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Therapeutic emails

Farrokh Alemi1*, Mary R Haack2, Susanna Nemes3, Renita Aughburns4, Jennifer Sinkule5 and Duncan Neuhauser6

Author Affiliations

1 Department of Health Administration and Policy, College of Health and Human Services, George Mason University, Northeast Module, 4400 University Drive, MS 1J3, Fairfax, VA, 22030, USA

2 Chair and Professor, Department of Family and Community Health, School of Nursing, 655 W. Lombard St., Room 616, Baltimore, MD 21201, USA

3 Associate Professor, University of Maryland, School of Nursing, 655 W. Lombard St., Baltimore, MD 21201, USA

4 NYCHA Classic Center Director, 555 Mt. Prospect Avenue, #17H, Newark, NJ 07104, USA

5 Department of Psychology, David King Hall, Rm. 2003, George Mason University, 4400 University Drive, MS 3F5, Fairfax, VA 22030, USA

6 Department of Epidemiology and Biostatistics, Medical School, Case Western Reserve University, 10900 Euclid Ave., Cleveland, OH 44106, USA

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Substance Abuse Treatment, Prevention, and Policy 2007, 2:7  doi:10.1186/1747-597X-2-7

Published: 16 February 2007



In this paper, we show how counselors and psychologists can use emails for online management of substance abusers, including the anatomy and content of emails that clinicians should send substance abusers. Some investigators have attempted to determine if providing mental health services online is an efficacious delivery of treatment. The question of efficacy is an empirical issue that cannot be settled unless we are explicitly clear about the content and nature of online treatment. We believe that it is not the communications via internet that matters, but the content of these communications. The purpose of this paper is to provide the content of our online counseling services so others can duplicate the work and investigate its efficacy.


We have managed nearly 300 clients online for recovery from substance abuse. Treatment included individual counseling (motivational interviewing, cognitive-behavior therapy, relapse prevention assignments), participation in an electronic support group and the development of a recovery team. Our findings of success with these interventions are reported elsewhere. Our experience has led to development of a protocol of care that is described more fully in this paper. This protocol is based on stages of change and relapse prevention theories and follows a Motivational Interviewing method of counseling.


The use of electronic media in providing mental health treatment remains controversial due to concerns about confidentiality, security and legal considerations. More research is needed to validate and generalize the use of online treatment for mental health problems. If researchers have to build on each others work, it is paramount that we share our protocols of care, as we have done in this paper.