Teuvo PeltoniemiHead of Information Department, A-Clinic Foundation, Helsinki

Vice President, Prevnet NetworkTeuvo.Peltoniemi@a-klinikka.fi

www.teuvopeltoniemi.net, www.a-klinikka.fi

New information and communication technologies in the service of drug prevention and treatment: experiences and perspectives

Pompidou group Prevention Platform, 3rd meeting, Helsinki, 5-6 April 2005

Virtual GSM and SMS community in a summer scene at a Helsinki park. Picture from the ”Wired”

Direct connections between drugs and telematics

Drugs and telematics in the youth culturesWhy telematics?Telematics situationTelematic drug prevention and treatmentFuture technical perspectivesFuture contents perspectivesNet addiction (NA)Virtual Reality (VR)Future systemic perspectives

TELEMATICS AND THE YOUTH

Telematics and the youth: the trend indicator

@ Good financial position

@ No old traditions and good biological resources

@ Symbolic youth-related value in growing-up culture: anti-adult things, telematics as a sign of the excellence of the youth, new technology plus techno plus new drugs

@ Great practical value; good instrument for more fun and experiences, even utopias: new and deep sensations: another world, global life style

@ Strong brand value, self labelling cultures and powerful marketing and advertisements

@ Great psychological value, help to build

identity and play

@ Filling emptiness

Telematics and the youth: biological factors

@ Biological resources: Good reaction and learning times

@ Openness to new: Ready to test new things, eagerness to learn

@ Short time perspective: No sickness, no death, not much worries about security or ethical questions

@ Growing-up culture: Strong peer cultures, building social networks and companionship

@ To build identity and play: Modifying personality, role games

@ Sexual relations: Dating on net, net porn

@ Great psychological value: Regulation of psychological distance (anonymity), feeling of controland command, possibility for role change

WHY TELEMATICS?

Many claim that the speciality in human related work isthe face-to-face contact. But is it really…

No, but a feature of limits of the real world as for instance the quick success of the

ATM shows: people want cash, not a new human relation every time they need

money. In reality, people want to regulate the psycho-social distance themselves

Picture from prof C. Jones at cashpoint

…an indispensable element in human interaction?

Telematics as regulator of social distance: losing face

Telematics makes possible to avoid the unpleasant situations of losing-face. Ability to regulate possible shame helps communication in difficult issues and lowers the threshold to seek and give help.

Example: Cultural differences in ”losing face”Do’s and don’ts in Japan

Keep in mind that losing face is a big issue in Japan. Therefore it might be advisable to use a third party

to minimise the risk of losing face.

Special case: benefits and drawbacks of written messages in prevention and treatment

@ Time shift

@ Accuracy of messages

@ Possibility to return to the message and the answer

@ Anonymity and regulation of social distance

@ Slowness of interaction: no immediate feedback

@ Demands writing skills and habits

@ Anyway, people seem to love written telematics(e-mail, SMS, chat,)

Suicides and the Mobile PhonesIn Finland suicides have decreased by a third. This has been explained by three factors: 1. National Suicide Prevention project, 2. New anti-depressants and 3. Mobile phones. @ SMS are used to transfer feelings and give and get support@ Mobile phones add safety as instruments@ The mobile phone can help in asking for and giving help when needed@ Next Nobel Prize in Medicine to mobile phone industry?

