Finnish SMS services for drug prevention and treatment - background and experiences

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1 Teuvo Peltoniemi Editor-in-Chief, A-Clinic Foundation, Helsinki President, Prevnet Network Finnish SMS services for drug prevention and treatment - background and experiences International Psychonaut Web Mapping Conference Ancona, Italy 18 September Virtual community versus traditional community: The young already live it and it is mobile Updated 17 September 2009 Virtual GSM and SMS community in a summer scene at a Helsinki park. Picture from the Wired

2 Important features of the ICT for alcohol and drug services

3 Factors influencing the choice of ICT Responding to real Simple and easy to Commonly Giving instrumental added value But important features are also Interesting and fun Give social support Have symbolic and ritual values teuvo.peltoniemi@a-klinikka.fi

4 (Mobile) phones and text messages Phone is the oldest commonly used telematic method Mobile phones are better available than Internet; thus more democratic. Phones, computers, television, Internet, are possibly integrating (convergence) (Mobile) phones deepen the freedom available from ICT Writing and reading is back via s, text messages (SMS) and instant messaging (and now also pictures and videos seem to getting are back)

5 ICT infrastructure in Europe and in Finland Mobile phones per 100 inhabitants in Europe in ,1 million mobile phone extensions 1,7 million broadband extensions 3,2 milliards ( ) SMS or 524 messages per subscriber (10 messages per week) Three quarters use Internet during 3 month Two thirds search for health issues in the net (Tilastokeskus, Aaltonen 2008)

6 Many claim that the speciality in human related work is the face-to-face contact. But is it really an indispensable element in human interaction? No, but a feature of limits of the real world people want to regulate the psycho-social distance themselves 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.

7 "I, me, myself!" For the psycho-social problems there are simultaneously emphasizing own particularity and underestimating it Important are also own motivation using own resources peer help Hi, its only Mary here.

8 Earlier Finnish SMS services

9 Anonymous distant BAC calculator "Promille-GSM" INFORMATION TO SEND: * Gender * Weight * Alcohol units consumed * Drinking start time Men 74 % Women 26 % Often contrary Cognitive therapy based supporting small steps by monitoring and giving practical tips to control and cope. Socially invisible way to control drinking. Intended uses: 1. Avoid drinking & driving 2. Help in controlled drinking (self-) treatment Promille was designed by Teuvo Peltoniemi at the A-Clinic Foundation in It was opened also in Czech Republic in 2005 and in Slovakia in As a NGO, A- Clinic Foundation only keeps moral copyrights, thus there are unknown number of "pirate" copies in Finland and elsewhere. teuvo.peltoniemi@a-klinikka.fi

10 General support for the young: Textari-Helppi SMS service Operators: Church & Polytechnic in Lahti with 92 student & 5 teachers (4-5 students per night). In October-November 2001 (50 duty nights) 208 messages and 383 exchanges of SMSs took place. Subjects of SMS: Main topics: Dating and sexuality Also: alcohol, aggression, abortion, army, communication problems, fun making, mental health questions, etc Source: Kaarina Koho-Leppänen, teuvo.peltoniemi@a-klinikka.fi

11 A SMS service for the very marginalized: Quick Drug Info "18182 Vinkki" SMS for IV drug users Vinkki SMS service for IV drug users in Finland - Timetables and locations for mobile needle exchange bus and other practical info free of charge messages per year - EOPH, A-Clinic Foundation &Helsinki Deaconess Institute - System is being extended to include more services and multimedia contents Early detection and warning systems coming (maybe also Psychonaut) Epidemics early warning system New drugs and use manners Chemical contents (e.g. testing ecstasy pills by SMS) Dangerous concentrations in the street drugs Individual warnings like someone infecting HIV consciously Compiling and searching database FUTURE?: Automated location monitoring to support avoiding risky zones or triggering peer support teuvo.peltoniemi@a-klinikka.fi

