Jeffery Smith, MD

From the beginning, the mission of Addiction Resource Guide (ARG) has been to provide sophisticated information about addiction treatment and to make that information easily accessible to both the public and professionals. From a modest start with profiles of 10 facilities, the Guide, which can be found at <www.addictionresourceguide.com>, currently features comprehensive information for more than 200 treatment programs in 47 states and eight countries.

For us, the most intriguing aspect of the Internet is how it obliterates the boundaries that have shaped the world throughout history. Distance disappears, national borders are made insignificant and the distinctions between big powerful organizations and small ones are flattened. On the Internet, a small operation can be just as impressive (or boring) as a large one. As it turns out, this democratic environment has been just right for the growth and development of our service, where the depth and quality of the information presented, rather than its size or impressiveness, are the key features.

When my children came back from college and showed me the Internet, I wanted to get involved. I knew that I did not want to put up a picture of my dog, or my office, or a list of my favorite books. But, like so many people who set up a home page, I was missing an idea that would naturally lead to something significant. Instead, in keeping with my background, I posted a piece about emotional trauma.

And then one day, I had an idea for an Internet venture that seemed promising. As a specialist in addictions, I knew about rehabilitation services and what questions were needed to determine if a facility would be a good match for any given client. An Internet directory would answer these key questions and provide helpful material on making sense of the answers. People need more than the usual name/address/phone number in order to make intelligent choices. I wanted to ask the kind of questions magazine articles advise, but practically no one actually dares to ask.

I realized the information would have to be provided free to the consumer, but there would have to be some source of financial support for the service. If enough users came to the directory, it would function as a clearinghouse, and the growing number of treatment programs that have their own Web site might be willing to pay a modest fee to link the ARG directory with their site. Users would obtain structured information from the directory itself, then hyperlink to the facility for a more personalized look.

Despite my enthusiasm, I had to admit to myself that the project would take too much work to do alone. Fortuitously, a few months later, in early 1997, Polly Waldman, a teacher, mother and friend, had purchased a computer and begun surfing the Web. During a conversation, she mentioned that she had been looking on the Web for addiction facilities and was surprised to find a lack of comprehensive, comparative data. The only thing she found was an out-of-date book that listed the top rehabilitation centers, but many of the facilities were no longer in business. She wondered out loud about publishing an updated directory.

Instantly, I thought of my unused business idea. "Bingo!" I exclaimed, "I know just what is needed!" It took only a few minutes to convince her that the Internet was better than paper because it can be kept constantly updated and is accessible to anyone with a computer or access to a library. I asked if she would like to join me in developing a really helpful Web site. It was characteristic of her that she agreed on the spot. However, Polly didn't have experience with Hypertext Markup Language or the technical aspects of the Web. Fortunately, my oldest daughter, Anne, wanted to move into an Internet career. She was already interested in developing the skills to build her Internet portfolio, and she agreed to become the Webmaster for the new venture. 

The unique, central element of the Addiction Resource Guide is the standard questionnaire given to participating facilities. Their answers form the database that is published on the Web. The best way to make an informed decision when choosing a service is to ask probing questions. The problem is that almost no one thinks or dares to ask the crucial questions at a time of crisis and need. The ARG questionnaire asks those questions so that the answers can be published for all to see. This, in turn, allows consumers to make the best decision possible. The following are examples of the revealing questions facilities are asked: What is your program's attitude toward 12-step participation? What percentage of your patients are given psychotropic medication? What percentage are women?

Although one might wonder about the accuracy of the answers given, program staff realize that their answers set up expectations. Vague answers will fail to attract potential clients, and misleading ones will quickly result in disappointed referents and clients. Through combining short-answer questions and selected program statistics, the user assesses the size, patient population, style and emphasis of each program.

As the Internet grows in popularity, there is a temptation to include flashy graphics and animation. Unfortunately, all these visually exciting effects greatly slow navigation. The philosophy behind our Web site is to have a pleasant but simple look with fast, efficient loading of pages and logical, intuitive navigation for the user.

