Discussion: Impact of Telehealth on Women
Discussion: Impact of Telehealth on Women ORDER NOW FOR CUSTOMIZED AND ORIGINAL ESSAY PAPERS ON Discussion: Impact of Telehealth on Women Chapter 1: Introduction to the Study Introduction Drug and alcohol addiction as a major health problem throughout the world (Miller, 2013). The World Health Organization (WHO; 2014) indicated that worldwide, 5.5% of the worlds population suffer from drug or alcohol addictions. The National Survey on Drug Use and Health (NSDUH) showed that slightly less than 11% of Americans with substance use disorder (SUD, which can include drugs or alcohol) were able to receive treatment at a facility (Center for Behavioral Health Statistics and Quality, 2016). Some of those suffering from addictions are not able to or choose not to get help with their substance use disorders (Cook, et al., 2013). Discussion: Impact of Telehealth on Women Different definitions exist for the term recovery. One definition is generalized as a journey a person takes over time, including multiple stages throughout the process (Substance Abuse and Mental Health Service Administration, 2012). These stages can be seen as early recovery, sustained recovery, and stable recovery (Betty Ford, 2007). Neale (2014) discussed recovery as abstinence, or reduction in use of substances, that results in better living situations, better health, employment, or some positive outcome. Recovery from dependence on a substance is seen as a voluntary act, maintained by change in lifestyle to include sobriety (abstinence) health, and community involvement (Betty Ford, 2007). In 1991, The U.S. Department of Health and Human Services developed an office to focus on the health and wellness of women (National Institute Drug Addiction, 2018). The National Institute of Drug Addiction (NIDA) focused on studies in women as the biological differences between men and women became more prominent in addictions to drugs and alcohol (NIDA, 2018). An entire department titled the Office of Research on Womens Health is dedicated to determining the differences between the genders on health-related topics (NIDA, 2018). Women face unique challenges surrounding substance and alcohol abuse that are also impacted by culture and geography (Wilsnack, 2013). A few of these challenges facing women entering recovery include problems with domestic violence, victimization, sexual assault and trauma (Evans, Padwa, Li, Lin & Hser, 2015). These instances can lead to co-occurring disorders in women to include depression, anxiety, and low self-esteem (Evans et al., 2015). Background The following articles form the background to this research. Benavides-Vaello, Strode and Sheeran (2013) discussed the use of technology for treating persons with substance abuse to reduce disparities. Discussion: Impact of Telehealth on Women. Dixon and Chartier (2016) presented that alcohol is the most abused drug in the rural areas within the United States. Edmond, Aletraris and Roman (2015) showed the fundamental and quality difference that exists between the rural and the urban treatment centers. Ghia, C. J., Patil, A. S., Ved, J. K., & Jha, R. K. (2013) acknowledged that telemedicine is increasingly becoming a widely recognized concept globally. Hickson, Talbert, Thornbury, Perin, and Goodin (2015) discussed online technologies, and how there is a more efficient and better care system. Melemis (2015) acknowledged that four primary ideas exist for relapse prevention. Pullen and Oser (2014) highlighted substance abuse as a major concern in both urban and rural areas, with more focus on the rural areas. Sigmon (2014) focused on the access to treatment for those who are in rural America. The specific target treatment for the study is on opioid dependence. Wang, Becker and Fiellin (2013) is premised on the fact that rural areas in the United States have shown an increase in overdose deaths due to the nonmedical use of prescription opioids. Zanaboni, Knarvik and Wootton (2014) explored the state of application of routine telemedicine with specific reference to Norway Problem Statement Substance abuse is a steadily growing concern (Pullen & Oser, 2014) in rural America (Sigmon, 2014). According to the U.S. Census Bureau (2016), a rural area is defined as areas of population not classified as urban. Areas of urban populations are denser, with more developed territories, leaving areas farther away from city centers to be classified as rural (U.S. Census Bureau, 2016). In general, rural areas lack easy access to quality healthcare (Pullen & Oser, 2014). Throughout the United States, rural areas report physician shortages, travel difficulties, and lack of specialized treatment options (Warren & Smalley, 2014). Alcohol and substance abuse in Georgia is a social problem that has caused a significant level of social and economic problems (SAMHSA, 2016). In a paper, Gender Impact Assessment of Georgias Drug Reform, the Gender Equality Council of the Parliament of Georgia (GECPG) indicates that there are over 45,000 substance abuse cases in Georgia. Out of this number, 