12 Basics of Voimapiiri (PowerCircle)

13 Voimapiiri (PowerCircle) - A low threshold peer-group based SMS/WEB service VOIMAPIIRI HELSINKI PILOT A joint project of the A-Clinic Foundation (large NGO an addictions), the Social Services of the City of Helsinki, the Centre of Expertise on Social Welfare in Helsinki Metropolitan Area SOCCA, and Kuulalaakeri (technology cooperation). Since 2009 Helsinki alone Financed by the Ministry of Social Affairs and Health and Slot Machine Association (RAY). Total costs about euro. Geographical area Helsinki (where also marketed) but operates via 99 % of Finnish mobile operators everywhere Helping to control or stop alcohol or drugs problems Special peer groups for children, the young, mothers, fathers, drug users, cannabis users etc Semi-open peer groups requiring registration with a nickname Messages from a member to all group Private messages between members Automated support message sets Self written and scheduled support reminders Info messages of help agencies

14 PowerCircle SMS/WEB peer support service model Group messages Answer to whole group or the sender only SMS gateway and operator (Kuulalaakeri & Sonera) Automated support messages sent at 6pm Free SMS number and Own reminder messages Private support messages Info on service agencies and on-line services like AddictionLink Voimapiiri (PowerCircle) Helsinki pilot system in 2008 Registration for a user name Registration, monitoring therapeutic support and coordination professional(s) Database access Research Database access

15 Brief basic Voimapiiri statistics as of October 23, messages in total 880 users joined, 550 remains different messages in 17 months different group messages 6000 private messages between members 3300 own scheduled reminders 4200 subscribed automated support messages 5 info messages on services Messages via SMS 39% and WEB 61 % Source: Jäppinen et alia 2008 Note: We do get any user background data from operators, but only have the parameters used in the messages

16 Some basic statistics of Voimapiiri pilot users 80 % are women and 20 % men Average age is 36 years 44 % had had previous contacts with alcohol or drug treatment Reading only without writing messages is common (80%) Writing is heavily concentrated 66 % of messages are directed to all group members and 33 % for one individual Over 50 % had subscribed support message sets One third subscribed wrote reminders

17 All Voimapiiri (different) messages per day from June 1, 2007 to October 15, 2008, N=25020, Data 1 Messages Figure 1. Finnish PowerCircle (Voimapiiri) SMS service All (different) messages/day from June to 15 Oct 2008 (N=25020) Messages Day The TOTAL number of messages is about There are about DIFFERENT messages as - group messages go normally to all members of the group - long messages (over 160 characters to 445) are counted as 2 or 3 Marketing campaign in Helsinki metropolitan area

18 All Voimapiiri (different) messages by the hour from June 1, 2007 to 15 October 15, 2008, N=25014, Data 1 Figure 2. Finnish Voimapiiri (PowerCircle) SMS service All messages by hour from June to 15 Oct 2008 Messages Hour All messages (25014) In two Aaltonen's (2008) study groups about 50 % of messages were sent during the day, 40 % after 5 pm and 10 % after 11 pm.

19 All Voimapiiri (different) messages by the day of week from June 1, 2007 to 15 October 15, 2008, N=25014 Figure 3. Finnish Voimapiiri (PowerCircle) SMS service All messages by the day of week from June to 15 Oct 2008 Messages Day of the week All messages (25014) Contrary to what one would expect, there are less use of Voimapiiri at weekends than during the week.

20 Voimapiiri (PowerCircle) groups as of October 24, 2008 Group description Mem bers Members recruited from Started Note Group for children and teenagers 4 AddictionLink web groups, youth clinics, MLL phone/web help line 06/2008 Mothers' group 21 AddictionLink Mother s web group, campaign in public transport, social and health care and addiction agencies, Voimapiiri web site 09/2007 Fathers' group 6 Voimapiiri web site 08/2008 Drug user groups (3) 61 Campaign in public transport, social and health care agencies, Voimapiiri web site 10 & 11/ 2007 & 01/2008 One only for cannabis users Family members and friend s groups (3) 55 Campaign in public transport, social and health care and addiction agencies, Voimapiiri web site 06 & 10/ 2007 & 08/2008 Stop drinking groups (3) 123 AddictionLink web groups, public campaign, social and health care and addiction agencies, Voimapiiri web site 06/2007 & 08 & 09/2008 One was study group of Aaltonen Reduce drinking groups (3) 94 Groups in AddictionLink, campaign in public transport, Voimapiiri web site 06/2007 & 08& 09/ 2008 One was study group of Aaltonen Closed groups with prior enrolment and professional guidance 15 One A-Clinic clientele, AddictionLink web group for drug users, youth clinics etc. 06 & 10/ 2007 & 01/2008 Also face-toface meeting groups ALL 379 As of now

