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The founders of the only online drug treatment program are betting that the anonymity of the Web will encourage addicts to get the help they need. But can talk therapy without personal interaction really do any good?

Published May 13, 2003 6:34PM (EDT)

Two years ago, Jake, an engineer with a major telecom firm in Northern California, found himself snorting up to 10 lines of crack a day -- on his lunch break from work or, because his job required him to travel, in airport restrooms around the world. After staying awake for days at a time, Jake learned to down eight ounces of straight tequila and pop a few Xanax in order to get a few hours of sleep. Then, he'd start the whole process again.

When Jake's girlfriend threatened to leave because of his drug abuse, the 29-year-old California native quit his job and sought help for his addiction. Not able to afford the high cost of rehab, Jake searched the Internet for alternatives and signed up with eGetgoing, the only online drug treatment program.

Armed with a headset microphone and special software, Jake began "attending" twice-weekly group therapy sessions. Although he already had several weeks of Narcotics Anonymous (N.A.) meetings under his belt by the time he began eGetgoing, Jake attributes his ability to get clean with the online program.

"N.A. is a lot of people sharing what goes on in their lives, and how they're dealing with cravings or with their mother-in-law staying over," Jake explains. "EGetgoing is more like a clinical program. It gives you an incredible amount of scientific information, like how drugs affect your brain chemistry, and really teaches you how to change your behavior."

Since its launch in March 2001, eGetgoing ("e" for electronic, and "get going" shorthand for the chirpy "Let's get moving toward a new, healthy, positive future!") has offered "online, real-time, interactive audio and video-based out-patient counseling" to approximately 50 clients. This March, it expanded into the teen market with teenGetgoing, which offers drug abuse awareness and treatment for the high school set. While the Internet has long been criticized for encouraging anonymity and depriving users of "real" experience, eGetgoing is betting that hiding behind screen names might be just what some substance abusers need to get clean and stay sober.

"Chemical dependency is a disease like cancer or heart disease, but there remains a stigma about it," explains eGetgoing's CEO and founder Barry Karlin. "A great number of people are not willing to go into a treatment center and announce they have a problem."

Karlin knows a lot about addicts. He's also the CEO of CRC Health Corp., eGetgoing's parent company and the largest drug treatment provider in the United States. Since CRC was founded in 1995, the company has grown from one center in Northern California (where CRC is based) to 71 facilities in 15 states. CRC claims to have helped some 30,000 drug abusers, but there are plenty more waiting in the wings: According to the Substance Abuse and Mental Health Service Administration (SAMHSA), 16 million Americans are in need of drug or alcohol treatment. While 5 million actually contact traditional treatment centers each year, only 20 percent are admitted. Reasons for this vary, from the centers' limited space and high cost (on average, a three-month outpatient program runs $3,000, while residential costs often exceed $10,000), to privacy concerns.

Enter eGetgoing, which claims to offer anonymity, affordability and convenience. And while the company states that it's not a substitute for traditional rehab (interested visitors can follow links to CRC's offline treatment centers), Karlin's ambition to bring at least part of the mountain to Mohammed, so to speak, has motivated big-name addiction experts such as former White House drug czar Barry McCaffrey to join eGetgoing's advisory board.

Fifty clients in two years may not sound like a lot, but Karlin notes that eGetgoing hasn't done any advertising. For now, its clients come through referrals from treatment facilities, private practitioners, corporations and school districts.

Because eGetgoing promises to keep its clients anonymous, it's difficult to paint a picture of just who, exactly, is using the program. According to Cynthia Reinbach, vice president of eGetgoing's compliance and quality management, the average age of its clients is early to mid-30s, and slightly more than half are male. The clients "tend to have jobs," says Reinbach, and own or rent their homes. While 15 percent of the clients live outside the United States, eGetgoing won't disclose their exact locations.

"Anonymity is a big factor in why people choose to enroll in the program," Reinbach explains. "That's the feedback we hear over and over. People feel they have nothing to lose by telling the truth."

Visitors to eGetgoing's site are invited to take a confidential questionnaire that asks them to respond to such statements as "I hide how much I use or drink from those around me" and "I promise I'll get myself together but it never works out that way." In seconds, an automatic assessment based on their answers pops up on-screen, along with links to treatment options. Those who choose to click on the button "I Can Handle It Myself" are offered the opportunity to prove it: They can sign up as a member (for free) and state their goals for getting clean. EGetgoing will chart their progress for up to seven days, even graphing the results.

Technical requirements for people who decide to enroll in one of eGetgoing's six-week ($800) or 12-week ($1,200) programs include a PC that runs Windows (Macintosh users are out of luck), broadband access, and a "quiet, uninterrupted, PRIVATE environment." EGetgoing provides the rest, including software to enable real-time audio and text chat, CD-ROMs containing slides and videos utilized in group sessions, a headset, and tech support.

Twice a week, up to 10 clients meet for an hourlong group session led by one of eGetgoing's four counselors, all of whom have the same credentials and level of work experience as counselors at CRC's "real" treatment centers. While each client is able to watch the counselor in a small box on the left-hand corner of the computer screen, the clients can't see each other. No real names are used, only screen names, and giving out phone numbers or private e-mail addresses is strongly discouraged.

In Jake's group, short videos showing a fictional group in treatment served as a springboard for each discussion. "They have actors playing all the different character stereotypes -- the angry drunk, the pill-popping lady, the guy with his arms crossed, saying, 'I'm not in denial,'" says Jake. "But I was pretty impressed with it. You really get to know the characters and see them progress from week to week. It's like they're going through the same things you are."

