appointment, that's a pretty tough thing to do. Doctors get to see what's really happening, can make better diagnosis's and can react to changing symptoms in real time. It provides a way for more accurate information sharing, it saves money and everyone's time, and it allows doctors to treat their patients more effectively.

That's the kind of stuff we need. Platforms that improve healthcare efficiency while at best also improving the standard of care, or at the very least - not reducing it.

Except for the very rich, in any country you can name, healthcare systems are overburdened. Resources are finite and never enough to provide optimal care to all that demand it. It's a fact of life, and for now, it's just a case of managing the shortfall.

Internet healthcare systems could free up such enormous resources of time and money - ensuring that those that need a hospital bed and a doctor's care get it - and those that don't, stay home. How many parents, after some deliberation, make a midnight trip to the emergency room in search of treatment for something that they are 99% sure is not serious? For parents, a 1% chance of tragedy is more than enough to justify a few hours of inconvenience and 99 wasted trips out of a hundred.

On an individual basis, this makes perfect sense - but systematically, it strains resources - and strained resources mean lessened care for everyone.

E-based diagnostic platforms, staffed by doctors and nurses, serving as a front line operation would make sense, and in some jurisdictions, already exist. Get on the video phone, explain the situation, and a lot of the time, they are going to be able to tell you with certainty that there is no need to go to the hospital.

How about on the back end? How many hospital beds stay filled each year by doctors pretty sure that the patient could go home, but wanting one more day of observation - just to be certain. What if those patients that doctors were almost sure were going to be OK - were released one day earlier, but remained linked via web based diagnostics tools? The doctor could still monitor the symptoms in real time - could get someone back to the hospital if needed, but tens of thousands of beds a year would be free to people waiting for them. Better health care for all. Some people would die, but many more people would live - saving more lives for the same expenditure.

The Bad - When Only Face-to-Face Will Do

In the short to mid range future, you need not be terribly imaginative to envision the sort of benefits that interactive net based healthcare services could result in - the two suggested above are only the tip of that iceberg. But there are certain services that do not lend themselves well to distance interaction. Poisoning, trauma, pancreatitis - you can name thousands of conditions that, if you had one, you'd probably want in-person and face-to-face medical care for.

What about addiction counseling? I'd argue that although less obvious and dramatic, it also requires in-person treatment for any real odds of success. I'm not talking about detox, which obviously demands medical supervision; I'm talking about the nuts and bolts of long term treatment - group therapy, cognitive therapy, psychotherapy, etc. A case could be made that such forms of counseling could be provided more cheaply, and with little loss in efficacy, using internet communication technologies. Actually, a case will be made, and e-rehabs are likely on their way.

Addiction though, is tricky. It's a gestalt kind of disease, in which the sum of the parts never seem to equal the whole, and a disease that demands treatment of a psychological intensity that matches the cognitive manipulations of the disease.

You could arrange for an internet based group therapy session. It would be cheap and easy, but it wouldn't work very well. Group therapy works when participants are fiercely and honestly involved. You don't get that when tuning out is as easy as checking your email as you sit in therapy; and manipulations don't get spotted as they do when you squirm, lying, in person to a group.

You could conveniently get individual therapy at home, over the internet; but the trust building needed for effective counseling takes time in the best of cases, and a situation where the patient is miles removed from the therapist - is not the best of cases for relationship formation. And forget about what our non verbal communication would otherwise reveal.

Could you learn how to make sober friends again, online? Would you really do that yoga - if no one could see what you were up to? Would you tune out, when you didn't like what you were hearing - sometimes people need a little push to make a breakthrough, but it's a lot easier to close your browser window than it is to walk out of a therapy session.

Logistically, online addiction treatment is a cakewalk - online addiction treatment that works may be another story.

The Ugly - Financial Pressure

Interactive net communication will create savings opportunities. Ideally, healthcare e-sourcing never harms patient care. The selective application creates a higher standard of individual care in certain areas, and areas unsuited to the application of the e-sourcing benefit from increased funding from the savings - An opportunity for better healthcare, for all.

But if the potential savings in any area become significant enough, there will undoubtedly exist pressure to accept an erosion of healthcare quality in the face of savings - or to put it more bluntly - profit.

Already, consumers with excellent private health coverage who want to get residential drug treatment find that they are obliged to try outpatient first, for a long while, before their insurance company will fund a residential stay. Once insurance companies have an even cheaper option, it's hard to foresee how they won't compel us to use it first.