21 Example of Voimapiiri group discussions Group discussion: Member 1: " Awful fatigue and tiredness and depression. I do not have strength enough to go anywhere or do anything, I just would like to sleep. I just feel awfully tired and feel bad. And one does not have help from anywhere. I have kept well sober but even that does not cheer me up." Member 2. " Awful fatigue and tiredness and depression. It is caused by withdrawal symptoms. One has be without drinking a longer time, the it will ease. Half a year is a good time. Human body has time to get rid of the chemical which causes dependency. Then there is the psychological dependency. It really is a harder opponent. There is help available if one WANTS to receive it. If one really WANTS to stop drinking." (cited in Aaltonen 2008) GROUP DYNAMICS Of the chain of messages 94 % were positive and cooperating, and only 6 % negative, consists of conflicts. (Data 6) In the positive message chains there were social contents in 48 % and factual contents in 47 % Aaltonen 2008, (Data 6)

22 Voimapiiri (PowerCircle) reminders and support message sets for free subscription Key words For alcohol problems Evaluation of drinking patterns How much is too much? Changing drinking patterns Why change is worthwhile Effects and outcomes of heavy drinking Support for stopping or reducing drinking How to survive a wet party How to succeed in reduction of drinking How to succeed in stopping to drink For drug problems How to stop (illegal) drug use Changing drug use patterns How to reduce drug use and avoid risks Know the facts immediate risks of cannabis use Why not cannabis long-term risks For partners, family members and friends What to do for change Empowerment to survive with alcoholic Change of attitudes and action For children and teens in alcohol families How to find help Feelings and reactions Summary of the UN Declaration of the Rights of the Child Support message example: "Note which are the most important reasons to limit drinking. For instance save money, improve relationships etc. Keep the memo always with you." Reminder message example:"keep firm. No alcohol, shopping today."

23 Summary: Some experiences from the Voimapiiri SMS/WEB Professionally guided pilot groups did NOT success as peer support was strongly preferred by People were NOT interested to obtain info on agencies (only 5 messages 6 % would like to participate in face-to-face interaction with other Power Circle Of the chain of messages 94 % were positive and cooperating, and only 6 % negative, consists of In the positive message chains there were social contents in 48 % and factual contents in 47 % Aaltonen 2008 teuvo.peltoniemi@a-klinikka.fi

24 Future perspectives on Voimapiiri

25 Possible theme options for widening Voimapiiri Behavioural dependencies, especially gambling Tobacco cessation Prescription drugs addiction prevention and treatment Weight control Eating disorders Diabetes monitoring and control, as well as other diseases Supporting independent living of senior citizens Supporting and communication in various groups of disabled citizens Mental health problems, especially depression, work exhaustion, suicides Loneliness, exclusion, low self esteem Domestic violence treatment Aggression control Financial difficulties Bringing up of children Youth work, especially school truant, bullying Traffic behaviour, especially drinking and driving relapses, speeding Themes from completely other life areas like emigrants, (self) education, hobby, political and religious group

26 Future: Comprehensive addictions control support system by mobile phone combining self-help, peer support and professional assistance for Europe Geographical/ language/ group extensions Self-assessment tests online and at the premises of the face-to-face agency Online diaries for controlling the use Automated support messages triggered by the diary database or own requests Peer group support messages by own request Automated location monitoring to support avoiding risky zones or triggering peer support Professional monitoring and support Online booking and time reservation to face-to-face services Integrated pre, in-between and post support while in face-to-face treatment

27 @ Peltoniemi: Experiences and perspectives in using telematic prevention on sensitive health issues. In: Latifi (ed.): Establishing telemedicine in developing countries. IOS Press. Amsterdam Tammi & Peltoniemi, eds.: Telematic drug and alcohol prevention. EU. Prevnet. Helsinki (Available in print and pdf) teuvo.peltoniemi@a-klinikka.fi Join Prevnet EU Network and become an instant insider teuvo.peltoniemi@a-klinikka.fi