10% are women (Gender Equality Council of the Parliament of Georgia, 2017). Even though lack of rehabilitation is a threat to individual health and well-being, there remain significant hindrances to the treatment of abusers of substances (Pullen & Oser, 2014). One of the primary challenges to the treatment of substance abuse is the availability of resources in communities (Edmond, Aletraris & Roman, 2015), while marginalization and stigmatization are other devastating challenges. One proposed way to overcome the obstacles in addiction recovery in rural areas is the use of online systems. One such option for rehabilitation from substance use disorder is that of telerehabilitation, a sub-discipline of telemedicine. Telemedicine is one of the most recent improvements in the provision of medical services (Mid-Atlantic Telehealth Resource Center, 2016). It allows medical practitioners to provide medical services to patients without ever meeting them. It refers to the use of various forms of technologies and communication systems to offer rehabilitation services and assist the affected persons to start living independently (Mid-Atlantic Telehealth Resource Center, 2016). A study of online substance abuse recovery was completed in the United Kingdom in 2015, comprising of smart phone apps, online groups, and websites (Graham, Irving, Cano, & Edwards, 2018). This study revealed a strong correlation between those in established and stable recovery and the usage of some type of virtual recovery tool. Established or stable recovery is a period of sobriety of more than 5 years (Betty Ford, 2007). The study did not reveal if online services for those beginning recovery, or those in early recovery, which is a period of time less than 1 year, were used, which suggests further research is needed to understand recovery change via online sources with a focus on gender (Graham et al., 2018). Best et al. (2016) describes the amount of judgment from outsiders women receive in comparison to men when dealing with substance use disorders. According to the Federal Center for Substance Abuse Prevention (2017), about 2.7 million women in the United States abuse drugs or alcohol. Some women may know that they are struggling and will take pills or alcohol while hiding whereas other women will view it as a social activity and will not agree to see it as a problem (Bepko, 2014). Women face pressure to have everything together, meaning a perfect balance between work, raising kids and other social activities. It is for this reason that once a woman gets addicted, accepting that they are addicted is quite hard and seeking treatment is even harder (Bepko, 2014). Discussion: Impact of Telehealth on Women Although the aforementioned research regarding deliveries of rehabilitation services for women suffering from substance abuse and alcohol addiction illuminates important findings, I have found no research that has examined how women located in rural areas who suffer from addiction use telerehabilitation as a primary recovery option. Discussion: Impact of Telehealth on Women Purpose of the Study. The purpose of this general qualitative study is to gain deeper understanding of the experiences of recovery from substance abuse disorders among women in rural North Georgia who are limited in access to in-person treatment options and rely on online rehabilitation services. The research will explore the experience of recovery stabilization from substance abuse and related diseases. Focus will be limited to women clients of recovery treatments living in North Georgia. The online treatment platform provides a private and convenient option for drug and alcohol addiction recovery (Griffiths, 2015). Health related outcomes have been studied from the social media platform of recovery, showing positive benefits, with little negative impacts (Merolli, Gray, & Martin-Sanchez, 2013). Highly trained medical experts can provide therapeutic intervention via the internet. This platform offers numerous benefits in addition to the traditional recovery approach. Differing interactions via online such as counseling, peer groups, and other tools for successful recovery are available. More engagement online will positively influence the results of addiction treatment for women clients in rural areas. Utilizing the online tools, the women of North Georgia will benefit from full flexible schedules 24/7, therapeutic support, and continual progression in counseling. Connection is a strong part of recovery, and through online applications, women can stay connected to counselors and set up appointments as needed. Length of online meetings and sessions will vary, but the nature of interaction will depend entirely on the woman and her desire for support (Griffiths, 2015). Research Question What are the experiences of recovery from substance abuse disorders among women in rural north Georgia who are limited in access to in-person treatment and who rely on online rehabilitation services? Theoretical Foundation Framework The self-regulation theory will serve as the theoretical framework for this