Jake describes the group session as having "a classroom atmosphere," and much like a teacher, the counselor has access to a virtual white board where he or she can illustrate various points. Clients ask questions by raising their hands, responding verbally, or clicking a Yes or No button that appears on the screen. Private messages like "I'll be right back. I'm going to the bathroom" are instant-messaged only to the counselor.

Each client signs off with a "plan of action" to stay sober until the next session. Homework assignments -- identifying "relapse triggers," for instance, or "negative self-talk" -- are assessed by eGetgoing's counseling staff, who then personally e-mail the client with direct feedback.

"Because you never see anyone, you're going to either be a complete liar, or completely, completely honest," Jake says. "I'd found my bottom and knew I needed to quit, so I was very willing to soak up the sobriety." But while his group began with nine people, by the end of their eight-week session only Jake and another man remained.

Jake feels the dropout rate is on par with what he's experienced at N.A. meetings. But Jeff Schaler, the author of "Addiction Is a Choice" and a psychologist who teaches at American University, asserts that eGetgoing's "one size fits all" approach is "doomed to fail."

"EGetgoing views the addict population as homogenous," Schaler says. "We know for a fact that the addict population is a heterogeneous one: that is, everyone uses drugs and alcohol for different reasons, in different ways, and with different results. eGetgoing's program doesn't appear to look at the psychological aspects that drive people to addiction."

John Avery, the public policy director of NAADAC, the Association for Addiction Professionals, and a licensed social worker specializing in addiction, feels eGetgoing's therapeutic process raises some important questions. "It's an impressive site and the board of advisors is full of great minds from the field [of addiction treatment]," he says. "But there's a barrier here to interpersonal communication and interaction. How do you gauge someone's level of anger or indifference if you can't see them? What makes group therapy so therapeutic is that people get together in one place and have to interact with each other. This skews that interaction."

Jerry, a 60-year-old retired construction worker from Livermore, Calif., enrolled in eGetgoing for aftercare once he was released from a CRC residential treatment center in Scotts Valley, Calif., last May. "A few [people in the eGetgoing group] thought, This isn't the real thing, and dropped out," says Jerry, who's a recovering alcoholic. "Or they came in loaded or drunk. But I have news for them. They didn't give it a chance. Of the people who stayed with it, I'd say they think the world of it."

Jerry was so pleased with the support system he found at eGetgoing, he followed up his first session with another. "I couldn't have gotten sober just by using eGetgoing," he admits. "Some people like me need to physically be around other addicts to get better. But you learn so much in this program. It's total information -- what drugs do to your body, what they do to your brain. And learning is power, right?"

Barry Karlin hopes teens will think learning about drugs is cool, too. TeenGetgoing --with its pulsating dance music, vivid colors and hip fonts -- launched last November. Seven school districts in four states are currently using it. It's still too early to tell if the program will boost recovery rates for teens -- historically one of the most difficult groups of drug abusers to treat -- but so far, teen clients have logged on to the site 150 times.

While eGetgoing's site relies on lengthy FAQs that can be frustratingly slow to open even through a DSL line, teenGetgoing moves at warp speed and offers polls ("Do you have trouble saying no to pot?") and video presentations of the site's two programs. "Aware" educates teens about the dangers of drug use, and "Discover" features clips of teen actors using or getting drugs. A dramatization of a group therapy session is careful to include a character everyone can relate to: the angry, hoodie-wearing Eminem type, a pasty-faced nerd, the popular girl who doesn't understand why people think she has a problem.

"You're in trouble if you don't tell kids upfront that the kids they see in the videos are actors," notes Jacklyn Guevara, director of alternative education in the Eastside Union High School District in San Jose, where more than 100 students have been participating in teenGetgoing's pilot program since the fall. Guevara says students were disappointed at first that they weren't going to be viewing the confessions of real druggies and gangstas and spent more time critiquing the actors' clothes than listening to the dialogue.

"I just told them to pay attention to the scripts, that they're based on real life," she says. "After that, they seemed to relate to it."

Guevara estimates three-fourths of the nearly 1,000 alternative education students she oversees are involved with some sort of drug use. Because most school budgets allow for only one counselor on staff, or none at all, Guevara jumped at the chance to have students participate in teenGetgoing's pilot program. When it ends later this month, Guevara says she will gauge from student evaluations how helpful it's been. "So far, I think the program's outstanding, but I need to make sure it makes a difference in kids' lives," she says.

That seems to be the consensus: Organizations such as the National Institute on Drug Abuse and SAMHSA have chosen not to comment on eGetgoing, citing a lack of empirical data. Even eGetgoing's management isn't certain how successful it's been. Graduates are tracked only through a series of phone calls for one year (and can opt out of participating). Data on how many people have managed to stay sober is still being collected.

"The only thing really novel about [eGetgoing] is its medium," says Peter Graham, an expert on addiction and the director of psychology services at the Professional Renewal Center in Lawrence, Kan. "It's got everything else that other treatment centers have, except for a physical presence."

And just how crucial is it for counselors to make eye contact with their patients? Or notice that someone is tapping a foot, staring out the window, or nodding off? At this point, the jury's still out.

"I don't want to prejudge eGetgoing and say it can't be effective," NAADAC's Avery says. "After all, 100 years ago, no one believed that Freud's talk therapy would work, either. But face-to-face counseling sessions provide the opportunity for personal reinforcement -- echoing what someone's saying, mirroring their body language. And how do you get that from a computer rather than a person?"

By Stephanie Booth

Stephanie Booth is a freelance writer who lives in New Jersey.

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