The first keynote address at the National Frontier and Rural ATTC 2014 Addiction Treatment Technology Summit was presented by Dr. Lisa Marsch, Center for Technology and Behavioral Health Director and Department of Psychiatry faculty at Dartmouth College. Dr. Marsch opened her keynote presentation by reminding everyone of the benefits of utilizing telehealth: improving the quality of care through increasing treatment fidelity; increasing access to care through more widespread dissemination of treatment in ways that reduce barriers to and disparities in care; increasing the capacity of the system to provide services to more individuals in need; and decreasing costs of providing are or escalating problems. The significance of the benefits was made tangible by her citation of the statistic that 20-25% of American’s suffer from at least one mental health disorder and 10% experience a substance use disorder, each of which are exacerbated by comorbid chronic physical and mental health conditions. Dr. Marsch also outlined research supporting the use of one technology-based intervention, Therapeutic Education System (TES). The TES program focuses on skills training on a number of skills, including problem solving, coping, decision-making, communication, stress management, goal setting, and managing negative moods. TES is available for use on computers, Android smartphones, iPhones, and iPads. The program has fared well in clinical trials analyzing health outcomes and cost-effectiveness, with TES performing as well as therapist-delivered treatment on improving abstinence rates; decreasing recidivism in a criminal justice population as a stand-alone intervention; demonstrating better abstinence ratesand increased treatment retention when used in addition to clinician-delivered therapy; and reducing downstream medical costs. In particular, TES has been shown to improve outcomes for clients with low cognitive functioning, high anxiety, high ambivalence about treatment, heavy alcohol use at treatment entry, and a greater number of prior treatment episodes. Key take-home points from Dr. Marsch’spresentation were that technology

  • offers patients tools to engage in their own disease management, through documenting and sharing data about their condition with friends/family/caregivers and use of decision support tools to make informed choices;
  • provides opportunities to facilitate the integration of mental and behavioral healthcare with physical healthcare by giving physicians tools to build expertise, and screen and intervene with limited time and resources;
  • allows for detailed data capture to monitor health behavior outside of the clinic;
  • can transcend the boundaries of the clinic to offer a mechanism for achieving physical and mental health and social well-being; and
  • presents challenges, such as scalability of technology, reimbursement, resistance to new models of healthcare.

For more information on Dr. Marsch’s work, here is a list of some of her most recent published research:

Acosta, M. C., Marsch, L. A., Xie, H., Guarino, H., & Aponte-Melendez, Y. (2012). A web-based behavior therapy program influences the association between cognitive functioning and retention and abstinence in clients receiving methadone maintenance treatment. Journal of Dual Diagnosis, 8(4), 283-293.

Marsch, L. A. (2012). Leveraging technology to enhance addiction treatment and recovery.Journal of Addictive Disorders, 31(3), 313-318.

Marsch, L. A., Carroll, K. M., & Kiluk, B. D. (2014). Technology-based interventions for the treatment and recovery management of substance use disorders: A JSAT special issue. Journal of Substance Abuse Treatment, 46(1), 1-4.

Marsch, L. A. & Dallery, J. (2012). Advances in psychosocial treatment of addiction: The role of technology in the delivery of evidence-based psychosocial treatment. Psychiatric Clinics of North America, 35(2), 481-493.

Marsch, L. A., Guarino, H., Acosta, M., Aponte-Melendez, Y., Cleland, C., Grabinski, M., . . . Edwards, J. (2014). Web-based behavioral treatment for substance use disorders as a partial replacement of standard methadone maintenance treatment. Journal of Substance Abuse Treatment, 46(1), 43-51.

Marsch, L.A. & Gustafson, D. H. (2013). The role of technology in health care innovation: A commentary. Journal of Dual Diagnosis, 9(1), 101-103.