study. The self-regulation theory developed by Baumeister and Bandura (1989) is a self-directed management system that involves guiding ones thoughts, feelings and behaviors towards the attainment of certain goals (Baumeister & Vonascha, 2015). It involves what we feel, think, say or do that helps in controlling our urges, emotions and behaviors (Baumeister, 1994). This theory is effectively used for impulse control, illusion control, goal attainment and management of sickness behavior making it eligible for this study (Baumeister & Vonascha, 2015). Bandura claimed that humans control behaviors through self-regulation and the behaviors associated with the social cognitive theory and social learning theory (Baumeister, Bratslavsky & Muraven, 2018). Schunk and Zimmerman reviewed the theory and came up with particular strategies that contribute to an individuals learning process that leads to self-regulation (as cited in Panadero, 2017). Baumeister designed four components of self-regulation to be the standard of behaviors that are desired, the motivation to meet the standards, analyzing and evaluating situations and ideas and the willpower to control urges (Baumeister, Bratslavsky & Muraven, 2018). Individuals engage in their own learning in three stages: planning, monitoring and reflection (Panadero, 2017). The individual lays out strategies to tackle the tasks, monitors their performance and reflects on the outcome (Panadero, 2017). In monitoring of health-related issues, the self-regulatory model may be used. It describes the stimulus, cognitive and emotional responses, the coping responses and evaluation of the coping responses and health outcomes (Baumeister & Vonascha, 2015). Patients are guided in identifying their health problems, the risks and issues involved and an action plan to handle the problem (Panadero, 2017). The self-regulation theory is applied by an individual who takes control and evaluates his/her behaviors to attain satisfaction trough life experience. Definitions Recovery Recovery, for the purposes of this paper, will describe the process of change that an individual achieves through abstinence and improved health, wellness, and overall quality of life. (Center for Substance Abuse Treatment, 2007). Telehealth The usage of electronic information and telecommunication strategies to support and promote long-distance clinical health care, patient and professional healthcare education, and health and public safety administrations. (Department of Health and Human Services, 2019). Telemedicine Similar to telehealth , telemedicine is the practice of the medical field using technology to deliver care at a distance. Physicians in one location can utilize telecommunications infrastructure to provide adequate care to a patient who, for one reason or another, is separated from them. (AAFP, 2017). Tele-Rehabilitation Rehabilitation through traditional techniques, but utilized through telecommunication devices like computers, web-cams, and telephones. (Peretti, 2017). Relapse The return of a disease or the signs and symptoms of a disease after a general improvement period. Moreover, the returned use of addictive substances or behaviors. (NIH, 2018). Substance Abuse The usage of illegal drugs, prescriptions, over-the-counter drugs, or alcohol for purposes other than what they were initially intended for. Typically, these substances are abused or utilized in excessive amounts that do not have clinical reasoning. (NIH, 2018). Opioid Dependence The dependency on opioids, a substance used to treat moderate to severe pain. A dependence on drugs like morphine and codeine are detrimental to the receptor in the central nervous system. (NIH, 2018). Rural Areas Areas in the continental United States that are open country and settlements with fewer than 2,500 inhabitants. (USDA, 2019). Urban Areas Unlike rural areas, urban areas refer to larger places where the space around them is high in population density. Urban areas do not follow clear municipal boundaries and are often classified with inhabitants of roughly 50,000 people. (USDA, 2019). Treatment The desired course of action between a doctor and patient in rehabilitating an ailment of disease. Plans are structured around or deliberately designed to curtail the disease or ailment through medication, procedures, and medical devices. (Hart, 2020). Rehabilitation The process to restore mental or physical health incurred from an injury or disease. The programs are used in order to allow someone to function in normal or near-normal life. (NIH, 2018). Medical Practitioners A practitioner is an individual who is qualified and experienced to work in a specific medical profession. A doctor or nurse are considered healthcare practitioners. (NIH, 2018). Assumptions The nature of this study will be qualitative inquiry with a general approach that will focus on the lived experiences of women living in rural north Georgia who utilize online treatment for recovery from substance use disorder. According to van Manen (2014), the heart of human experiences presented to the researcher has