Technology Coming to Alcohol Treatment

New software, websites and Web applications exist — including an interactive video patient interview simulation — to aid doctors in diagnosing and treating alcohol-related disorders, and to allow people with drinking problems to get help.

That was the message of Saturday’s symposium, “Emerging Technologies: Translating Interventions Across a Spectrum of Risk for Alcohol Use Disorders.” The new technologies were funded by the National Institute on Alcohol Abuse and Alcoholism (NIAAA).

Robert Huebner, Ph.D., Acting Director, Division of Treatment and Recovery Research, NIAAA, introduced the session, saying, “We believe there are a spectrum of alcohol problems and we need to match treatments (to them). We have a good foundation of treatments. Where do we go from here? How can technology supplement and complement our evidence-based treatment options?”

One answer is a video avatar named Christy Johnson. She’s the patient in the lifelike, interactive video simulation demonstrated by Paul Grossberg, M.D., Clinical Professor Emeritus, University of Wisconsin-Madison, School of Medicine and Public Health, and Dale Olsen, Ph.D., President of SIMmersion LLC.

They presented their training software, “Alcohol Screening & Brief Intervention,” which features video of an actress who plays “Christy Johnson,” a patient on a follow-up visit after having headaches (now resolved) after a car accident.

One-third of the screen shows video of Christy; part of the screen features question prompts for the physician trainee to ask; another part includes video of an attending, who gives thumbs-up or thumbs-down reactions to the trainee’s questions.

Dr. Grossberg ran through several sets of questions with Christy, asking her aloud about her drinking. Christy responded very much like a real patient, even getting defensive at one point: “I never need to have a drink, in the morning or any other time.”

“This simulation is different every time,” said Dr. Grossberg. “The computer chooses whether Christy is low-risk, at-risk, or severely dependent.” The “dependent” Christy can be cooperative, resistant, or ambivalent, and each version answers questions differently. The program contains hundreds, if not thousands, of video responses from Christy.

“For everything you say, there are three to 40 things the character could respond. It gives you a rich variety — you never know what Christy is going to say.”

After you finish, the program asks which Christy you just interviewed, then gives you a Brief Intervention Score and shows you what you did and didn’t do, and what you should be asking.

Reid K. Hester, Ph.D., Director, Research Division, Behavior Therapy Associates, LLP, gave the second presentation of the morning, “Computer Delivered Interventions: A Stepped Care Approach for Problem Drinkers.”

“When people are involved in addiction treatment, we’re often seeing people at the extreme end of the spectrum,” Dr. Hester said.

He said the Stages of Change model — which identifies stages from pre-contemplation, contemplation, preparation, action, maintenance, exit, and relapse — is useful for “thinking about how and where you intervene with people.”

“The first thing they ask is, ‘Should I change my drinking? How bad is this?'”said Dr. Hester. “We developed two programs for this state of change.”

The two programs are online at DrinkersCheckUp.com and CollegeDrinkersCheckUp.com. In a randomized clinical trial of the Drinker’s Check Up program, he found moderate drinking outcomes were more common than abstinence.