New Social Technologies in Alcohol and Drug Prevention

Welcome to the third edition of PolicyTalk from the Australian Drug Foundation. PolicyTalk provides an overview of topical debates to help senior policy makers find the right solutions for the community on alcohol and other drug issues.

This edition examines issues for the AOD sector posed by the explosion of social media and the wider revolution in information communication technologies.

Technological advances offer us tremendous opportunities to communicate with existing and new audiences, but the process is fraught with challenges.

I look forward to your thoughts and contributions to this and future debates.

John Rogerson

Chief Executive Officer

Australian Drug Foundation
December 2011

Jump ahead to:

1.  What's the point of the new social technologies?
   Social technologies offer alcohol and drug agencies new ways of communicating with their audiences - and the audience is already using them.

2.  How alcohol and other drug services are using social technologies
   Social technologies are about two way communication. The AOD sector is already employing new tools to stay in touch with their audience and target groups.

3. The Digital Divide and other challenges
   Will social technologies enable disadvantaged people to catch up, or will they increase the gap between the privileged and those on the margins?

4. Making the most of social technology's opportunities
   Organisations might be left behind if they don’t use information technology creatively. What do services need to do to ensure they remain relevant? 

5. Implications for government policy
   How can government policies for social technology help to improve the future health of Australians?

6. References

Go here for previous issues of PolicyTalk.

What's the point of the new social technologies?

New developments in information communication technologies (ICTs) offer exciting ways of communicating with a potentially limitless audience. ICTs are electronic means of storing and sharing information, including the Internet, email and short message service (SMS) or texting [1]. Use of ICTs is most prevalent among people under 25 years [2] - the ‘digital generation’ [3].

One feature of the ICT environment is its ‘Web 2.0’ capabilities. 'Web 2.0' denotes a shift from uni-directional information delivery to consumers via the Internet towards interactive and collaborative ICT use which means Internet users are not only consumers of information, but are active contributors [1, 2, 4].

A core component of Web 2.0 technologies is social media. Social media are interactive web-based or mobile ICTs that enable content to be created and exchanged within online communities [1]. Examples include social networking, blogs, multimedia sites, wikis and podcasts [5]. Social media creates a rich, collaborative environment that enables people to express themselves, share ideas and communicate in multiple forms (including text, video and audio) and are having a profound impact on politics, social organisation, and marketing [5, 6].

Social media are the most popular form of ICT use among young people [3, 7] and it offers significant opportunities to alcohol and drug workers to communicate preventative messages to young people in particular.

However ICT poses serious questions: How are social media and ICTs currently used within the AOD sector? How can social media be used to prevent AOD problems? Will ICT replace traditional services? Is ICT equitable, or do some people miss out?

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How alcohol and other drug services are using social technologies

Peer-led: Hello Sunday Morning

Many AOD-related programs and campaigns have already harnessed social media as a way of reaching out and engaging with their target population. A prominent Australian example is Hello Sunday Morning (HSM), a peer-led program which encourages individuals to abstain from alcohol for 3, 6 or 12 months in order to learn about themselves and gain a better understanding of Australia's drinking culture through an experience of sobriety. The program is coordinated through a blog-sharing social media site (hellosundaymorning.com.au) where users create a personal profile and outline what they hope to achieve through their HSM experience. Participants can blog about their experiences and registered HSMers connect with them and show their support. Personal profiles remain live after the individual has completed their HSM experience, enabling them to keep in contact with the program and perhaps repeat it.

A similar format has been adopted by other programs such as Between the Lines, a drug discussion site (betweenthelines.net.au) which provides information on the latest drug news and research, relevant laws and policies, and provides registered users with the opportunity to post blogs about their personal stories.

Health promotion websites

Although health promotion websites traditionally are a one-way form of information transfer, they are adopting social, interactive and user-generated features [1]. Primarily they provide information and support for current or potential AOD users in order to prevent or reduce harm. Typically they include information on substances and their effects, and strategies for quitting or cutting down and relapse prevention [1].