(Adapted from Jussi Huttunen,Duodecim 2003)

The complex world of services: How the man in the street sees us professionals:

("Main features of the Finnish addiction treatment system in the 1970s")Here telematics can help by channelling through the multitude

Need for a portalExtending from own field to better help people

(Top search phrases in AddictionLink)

CannabisDrugsPregnancyAddictionLinkDepressionAlcoholEcstasy

Family violenceHashishDrug

Services want to specialize, not necessary people

Only a partial solution

Sites rarely have the critical mass to become commonly known:

Sites of the some members of www.apua.info

The virtual world allows more freedom of action e.g. in terms of following aspects:Time, Anonymity, Identity, Integrity, Location, Motivation, Attitudinal range, Cognitive resources,Intensivity, Logics, Autonomy, Social capacity, Interactivity, Experience range, performance results

Social and psychological regulation(Anonymity, autonomy)

Time

Location

Structural Complexity,Intensity and Logics(Cognitive resources) Status and symbolic dimension

(Motivation, attitudes)

Self identity(Integrity)

Interactivity(Experiences, sensations)

Performance(speed, perfection, intensiveness immersion)

Now in use Coming

The basic characteristics and differencesbetween the real and virtual life

More freedom for individual choices

Teuvo.Peltoniemi@a-klinikka.fi 2005

SUMMARISING: WHY TELEMATICS?Features of telematics especially suitable

for alcohol, drug and mental health prevention

@ Simplification of the continuously more complex society

@ Interactivity, feedback and democracy

@ Anonymity, and closeness at will

@ Low threshold to evaluate, motivate and seek help

@ Empowerment to use one's own resources

TELEMATIC SITUATION

Usage of mobile phones and Internet

Mobile phones are reaching saturation point in many

Western countriesInternet is less common with

large differences between countries

Italy

Are old people out of telematic development?Do low-income people stay with

the development of information society?

@ Gender symbol and divider: Unlike normally in technology, girls speak (at least in Finland) mobile and SMS more than boys. They write longer and more emotional messages. In Internet boys still dominate.

DRUG AND ALCOHOL PREVENTION IN THE NET

Drug and alcohol prevention in the net

Päihdelinkki - AddictionLinkThe full-service addiction site of Finland

”Everything from information to net therapy”

@ Since 1996 the most popular addiction site in a country with only five million people – now 30 000individual visitors a month.

@ AddictionLink lowers the threshold in a sensitive area, with a user-friendly interface

@ Maintained by A-Clinic Foundation – the largest Finnish NGO on addictions and now also a well-known eHealth services developer

@ AddictionLink has received financial support from: The Ministry of Social Affairs and Health, Finland’s Slot Machine Association RAY, The Finnish Centre for Health Promotion, The Prevnet/EU projects

@ Standard link and reference site for schools and media as well as social and health care.

@ AddictionLink was awarded as the Best Health Education Product in Finland in 1999 and was a finalist for the eHealth2004 Awards.

www.paihdelinkki.fi

@ Large Infobank• Alcohol, drugs, smoking, gambling and net addiction• News from media monitoring• Special actual themes

@ Evidence based self-assessment tests@ Promille Internet, SMS and mobile service@ On-line self-help tools for controlled drinking@ Web counselling and consultation on all addictions@ Surveys and a quick poll@ Family section for Parents, youth and children @ Edutainment part@ Popular discussion forums (peer support)

• Sauna - drugs• Slowing down - alcohol• Home channel- parents• Hooked – net addiction

@ English, Swedish and Sign language versions

AddictionLink services now

”Because of the nature of the subject I wish to stay anonymous. I’d like to thank the people who maintain AddictionLink. I feel I have got help from your service when I have tried to cut down my drinking and its harmful effects.” (Authentic anonymous user comment)

Services of the AddictionLink in 2005

Facts; data bank

Tests

Self-help: diary

Individidual professional conselling

Peer group discussions

Referral to professional face-to-face services

Language services

News from media

For parents: How to meet drug problem

Since 1996 the most popular addiction site in a country with only five million people – now 30 000 individual visitors a month.

Anonymous distant BAC calculating:"Promille-GSM" SMS text message service

INFORMATION TO SEND:* PROMILLE* M (male) or N (female)* Weight in kilograms* Number of alcohol units* Time when started drinking (e.g. 9 p.m. as 2100)(* Separate values by spaces)

Example --- PROMILLE N 60 5 1930 Example ---

How much is one UNIT of alcohol?

