title: Therapeutic emails.
abstract: BACKGROUND
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: 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. falemi@gmu.edu
authors.forename: Farrokh
authors.initials: F
authors.lastname: Alemi
authors.forename: Mary R
authors.initials: MR
authors.lastname: Haack
authors.forename: Susanna
authors.initials: S
authors.lastname: Nemes
authors.forename: Renita
authors.initials: R
authors.lastname: Aughburns
authors.forename: Jennifer
authors.initials: J
authors.lastname: Sinkule
authors.forename: Duncan
authors.initials: D
authors.lastname: Neuhauser
mesh_terms: D003376:Counseling / Q000379:methods*; D034742:Electronic Mail; D006801:Humans; D019114:Remote Consultation / Q000379:methods; D019966:Substance-Related Disorders / Q000628:therapy*