A good example is Tune In Not Out (TINO), (tuneinnotout.com) which informs on AOD use and mental health issues while allowing users to create and share content in the form of blogs, videos and audio clips. Another example is the Australian Drug Foundation’s Somazone website (somazone.com.au) which provides information and support for young people under 18 years. Materials include fact sheets, a searchable service directory, advice, a question and answer forum and personal stories.

Social networking sites

Social networking sites (SNS) are also important. SNS and related communication technologies (e.g. emailing, messaging, chatting) are among the most common forms of social media [7, 8]. Various health promotion campaigns and harm prevention programs have tapped into SNS such as Facebook and Twitter to enhance their appeal and visibility. The Government campaign Don’t Turn a Night Out into a Nightmare, for example, included a Facebook page (facebook.com/nationalbingedrinkingcampaign) to complement its website (drinkingnightmare.gov.au) which posts videos, photos of campaign events, and regular tips about safe drinking . Programs such as drinkerscheckup.com, whose main website offers a self-screening service where individuals can complete a survey and receive feedback about their drinking, also have Facebook and Twitter pages which notify followers of new developments relevant to the program.

Moderated forums

Online discussion forums enable communication between health professionals and/or members of the community. Forums are typically moderated by a professional to ensure posts do not include abusive or offensive messages, and to ensure an appropriate respond to problematic posts [1]. Moderated forums may operate as stand-alone discussion sites or be supported by educational materials, email support or structured self-help programs [1]. One example is alcoholhelpcenter.net, which provides users with specific strategies, success stories and encouragement from the moderator and peers [1].

SMS and email

SMS and email are used in campaigns and programs to keep subscribers motivated, engaged and updated on developments. HSM updates registered users on campaign news via email, and meth.org.au, a self-help website for young people using methamphetamines sends tips by SMS on harm reduction and remaining abstinent [1]. The Inspire Foundation’s mental health site ReachOut.com, offers SMS tips and challenges around a specific topic. SMS is used in the offline world to provide appointment reminders and at events including Big Day Out to remind attendees about keeping safe [1].

Intervention and treatment options

The interactivity offered by Web 2.0 technologies has assisted early intervention and self-help programs for the prevention, management or treatment of AOD-related problems. Self-screening and assessment tools allow individuals to receive personal feedback on whether they may have a AOD problem, and how they can change their behaviour, or seek treatment [1]. Examples include alcoholscreening.org, a US-based website for users to assess their drinking behaviours, and checkyourdrinking.net, a Canadian website which provides an anonymous 18-question survey to help people assess their own drinking, or that of a friend, family member or client and develop a management program. A related option is mobile phone applications (‘apps’) which can track and mediate alcohol use. These options may be particularly valuable due to their portability and convenience [9].

Interventions may stand-alone or are complemented by support via telephone, email or moderated forums [1]. Other treatment options include synchronous or asynchronous e-Counselling, as provided by Turning Point (counsellingonline.org.au) and Kids Helpline (kidshelp.com.au). Asynchronous counselling occurs via email, allowing individuals to gain information or support without having to consult a health professional face-to-face [1]. Synchronous “chat” mode operates similarly to instant messaging on social media sites and allows real-time, text-based communication between counsellors and clients [1].

Expanding service options

Social media and other ICT-based programs improve contact with people who face barriers in accessing traditional AOD services. Current barriers include:

• The embarrassment or stigma associated with seeking help, a particular concern of young males, and in rural areas [10, 11].
• Lengthy waiting periods to gain an appointment and time spent in the waiting room [12].
• The cost of health services is a concern among young people who require access to their parent’s health care insurance to pay medical costs [11].
• A lack of appropriate services. Young people have both specific and diverse needs, which may not always be catered for by traditional health services [11, 12].

By contrast, accessing health- and AOD-related information via ICTs is generally:

• Accessible: ICT-based services are not subject to geographic or temporal constraints and offer 24-hour access to information [13, 14].
• Low cost: ICTs are more cost-effective than many traditional services [2, 15].
• Anonymous: ICTs provide an anonymous and face-saving means of seeking health information for people who feel uncomfortable with personal encounters [16].
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The Digital Divide and other challenges

While social media has the potential to improve the ease, scope and availability of AOD information, programs and campaigns, several challenges exist.