BASIC ANSWER MESSAGEESTIMATE: BAC x.x. Metabolization will take at least xx hours. Extensive individual and situational differences. Responsibility only YOURS. If unsure, don't drive!

Finnish SMS service number 16400

Drug and alcohol prevention, AIDS

Operational themes and services of the www.apua.info portal

Mental health care

Child welfare youth & family problems

Family violence and child neglect

teuvo.peltoniemi@a-klinikka.fi

@ Emergency help referral: @ Information on different topics@ Interactive self-evaluation tests and

tools @ Peer group discussion areas@ On-line counselling and support

One channel = No obligation for self-diagnoses before seeking for help but a possibility for it in systematic and fact-based way.

A virtual prevention example: Virtual chat bus HUBU

Virtual drug information bus HUBU by ”EOPH” is a part of the popular Finnish animated chat Hotel Kultakala. Over 400 000 different characters are created by youth aged 10-16. A mediator directs talks and answers questions. Virtual HUBU bus has a constant line-up.

FUTURE TECHNICAL EXAMPLES

Examples of new ICT features

@ New: MMS phones, positioning services, ubiquitous computing, electronic tags…

- Can phone cameras be used everywhere?

- Privacy questions, copyrights

- Different legislation inside EU, in EU, in the USA, Japan etc

- Targeted commercials (Ubiquitous computing)

- identification cards, tags, networks

Locating services and mobile video

Two examples of Japanese tobacco (left) and alcohol prevention

programs using i-mode 2G/3G mobile phones

Do you want your wife/husband/parents/

children/employer/police to know always where

you are?

Map diagram of movements of one particular mobile

phone in Japan

Multimedia and VC

NEW

@ Better multimedia (still camera, video, video conference)

WCDMA mobile phone video

conference in Sendai, Japan

D-link web video phone

Addiction as a bio-electric process – manipulation of brains

Mechanical traffic police from Tokyo

Nanotechnology & biotechnology

may be the future great leap forwards

Medical wireless capsule camera, PET screening, and virtual endoscope camera

(From left) Medical wireless capsule camera diagram and at work, magnetic screening, and virtual endoscopecamera based on magnetic images

Examples of new networks: Ubiquitous computing & communication

Source: Anu Kankainen, Antti Oulasvirta, Matti Rantanen, Sauli Tiitta, Tomi Kankainen & Martti Mäntylä , Prosessori 11/2003

Be always aware and active: More supervison, manipulation and stress?

FUTURE CONTENTS PERSPECTIVES

Types of relations between telematics and the user: the future of telematic care and treatment

Administrative, logistics, processing, system providing

telemedicine

Supportivecounselling

Instrumental, informative

Interactive, communicative

Experiences, feelings, sensations

TelecareSelf-assesment

and self-help

Entertainment

Chat

E-mail

E-trade,e-banking

Virtual realitySupportive peer

groups

Distance learningNEW SOLUTIONS

Now in use Coming

NET ADDICTION

Types of net addiction(Uncontrollable or compulsive use of net)

1. Chat addiction (also SMS)2. Net games addiction3. Net gambling addiction (also day shares trade)4. Net relationships addiction (dating sites)5. On-line sex addiction (also phone)6. Surfing addiction7. Information addiction (news; cf. info-glut)8. Mobile phone addiction (calls, messages, games)9. General addiction on computers and ICT

@ unable to control the use of internet

@ stays on-line longer than intended

@ withdrawal symptoms if not using internet

@ prefers internet to relationships, work or study

@ uses internet to feel better

@ conceals the extent of Internet use

from family

@…..