Addiction treatment isn't like a lot of other disorders. If you had cancer, and the insurance company forced you to try a less expensive procedure first, prior to allowing the more intensive treatment - if that first one didn't work, you'd be ready that next day to sign up for the better one. Alcoholics and drug addicts are more easily discouraged (or their disease is better at manipulating their behavior) and if the first treatment doesn't work, odds are it will take a while (if ever) before they approach a second round. A very cynical person might suspect that insurance companies are counting on this...

It will be interesting, and great changes in healthcare over the next decade are a certainty. Most will be positive. The potential for great advances in systematic levels of care exists through the selective application of resource saving distance treatments. There will, I suspect, be an ugly side to it though, and I'd wager virtual drug rehabs will be at the head of that, unfortunate, pack.

I hope I'm wrong though.

I am not a holistically inclined kind of guy, and regard with skepticism many of the more mystical claims made by alternative practitioners. I have to admit though, my hardened shell is crumbling as I get old, and I guess, soft. Meditation works, it does wonders; yoga apparently offers as much against relapse as group therapy, and acupuncture shows an incredible ability to reduce the suffering of those going through detox and withdrawal pains. No one can say with certainty why these activities help, but they do, the anecdotal evidence is strong, and evidence based studies confirm their efficacy. And music therapy, apparently, also works very well as a complimentary therapy for addiction treatment, as it does in many other health promotional fields. It works; people sing its praises, but the relatively new discipline still lacks those strong scientific and evidence based studies used to convince all of us doubting naysayers of its merits. It’s getting there though. There are music therapy degree programs at many respected universities, an accredited association of trained and professional therapists, and increasing acceptance in the health world – an acceptance grudgingly earned by those that have to respect the results it shows. Late stage Alzheimer’s patients, completely incommunicative, can still on a preconscious level participate in group sessions of rhythmic music - a last communication from a fading mind. Music is elemental and emotional, and far removed from the conscious chatter of our forebrain - our thinking brain, and so it makes sense that music could be an effective tool to delve into our emotional selves. And that, when patients receive appropriate guidance from a trained professional, is what seems to happen. Addicts or alcoholics in recovery are encouraged to make music, as a way of releasing-purging-deep seated and destructive emotions. Emotions that may be too painful to put into words - emotional experiences that may influence our behaviors – yet that we couldn’t put into words even if we tried. Through self expression, addicts bleed off some emotional intensity, and may then be better able to manage what remains. Some techniques used include using music and imagery for relaxation and anxiety control, self expression through group lyrical song writing, and most commonly as used in addiction treatment, through drumming circles. In shamanistic and ritual traditions from cultures across the world, drumming serves to facilitate an altered and ecstatic state. It influences a trance like state; and in the mind, it produces theta waves of deep relaxation, similar to a meditative consciousness. Anecdotal evidence from practitioners suggests that drumming in a group can transform fragmented and angry individuals, and produce a state of group harmony and openness, perfect for the exploration of group therapy. Those that work with troubled youth report that through drumming, they can often break through a tough external veneer, and get to the real kid inside. And the drummers love it. Participants in drumming therapy report a high satisfaction, and in an Australian study, the use of music therapy in treatment increased total-length retention rates. We don’t yet understand addiction, not really, and so we still lack that perfect treatment formula. We do know, intuitively and experimentally, that addiction exists on a mind-body-soul plane, and that treatments that combine cognitive/ psycho therapies and medical health promotion – with a third more intangible “spiritual” element, seem to offer those in recovery more. Spirituality is a tough nut though - hard to define, even personally, and very tough to study scientifically. It’s an intangible, but it’s a valid and necessary part of life-changing addiction treatment, and it is a necessary and vital part of the human experience. No one is saying the music alone offers a cure for addiction, but it does seem a valuable peripheral therapy – and to be honest, it sounds kind of fun too.

They say that every dollar spent on addiction treatment and prevention yields a 7 dollar societal dividend. Hey – you gotta' spend money to make money right… Or maybe not – as the Bush administration must like money, yet once again they have cut total spending on addiction treatment and prevention programs; shaving an additional few hundred million or so from the 2009 budget. They must have a master plan - those crafty buggers. They must know something we don't! Here are some of the highlights:

• SAMHSA, the main recipient of federal funding, will receive 70 million less in 2009 than in 2008.
• The Center for Substance Abuse Treatment will lose 63 million.
• The Center for Substance Abuse and Prevention will lose 36 million.
• The Center for Mental Health Services will limp on, short 126 million.
• The Safe and Drug Free Schools Program will lose 194.8 million in 2009 (but how important are safe and drug free schools anyway?)