Ensuring information is timely, appropriate and of good quality

Ensuring access to quality, up-to-date information appropriate to individual needs confronts AOD services that utilise social media and other ICTs. While using ICTs means young people have access to a far broader range of information and supports, that may lead to 'information overload' and difficulty in finding accurate information [1, 3, 14, 17].

A related concern is how to monitor content to allow timely upload to an online network or resource [18]. Ensuring the quality of information provided on user-generated ICTs means it must be checked before it is published. Time taken to conduct such checks may sometimes mean it is not longer relevant when it is uploaded.

Safety and security concerns

Accessing information and socialising via ICTs poses a number of risks including exposure to inappropriate material, cyber-bullying, and having strangers ask for or gain personal information [3, 19]. However a recent survey of children aged 9-16 years found an increasing proportion (37%) are developing sophisticated ways of negotiating potential security threats, including finding safety information, blocking messages and applying filters [20].

Preoccupation with the potential safety and security threats in ICT use may obscure the benefits. An example is the Australian Government’s proposed ISP-level filter, which might block harm reduction websites due to the detailed instruction they provide on 'safer forms of drug use' [21].

ICT knowledge of service providers and health professionals

Service providers and health professionals need ICT knowledge and capacity to use ICTs to engage effectively with young people [2, 13, 22]. A lack of knowledge about ICTs could compromise AOD organisations’ ability to understand what is required to use social media effectively.

Visibility

The plethora of sources of information means it is hard for each campaign or program to gain the visibility and credibility required for its success.

Relatively new area

Utilising social media and other ICTs is relatively new and there is relatively little empirical evidence upon which to base future practice. More research is needed if the AOD sector is to take advantage of the opportunities afforded by ICTs.

The ‘Digital Divide’

A significant challenge is the so-called ‘digital divide’, which refers to people who do not have access to the technologies required for social media [2, 4, 22, 23]. Some may be people in most need of information, advice and support. Those who do not or cannot access ICTs may be increasingly isolated [3]. Key factors contributing to the digital divide include:

• Socioeconomic status: The cost of ICTs may constitute a significant barrier for many young people and people of lower incomes are less likely to have home Internet access [24].
• Homelessness: Young people represent 31% of all homeless people in 2009 [3], which is likely to diminish their access to ICTs.
• Geographical location: Young people in rural and remote areas are less likely to have access to ICTs (computer, Internet, mobile technologies) than those living in inner cities [2, 19, 24] yet people in rural areas are less likely to see traditional services.
• Indigenous people and people of culturally-and-linguistically diverse (CALD) backgrounds: Young people from Indigenous or CALD backgrounds are less likely to use ICTs [3] due partly to socioeconomic disadvantage but also because ICTs often do not cater for differing linguistic and cultural needs [16, 25].
• Physical or intellectual disability: Disability poses a challenge to young people in using ICTs. However these technologies can promote social connectedness and civic participation among marginalised groups when they have the means to use them [2].

Unless policymakers are careful to close the digital divide it could contribute to a widening of existing social and economic divisions as the divide affects those who are already marginalised [4].

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Making the most of social technology's opportunities

Making the most of the opportunities afforded by the ICT environment is not as simple as setting up a Facebook page, Twitter account or other service. A number of things need to be considered if the ICT-based resource is to be successful.

Be strategic

No single ICT technology is attractive or accessible to all populations [1]. Successful use of social media requires the message, target audience and its needs must be clearly defined. Programs should be guided by input from the target audience to ensure the design, content and technology is appropriate [1]. The ICT service also has to fit the organisation's existing programs.

Staffing and financial considerations

Organisations need to budget and plan for the development, implementation and ongoing maintenance of the ICT. Although websites may be ‘free’ initially, they require significant ongoing resources including staff time [1], and the staff responsible need sound knowledge of the ICT and the target population.

Organisational considerations

Clear and coherent policies regarding the use of ICTs by staff and the target population are required. Will staff be able to access social media during work hours? Will content be monitored (this may entail a trade-off between monitoring and the timely upload of content)? Who will be responsible if information on the social media site is used for harmful purposes? Policies may also need to deal with how to negotiate the presence of alcohol advertising on social media sites if this becomes common.

