Can Online Counseling for Drug and Alcohol Addiction Problems Be Effective?

The answer to the question in the title of this article is: "Yes, but with the need to understand the limits of online help."

Definitions
The words "alcohol dependence" or "addiction" are often used without definition. So, let's first define some terms. As used in this article, alcohol or drug addiction means that a person's alcohol or other drug use has reached the point that the person cannot use without loss of control over use of the substance and/or cannot use without producing adverse consequences in significant life areas. The addicted person has developed a psychological and/or physical dependence upon the substance. An addicted person will continue to use the substance in the face of adverse consequences.
The term alcohol or drug dependence is often used interchangeably with addiction, but here I use the term dependence to mean physical dependence on a substance, meaning that stopping use of the substance will result in withdrawal symptoms. A person can develop dependence on a substance without developing addiction; the best example of this physical dependence would be the person who takes a narcotic analgesic (pain killer such as oxycodone or morphine) as prescribed by a doctor long enough to be physically dependent on the drug, a natural, inevitable consequence of chronic use of such a drug. Under these circumstances, abruptly stopping use of the substance will result in the withdrawal syndrome typical for the class of substance involved. Most persons with addiction (for ex., alcoholism) are NOT physically dependent on their drug and will not experience the full blown physical withdrawal for the substance. They will, however, experience cravings, sleeplessness, and other symptoms caused by their psychological dependence on the drug.
Diagnosis
Alcohol or other drug problems fall within two diagnostic categories: abuse or addiction (as I said, often called dependence). Abuse basically means the person has developed a pattern of use of the substance in the face of adverse consequences in significant life areas (medically, financially, legally, problems in relationships). Addiction is summarized in the first paragraph of this article.
Treatment
Alcoholism and other drug addictions are devastating disorders which negatively impact affected individuals and all who care about them, physically, emotionally and mentally, and spiritually. For persons diagnosed with full blown addiction, I favor an abstinence based treatment model, meaning a model whose basic ultimate (it may take a while to get there) goal is abstinence from use of alcohol or other drugs. This model should include education, cognitive behavioral counseling, and use of Twelve Step (for ex., AA) spiritually based principles. Online addiction treatment can be helpful in itself and/or as part of a comprehensive treatment program that includes traditional face-to-face counseling and other treatment interventions.
Treatment of Severe Addiction
Successful treatment of persons with full blown alcohol or other drug addiction may require a comprehensive treatment program, with services provided by professionals face-to-face. This treatment would be beyond that offered by online addiction treatment. Such a comprehensive program should be staffed by helping professionals from many disciplines. Staff should include physicians to address medical issues such as withdrawal, mental health professionals such as psychiatrists or psychologists, to treat co- or pre-existing psychiatric disorders that may be present, and last but not least, certified, licensed addiction counselors, preferably a significant number of whom are in recovery themselves. Such a Treatment Program should also provide individual and group counseling, educational groups, and, as important as any of the treatments, access to Twelve Step self-help groups such as Alcoholics Anonymous, Narcotics Anonymous, Al-Anon and Nar-Anon (for loved ones), and ACOA (Adult Children of Alcoholics), to name but a few.
An evaluation will reveal the extent of the treatment required. This evaluation can be performed online by a qualified addictions counselor.
Online Treatment or Counseling
Online help for persons with full blown addiction problems can be helpful, but the comprehensive programs outlined under Treatment of Severe Addiction may be necessary depending upon the seriousness of the problem. A comprehensive evaluation of the addicted person is needed. Such an evaluation can be done online, leading to recommendations for the appropriate treatment.
Persons who are already involved in any stage (intensive outpatient, continuing care, aftercare) of traditional treatment programs can use online services as a supplement to their treatment and to Twelve Step Program attendance. Persons who have completed traditional treatment can also benefit from these services.
Loved Ones of an Addicted Person
Spouses, lovers, friends, co-workers, parents, brothers, sisters, and sons and daughters, to name a few, can be concerned that the person they care about may have an alcohol or other drug problem. When adult children are concerned about use by a parent, the term "Adult Child of an Alcoholic or Addict" (ACOA) may apply. Persons close to an individual with a drug or alcohol need help for their natural feelings of confusion, hurt, anger, and loneliness. Online services can provide support, education, and recommendations for these concerned persons.
Cautions
Persons with serious emotional or psychiatric conditions (such as, but not limited to, eating disorder, anxiety disorder, bipolar disorder, schizophrenia), not stabilized through traditional treatment by a qualified mental health professional are not appropriate for the help offered online and should seek help from such professionals before accessing online services. These patients can, when stabilized by appropriate treatment, benefit from online counseling.
Persons who are depressed and thinking of harming themselves or others are also not appropriate for online help and should get help immediately by calling a crisis line, going to the Emergency Room of a hospital, or seeking other immediate help. These patients can, when stabilized by appropriate treatment, also benefit from online counseling
Persons who have a pattern of using addictive substances on a daily or almost daily basis need to access face-to-face evaluation and treatment service providers to address possible medical and other problems associated with withdrawal that may accompany physical dependence, before using online services available here.
Limitations
1. By its nature, internet counseling can be interrupted by technological difficulties beyond the control of either the counselor or the client. Before services are provided, the client will be given suggestions for alternative methods for contacting the counselor should disruptions in the client's service occur (for ex., a public library). The counselor should pledge that should technical difficulties result from his/her personal computer or other internet access, the counselor will have alternative internet access readily available.
2. The visual and auditory cues available during face-to-face counseling are, of course, not available in internet counseling. Therefore, it is vital that both the client and the counselor be diligent in seeking clarification of any communications, as needed.
3. The addictions counselor must at the outset of the counseling relationship help the client to identify local therapists and other treatment providers, including crisis services.
4. The addictions counselor must include safeguards to keep client information confidential and protected from unauthorized access. Client information, including history, diagnosis, treatment recommendations, and progress notes, should be for the counselor's eyes only. No one else must have access to this information. The information should be retained on a safeguarded CD for one year after the counseling relationship has ended, or for a longer or shorter period of time dictated by the client.

Under the circumstances outlined in this article, online counseling of persons with drug or alcohol abuse or addictions can be effective.