It's not all bad though; the National Institute on Alcoholism and Alcohol Abuse will actually see a funding increase in 2009 – that's right, an extra four hundred thousand dollars… Well, it seems crazy to me – but when you consider that spending on drug related law enforcement has increased a whopping 57% during the last 8 years (treatment is up 3% - a below inflationary increase) I guess they've just decided on going ahead with Plan B…throwing EVERYONE in jail! Americans now jail 1 in 100 - A record high, in any country, and at any time.

For any number of reasons, the vast majority of alcoholics and drug addicts never get help for their disease, and one reason given (with some regularity) for not getting treatment, is an inability to pay for it. Treatment costs can be high – many thousands of dollars for residential care, and sure, a lot of people can honestly say that they don’t have the money. At least, they don’t have it just sitting around. And there may be some people that, no matter what they tried, couldn’t come up with a few thousand dollars - but most of us, if we are completely honest with ourselves, could. Take 2 hypothetical situations as examples Scenario 1 I say to you – if you can give me $5000 in 30 days, I'll give you 1 million back. You'd say it was a scam, of course, but just imagine it's a real offer and you would get the reward. Could you scrape together $5000 to earn a million? Could you sell a car, or another prized possession? Could you borrow the money from friends, family, a credit card or a personal or home loan? Could you work for at least part of it? If you really believed that a million was coming; you'd get the $5000, one way or another. You would. Scenario 2 I say to you – if you don’t give me $5000 in 30 days, you will die on that 31^st day. Assuming again that you believe this to be true – could you get the money? More than likely, you could. So, if you could answer yes in either of the above scenarios, you must admit that you could, if the stakes were high enough, compile a few thousand dollars in a relatively short period of time. You might need to make some sacrifices, but you could do it; yet when considering money for treatment, most people don’t seem willing to make these self same sacrifices. People say they can't pay for rehab even with an expensive car (or 2 or 3) sitting in the driveway. When people say they can’t afford drug treatment, what a lot of people are truly saying is that they can’t pay for drug treatment without making any sacrifices. Now, the two scenarios outlined above are a bit extreme. No one is going to give you a million dollars for going to rehab, and you're probably not going to die if you don't get help this month. BUT No one that quits drinking or drugging suffers financially for it. In 5 years, if you can get clean and sober, you will have more money. You will likely live in a nicer house (this has been studied – it's true) and drive a nicer car. You won’t be spending all your money on intoxication, you'll perform far better at work and you'll have fewer healthcare expenses. Money is not a great reason to get sober, but when you look at the big financial picture, getting sober always pays off. Addiction is a disease. It's progressive, and without treatment, it's ultimately fatal. You probably won’t die this month or the next, but if you can’t stop using drugs or drinking, you will die from it eventually. Getting together some money for treatment could save your life. Invest in yourself. Make some sacrifices to get the medical care you need. You probably can afford rehab; you're just not trying hard enough.

We, as humans, are social animals. From birth we learn from our family; as children, friends take on a bigger role until when in our teens, the collective wisdom of our peers exerts a primal influence. As adults we tend to think it all past us, but in reality our peer environment still influences our actions and perceptions, and the people we choose to associate with tend to have a profound impact on our lives. And this is why although recovery alone is possible, recovery in a group is far more possible, and for the best likelihood of success recovery should harness the power of the group. As using addicts or alcoholics, we tend to associate socially with others who share our life-focus for intoxication; it's a natural byproduct of the disease! We take our social cues from our group of peers, and in a big way what we perceive to be acceptable standards of behaviors are derived from what others around us are also doing. If I drink 12 beers a day but my friend drinks 24 beers a day, well, I'm a moderate drinker! Getting into rehab offers a lot. It offers a period of enforced sobriety, which can transform a life on its own. It offers the wisdom and guidance of addictions professionals, and it offers classes in relapse avoidance and life skills that impart the tools we'll need to succeed. But more, much more than this, it also offers us the inspiration of others also in recovery. We learn through the process of group recovery that although we are unique as individuals, our problems with drugs and alcohol share an incredible similarity. We also see that if others, who have it just as bad as we do, can recover - then there is no reason why we can't too. There is a real sense of inspiration that comes from working together towards a common goal with others who share the same troubles; and it can work a real magic on even the most reluctant and hard-headed of addicts. Rehab is supposed to be a place of transformation, and there is true power in this collective effort of recovery. You might be able to do it alone, but it's easier and far more likely done in a group setting. Find a place of healing where you can find your inspiration. Find a group of fellow alcoholics or addicts who understand you as you understand them, and start your journey towards recovery together. It helps.