Facilitate the verification of accurate information

Organisations can facilitate users’ ability to verify the quality of information by making clear who is providing the information, who funds the site, and when the page was last updated [1].

Dealing with the digital divide

As highlighted above, there is currently a lack of ICT-based resources for people with specific linguistic, physical and mental needs. The gap needs to be addressed if AOD organisations are to improve equitable access to services.

Be active

The multiple modalities offered by the ICT environment afford an array of new means to communicate with the target population. Conversely, the plethora of potential information and communication options means that a service can be lost in the crowd.

Organisations need to consider how they will maintain credibility with their target audience. Utilising ICT options such as SMS and email to actively broadcast messages to the target population could help them keep contact with the campaign or program.

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Implications for government policy

Dealing with the digital divide

The digital divide is a serious concern for social justice and equity. Those excluded may be those most in need of the services offered. The National Broadband Network may help overcome the digital divide if it increases the speed, quality and reach of broadband access [26]. Further measures to reduce the digital divide include greater public access to cheap or free Internet for those who cannot access it at home.

The proposed ISP-level filter

The plan for the government's proposed ISP-level filter is to block sites that contain injurious information on drug use [27]. Some harm reduction sites that provide valuable information and advice to current users of drugs may be prevented from operating effectively unless the risk is understood and acted upon.

The regulation of alcohol marketing

The alcohol industry is already using social technologies creatively to promote drinking to young people. Monitoring alcohol marketing via social media will be an important responsibility of governments and non-government agencies to ensure the alcohol industry does not evade the regulatory restrictions on marketing of its products.

© Australian Drug Foundation. All errors or omissions are the responsibility of the copyright owner.

Author: Sally Cameron
Editor: Geoff Munro

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References

[1] Rodda, S., Harney, A. and Lubman, D. (2011) ‘Information and communication technologies in reducing alcohol and other-drug related harm’, Prevention Research Quarterly, DrugInfo

[2] Burns, J. and Blanchard, M. (2010) Social Participation in Technology: A Pilot Project for Young People with a Disability, Report for Interchange Loddon Mallee, Interchange Central Gippsland and VicHealth, Melbourne

[3] Muir, K., Mullan, K., Powell, A., Flaxman, S., Thompson, D. and Griffiths, M. (2009) State of Australia’s Young People Report: A Report on the Social, Economic, Health and Family Lives of Young People, Australian Government Office for Youth, viewed 24 September 2011 from http://goo.gl/owByb

[4] Wyn, J., Cuervo, H., Woodman, D. and Stokes, H. (2005) Young People, Wellbeing and Communication Technologies, VicHealth Mental Health and Wellbeing Unit, viewed 24 July 2011 from http://goo.gl/Tmzua

[5] Chung, C. and Austria, K. (2010) ‘Social Media Gratification and Attitude toward Social Media Marketing Messages: A Study of the Effect of Social Media Marketing Messages on Online Shopping Value’, Proceedings of the Northeast Business and Economics Association, pp. 581-586

[6] Park, J., Choi, H. Park, Sung-Min (2011) ‘Social Media’s Impact on Policy Making’, SERI Quarterly, Vol. 4, No. 4, pp. 125-129

[7] Australian Communications and Media Authority (ACMA) (2008) ‘Internet Use and Social Networking by Young People’, Media and Communications in Australian Families Series, No. 1, viewed 24 September 2011 from http://goo.gl/94u54

[8] Collin, P., Rahilly, K., Richardson, I. and Third, A. (2011) The Benefits of Social Networking Services’ Cooperative Research Centre for Young People, Technology and Wellbeing: Melbourne

[9] White, A., Fitz-Walter, Z., Hides, L., Kavanagh, D., Johnson, D., Tjondronegoro, D. and Connor, J. (2011) On Track: Exploring Mobile Phone Technology to Track and Moderate Alcohol Use, paper presented at the 6th International Conference on Drugs and Young People, Melbourne Convention Centre, 2-4 May 2011

[10] BoysTown (2010) Annual Report, BoysTown: Milton, viewed 27 September 2011 from http://goo.gl/nRf7X