For instance, a key capability is indexing the directory in multiple ways. Facilities can be located by name, program type and location. Perhaps the most important and special capability that the ARG offers is an index of the listings by specialties and subpopulations. Facilities are asked about specialized programming for subpopulations within their primary focus. For example, physicians, clergy or minority groups may be more comfortable in a treatment program with specialized services designed with their needs and special circumstances/challenges in mind. While specialized programs are not always the best option, there are occasions when a successful referral may depend on the ability to identify a specific program. Currently, over 50 subpopulations are indexed. Facilities are asked to rate their programming for specialized populations according to specific criteria for three levels. These range from a fully separate treatment track to programs that include specialized group treatment sessions dealing with issues specific to a subpopulation.

In addition, as the commonalities between chemical addictions and other impulse disorders become clearer and common biological causes more likely, the logic of including treatment programs that specialize in those disorders is obvious. We have recently begun to establish separate listings and distinct questionnaires geared for facilities that treat people with eating disorders. We plan to add sexual addictions and compulsive gambling. Although we do get inquiries about Internet addiction, we are still treating that as a subpopulation.

Information for potential patients and families on how to navigate the addiction treatment system is designed to be helpful in a crisis. The ideas presented represent clinical wisdom and experience rather than the latest research results. Topics covered include discussions of addiction, the pros and cons of inpatient versus outpatient treatment, and a glossary of terms. We strongly recommend the advice of an addiction professional and provide advice on how to find a licensed practitioner. 

We do have a bias toward the traditional 12-step treatment. Sometimes the 12-step orientation is misrepresented as being categorically anti-professional and anti-psychiatric. That has not been our experience. Over the years, we have been impressed with the effectiveness and professionalism of mainstream rehabilitation treatment, both inpatient and outpatient, in permanently changing people's lives. We have tried to give fair exposure to alternative points of view, and our questionnaires are aimed at fleshing out philosophical differences between facilities, but editorially we do not hold ourselves to a totally neutral stance. Consistent with our mission, we provide the best information we are able to, in the belief that the more informed people are, the better the decisions that they will make.

So far, the site has grown steadily in number of listings and daily traffic. A few look-alike offerings have appeared, but they have not matched ARG's growth. The increase in programs electing to buy links from ARG to their own Web sites has made it possible for us to buy advertising on the Internet and in print. This, in turn, makes ARG visible to new users searching for help with addiction treatment. We also utilize traditional search engines, which are free and very important.

The site keeps growing and changing, while staying focused on its mission. This year, ARG has had a cosmetic face-lift and several new initiatives. John Wallace, Ph.D., CASAC, a noted writer and speaker on addiction, has provided us with the first of an ongoing series of guest editorials. Wallace has written about the importance of skills training in recovery. The Manager's Yellow Pages is a page that lists products and services of interest to addiction program managers and professionals. Examples include alcohol breath testers, software, legal services and others. 

From the special subpopulation index, visitor statistics show that programs dealing with crystal methamphetamine and alcohol are consistently the most visited sections of the Web site. The Professional Page is another area that is particularly well-visited. On that page, ARG has collected links for a variety of resources of interest to professionals.

We try not to tackle more new things than we will be able to accomplish. We have identified three projects for the coming year. We are moving to a more sophisticated program search page with multiple criteria and planning to build our outpatient listings.

The final new project is perhaps the most interesting. When we exhibited our site at the annual meeting of the American Academy of Addiction Psychiatry, a researcher in the field mentioned the difficulty of finding research subjects. Since our site is available to both the research community and to potential subjects, we believe the establishment of a clearinghouse for research subjects in the addiction field would be a valuable resource.

Those programs that do fill out the ARG questionnaire benefit, without cost, from our active outreach efforts. Beyond statistics, our indication of the personal results of providing this service comes in the form of e-mail messages from the United States and all over the world. These messages make it clear, as one would expect, that addictions affect all kinds of people in all kinds of places. What is new is that many of them now turn to the Internet for help.

Early in our development, we realized that we were really publishers. Fortunes have been made and lost on the promise of the Internet, but publishers know not to look for instant rewards. They realize that it takes a long time to establish a readership. We feel fortunate that the Internet makes it possible for us to offer a quality service at a low cost. Our goal is to grow at a pace that allows the company to remain faithful to its mission and to continue to make good on our promises.

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A psychiatrist took his expertise in addiction medicine and coupled it with his desire to start a business. An addiction treatment facility clearinghouse, this Internet venture provides consumers with the opportunity to compare and contrast different treatment centers to find the one best suited to their needs.

Jeffery Smith, MD

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Addiction Resource Guide: An Internet Publishing Adventure