Since elected officials have repeatedly proven that they are far more likely to lock up a drug addict then offer needed help, we need to change the way we try to improve access to treatment. There are tens of millions of Americans with substance abuse problems requiring professional intervention, and only a small percentage of these people are getting the help that they need. While undoubtedly a significant percentage of these people have the means to afford drug treatment, and for whatever reason choose not to get it; it is estimated that about 30% of these people, or many millions of Americans, have no health insurance coverage nor have the financial capabilities to afford comprehensive drug treatment expenses. The fact that so many millions of Americans are slipping through the health coverage cracks in our Country should appeal to our humanitarian natures and induce a desire to enact change; but even if we view the issue callously and economically, we still come out far ahead by reducing the barriers to treatment entry. Substance abuse cost's Americans hundreds of billions of dollars a year in criminal and justice, health care and reduced productivity costs; and conservative estimates have 1$ spent on treatment reaping an eventual 7$ savings in societal costs. Since the numbers seem so overwhelmingly in favor of enacting social and economic change towards better treatment access, why are we not spending more public tax dollars on the very sound investment of drug treatment? "Because drug treatments don't work" Well actually they do work, and drug rehab programs save countless thousands of lives a year…but the nature of addiction is such that often a single period of drug treatment doesn’t induce permanent change, and thus the treatment statistics per individual rehab visit are not particularly encouraging. It's hard for public officials to publicly commit great resources to programs with such low success rates, and since incarceration and "getting tough on crime" are so much easier to sell to the electorate, we are continually enacting short sighted and ineffective policies. I think that ideally we should divert a massive influx of dollars into both treatment programs and addictions research, but since I don’t think that this is likely to occur lacking enormous political will; we should instead concentrate on increasing spending into addictions research. We need to develop better pharmacological and treatment interventions, and once we do have something more concrete to offer, something that does increase the recovery rates per individual rehab visit, then I feel that the political motivation to fund needed substance abuse programming will materialize. So get out the pen and paper, and if you've been touched by addiction either yourself or through the pains of a loved one, empathize with those that still need help, and let your State and Federal elected officials know that the funding of addictions treatment research is important to you. How many more billions are spent in the development of hair loss, and erectile dysfunction medications than in all addictions research combined? Not that government funded Viagra trials…but still, it's funny how our priorities can get so distorted.

There are too many doctors suffering from addictions to the medications they prescribe. The combination of easy access and a stressful job create great temptation, and the statistics show that doctors are at great risk for addiction. We need to protect doctors from these drugs just as we protect the general public, and there needs to be a policy shift away from doctors having easy access to potent pharmaceuticals. As much as I bemoan the over prescription of addictive drugs by doctor's, I also sympathize with members of a profession who combine a stressful and demanding job with easy access to drugs; to too often predictable results. Additionally, when admitting to a problem can ruin a reputation and severely compromise the ability to practice as effectively and profitably (hey doctor's are human too) the barriers to access for treatment are raised exponentially, and too often the tragedy of addiction progresses for far too long simply because the perceived costs of recovery are too high. Let's face it, addicts can be pretty self deluded, and I did a lot of things while using that I effectively rationalized as acceptable at the time that I now look back at with shame and regret. If we penalize doctors excessively for seeking treatment, and additionally, allow them too easy access to the kinds of substances likely to cause abuse, we are far too hard on those in our society dedicated to healing the rest of us. Now there are some solutions available, and some states allow for confidential treatment and recovery without the suspension of a medical license (a very controversial allowance) and there are private and confidential rehabs available, but far better I would argue is to change the circumstances that lead to abuse, rather than acting after the fact. Let's take anesthesiologists, these doctor's with continual and abundant access to the some most potent and addictive of substances, are among the most likely of all doctors to suffer from addiction. There however do exist programs for doctors with substance abuse histories, that allow them to continue working, and prescribing the drugs as needed, but do not allow them to ever actually handle the medications themselves. Instead of waiting for an all too common addiction to occur, why not simply place these same restrictions on all doctors, even before the first sign of trouble. While any restrictions to access undoubtedly complicate the practice of medicine, the fact that these programs are ever functioning suggests to me that this burden of restriction is not unreasonable or unworkable. Perhaps the cost of a small inconvenience during the practice of medicine is offset by the knowledge that by restricting access to drugs, we greatly reduce the probability of addicted doctors, and the probability of intoxicated and compromised doctors performing procedures on the unaware general public. I'm not a doctor. I'm sure I don’t fully understand the stresses that lead to prevalent abuse, nor do I understand the day to day realities that seem to allow for the easy access to drugs of abuse. Perhaps doctors at all levels need to be somewhat more removed from the drugs they prescribe. Perhaps the pharmaceutical company practice that gives doctors unaccounted for free samples of medications should be abolished. These initiatives should surely come from within the medical community, and medical professionals would no doubt be far more able to offer worthwhile and workable suggestions. But I feel that something should be done, and that any arguments that suggest that restrictions to access limit the ability of doctor's to practice effectively should be evaluated against the statistics of abuse within the profession, and the certainty that with so many doctors addicted to the drugs they prescribe, the public's health is surely at risk to intoxicated and compromised doctors performing irresponsibly. Doctor's are human too, and I feel that they need protection from drugs just as the rest of us do. They may be very smart, very educated and very capable, but addiction doesn’t discriminate, and they remain as fallible and vulnerable as the rest of us.