[11] New South Wales Association for Adolescent Health (2006) Position Paper: Young People and Access to Mainstream Services, viewed 27 September 2011 from http://goo.gl/0ho8l

[12] headspace (2011) Youth Future Crew Youth Survey Results, headspace: Barwon, viewed 27 September 2011 from http://goo.gl/7PqET

[13] Deegan, P. E. (2010) ‘A Web Application to Support Recovery and Shared Decision Making in Psychiatric Medication Clinics’, Psychiatric Rehabilitation Journal, Vol. 34, No. 1, pp. 23-28

[14] Ziebland, S. Chapple, A., Dumelow, C., Evans, J. Prinjha, S. and Rozmovits, L. (2004) ‘How the Internet Affects Patients’ Experience of Cancer: A Qualitative Study’, BMJ (Clinical Research Ed.), Vol. 328, pp. 564-569

[15] Orbach, T. and Vasquez, J. (2009) ‘Self-care and the need for interactive ICT’, Journal of Holistic Health Care, Vol. 6, No. 2, pp. 35-39

[16] Kay-Lambkin, F. J., White, A., Baker, A. L., Kavanagh, D. J., Klein, B. Proudfoot, J. Drennan, J. Connor, J. and Young, R. M. (2011) ‘Assessment of Function and Clinical Utility of Alcohol and Other Drug Web Sites: An Observational, Qualitative Study’, BMC Public Health, Vol. 11, No. 1, pp. 277-286

[17] Deluca, P. and Schifano, F. (2007) ‘Searching the Internet for Drug-Related Web Sites: Analysis of Online Available Information on Ecstasy (MDMA)’, The American Journal of Addictions, Vol. 16, No. 6, pp. 479-483

[18] Thompson, T. (2011) Facebook-Friendly Drug Education: Targeting Health Messages for Young GLBT People, paper presented at the 6th International Conference on Drugs and Young People, Melbourne Convention Centre, 2-4 May 2011

[19] Australian Bureau of Statistics (2011a) ‘Children of the Digital Revolution’, Australian Social Trends, June, Catalogue No. 4102.0, viewed 18 September 2011 from http://goo.gl/GiYVm

[20] Australian Policy Online (2011) viewed 18 November 2011 from http://goo.gl/Ls4vA

[21] Barratt, M. (2011) ‘Refused Classification’: Exploring the Unintended Consequences of the Proposed Internet Filter for Young Australians Who Use Drugs, paper presented at the 6th International Conference on Drugs and Young People, 2-4 May 2011

[22] Metcalf, A., Blanchard, M., McCarthy, T. and Burns, J. (2008) ‘Bridging the Digital Divide: Utilising Technology to Promote Social Connectedness and civil engagements amongst marginalised young people’, Journal of Community, Citizen’s and Third Sector Media and Communication, No. 4, pp. 2-15

[23] Cunningham, J. A., Selby, P. L., Kypri, K. and Humphreys, K. N. (2006) ‘Access to the Internet among Drinkers, Smokers and Illicit Drug Users: Is it a Barrier to the Provision of Interventions on the World Wide Web’, Medical Informatics and the Internet in Medicine, Vol. 31, No. 1, pp. 53-58

[24] Australian Bureau of Statistics (2011b) ‘Online @ Home’, Australian Social Trends, June, Catalogue No. 4102.0, viewed 18 September 2011 from http://goo.gl/zICBV

[25] O’Mara, B., Babacan, H., Borland, H. (2010) ‘Sending the Right Message: ICT Access and Use for Communicating Messages of Health and Wellbeing to CALD Communities, The Institute for Community, Ethnicity and Policy Alternatives, Victoria University: Footscray Park, viewed 24 July 2011 from http://goo.gl/8Azy2

[26] National Broadband Network website (2010) What is the National Broadband Network?, Australian Government Department of Broadband, Communications and the Digital Economy, viewed 10 May 2011 from http://goo.gl/wuNC8

[27] Department of Broadband, Communications and the Digital Economy, (Last Modified 20 August 2010) ‘Internet Service Provider (ISP) Filtering’, viewed 10 May 2011 from http://goo.gl/fOhBW

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