Examples of symptoms of net addiction

@ Addictions are basically similar, and therefore similar methods work

@ The goal, however, is limiting, not stopping net use because leaving one outside

of the information society would lead to exclusion

@ Much of the treatment is done in the Internet – a paradox

Prevention and treatment of net addiction

VIRTUAL REALITY

Virtual reality: possibilities for an addiction and a perfect simulator

Picture from CNN

Virtual reality: Classic Tamagotchi, virtual horse stable

Virtual life pet

Imaginary pet

Real life pet

Real virtual reality (VR) in the future

(Real life wife) (Virtual life wife)

Overlapping area

What happens when these worlds can overlap completely? - Excellent instrument for entertainment- Finally, a new killer appliance

Virtual reality: excellent instrumental value but maybe also adding to techno stress and addiction

What happens when virtual world comes in full? ALSO

@ Excellent instrument for training, prevention, treatment in substance abuse, smoking, mental health and other psycho-social problems

@ Difficult problem in VR as an addiction

FUTURE SYSTEMIC PERSPECTIVESMarriage of the traditional services and the ICT

From information to interactive experiencesFrom hierarchical system to network and self help

From telemedicine to eHealth and eWellbeing

E-therapy already is a big business

There is a transfer from telemedicine to telematic self-help and to eHealth

Telemedicine@ Instrumental (hardware based, distance, costs, logistics, transfer of place and time)

@ Professionalism defensive wall and paternalism slow replacement of face-to-face with telematic support

Telematic self-help@ Based on the own motivation of citizens

@ From system orientation to patient orientation

eHealth@ The health and social care system will be turned upside down: from hierarchies to networks and market model (Ricky

Richardson, Ehtel) where telematics play a major role. That will also concern mental health.

@ More telematics is needed as it fulfils better the needs of citizen, is systematic, effective, and measurable and improves the whole service system. That does not concern only information services but especially prevention, support and treatment.

@ More integration of telematic services with traditional prevention, support and treatment services in needed: there must become a service chain of options for the citizens via multi-channel infrastructure.

@ Broader concepts of psycho-social problems and more cooperation between the general and different specialized services is needed.

Three recommendations for the future

FORECAST: Telematics will replace much of the psycho-social prevention and treatment work yielding great benefits to the citizens!

Additional info

@ Tammi & Peltoniemi, eds.: Telematic drug and alcohol prevention 1999

@ Peltoniemi: Experiences and perspectives in using telematic prevention on sensitive health issues. In: Latifi(ed.): Establishing telemedicine in developing countries.IOS Press. Amsterdam 2004.

@ Peltoniemi: Young people and the new technologies:Internet and mobile services in drug and alcohol prevention: Stay in Touch. Bundesamt fur Gesundheit BAG. Bern 2003.

@ www.prevnet.net

@ www.ehtel.org

@ E-mail: teuvo.peltoniemi@a-klinikka.fi

@ www.teuvopeltoniemi.net, www.a-klinikka.fi

The A-Clinic FoundationLargest addictions treatment & prevention

NGO in Finland

VammalaKokemäki

TampereLahti

MikkeliKuusankoskiKouvola

AnjalankoskiKotka

JärvenpääSalo

HelsinkiTurkuEspoo

15 A-Clinics + 1 A-Polyclinic- withdrawal units- rehabilitation units- activity/day centres- support homes- therapeutic communities- health promotion units (needle exchange)- Youth Clinics (in 4 localities)- Järvenpää Addiction Hospital)

-Journal TIIMI and NetTiimi in the Internet- Extensive Internet and phone services (www.paihdelinkki.fi, Promille GSM)- large R&D, training and information services

Staff over 700Budget 35 million €- 25 000 outpatient clients- over 200 000 outpatient visits- about 100 000 treatment days- about 300 000 separate Internet & mobile phone services users

Web sites of the A-Clinic Foundationplus some of the close cooperating sites

www.paihdelinkki.fiwww.a-klinikka.fiwww.tiimi.comwww.lasinenlapsuus.fiwww.apua.infowww.encare.infowww.prevnet.netwww.narkohelp.netwww.narkopomosch.net