Rich or poor, young or old, pharmaceuticals are very addictive. Addiction doesn't mean that you're weak, and it doesn't make you a bad person, but it does mean that you need to get help, and break free from abuse. The drugs we are prescribed for valid medical reasons can too often prove seductive and it's so easy to take more than is truly needed. Addiction to pills can happen fast, and family and friends never know when our use has become abuse. Addicts don't have to look like junkies, and a drug addict may just as easily be a kindly grandmother or a soccer mom. Drugs don’t discriminate and the devastation of abuse can affect anyone. If you're abusing pills, you need help, and you need it now.

My last stint in rehab was for a pharmaceutical addiction, and my peers in recovery sure did look like a cross section of America! Drugs don't care about your gender your sexual orientation or your race; drugs devastate equally. I can't tell you how many people end up addicted to a medication originally prescribed to heal, and let that addiction grow for far too long, thinking that they could never become a drug addict! If you take drugs, whether prescribed or not, for any purpose other than explicitly recommended, you are abusing them, and once you start abusing a drug, it's a hop skip and a jump to dependence. The problem with drugs of course is that they feel so good. At least at first, and when they're prescribed we tend to minimize the dangers and justify our usage, and all the while we slide ever closer to dependency. Thinking that drug addiction only happens to other people, people with weaker morals or that come from bad families, is partly why so many people end up with problems of their own. Like I said, a drug doesn't discriminate, and if you abuse it, it will grab a hold of you. Dependency doesn't make you a bad person, you may do things you’re ashamed of while dependent, but becoming an addict can happen to the best of us. Prescription pills are really dangerous, and I never met a single person in recovery that didn't wish they had never started. Some people are using to get high from the start, but most are just regular people, with a medical problem, that just happen to be prescribed a seductive, pleasurable and addictive drug in the treatment of their symptoms. You don't feel like a junky when you buy your drugs at the pharmacy, and family and friends can rarely tell when your use has crossed into abuse. A pharmaceutical addiction can remain hidden for a long time, ever deepening its hold, and ever increasing the difficulty of rehabilitation. If you are abusing pharmaceutical drugs, now is the time to stop, not tomorrow…now! Every day you wait makes what must ultimately occur more difficult. If you are abusing a medication, and you are physically dependent on that medication, you are a drug addict. It doesn't make you a bad person, but it does mean that you're going to need to admit to your weakness and get the help you'll need. The detox from pharmaceuticals can be very tough, and for some drugs, can even be dangerous. It's best to get professional help when you decide to finally break free. A sequestered detox and rehab worked for me, but you'll have to decide what's right for you. Have the courage to admit your problem, and get the help you need. Admitting you need help doesn't make you weak, it proves that you are strong and determined and won't let a bottle of pills diminish your life anymore. Whether it's originally prescribed for pain, to help you sleep or for anxiety, once you cross the line you have to accept the reality of the situation, and if you are dependent on any drug, you should consider getting the help you need to take back your life, and live with clarity and sobriety once again.