meaning to the participants through their surroundings, and how their meaning influences behaviors. Purposeful sampling will align with the purpose of this qualitative study. Sampling will allow for selection of participants to meet the requirements needed to further the study (Suri, 2011). Individual interviews will be conducted, utilizing semi-structured questions. A total sampling of between 12 to 15 women will be selected on a voluntary basis, ensuring anonymity through only voice recording. Women will be a minimum of eighteen years old, with no age limit. Some will have entered into recovery on their own decision and some may have been assigned to it through court ordered processes. The location of the participants will be in Northern Cherokee County in the state of Georgia. Selection will be from more rural areas, with a minimum of 20 mile drive to the closest treatment option for addiction recovery. Participant pool will lead to a better understanding of the experiences of women entering into recovery from substance use disorders. Discussion: Impact of Telehealth on Women Scope and Delimitations In this study, the focus is on the analysis of the experiences in stable recovery for women living in rural north Georgia who treat substance use disorders through online rehabilitation services. The deeper understanding under investigation may accrue a qualitative attachment to the research methodology investigated. Hence, it is imperative to focus not on outside events, but on the experiences being presented. Following a thorough analysis of women seeking online treatment on drug abuse online, there has existed a limited scope and need to research the particular field to find out the motivation behind the action (Matua & Van Der Wal, 2015). The motivation behind the whole concept points to the fact that there are gaps within community centers charged with engaging the society in containing substance abuse amongst women in the Georgian community. From a sample of women, it was agreed that drug and substance abuse problems had online choices and should be expanded to other territories for better service (Van Manen, 2014). Of specific interest is: The experiences in stable recovery for women living in rural north Georgia; and The treatment of disorders through online rehabilitation services. Data will be analyzed through thematic content analysis. Through this technique, the common patterns across a data set will be established. During the analysis of collected data, individuals will read and re-read data, then label and code for broad patterns of meaning. The themes will be reviewed to ensure that the data will correlate (Braun & Clarke, 2014). Themes will be named and then defined appropriately. Write up will include quotes from the interviews. Limitations The method to be used, semi-structured interviews has its shortcomings. First, the method can be time-consuming and utilizes many resources. Additionally, the technique requires confidentiality which has to be assured and if not, the participants may feel hesitant to share information. The skills to analyze the data can be a problem as there are chances of construing so much (Van Teijlingen, 2014). A main limitation may be achieving the correct sample size. According to Babione (2015), saturation is the point in a qualitative research where new data and analysis only confirm previous conclusions. Consequently, it determines when to stop data collection and analysis. At the saturation point, the theory appears clear and is easy to construct since there are no gaps of unexplained phenomena. Sirakaya-Turk et al. (2017) considers saturation to be reached when no new concepts can emerge and the data cannot contribute any further to theoretical development. Data repetition and redundancy begins to appear and further collection is unproductive since it yields no new information. According to Phillips (2014), any additional information after saturation becomes redundant because the purpose of qualitative research is to discover the context and diversity rather than a large number of participants with the same experience. The failure to achieve saturation has a negative impact on the research quality and the validity of the results (Fusch & Ness, 2015). Further, there is no universal data collection method for attaining data saturation. According to Fusch & Ness 2015, some methods have a high probability of reaching saturation than others. Data collection approaches depend on the study design and hence researchers should select a study design that is explicit about reaching data saturation (Fusch & Ness, 2015). Saturation should be operationalized in a method consistent with the theoretical position, study questions, and the adopted analytical context (Saunders et al., 2018). Discussion: Impact of Telehealth on Women Ethical Procedures One of the things that will be ensured in the study is research confidentiality. The consent of the interviewees will also be sought before carrying out the study. The research aim and objectives will be made known to the researchers as well. A steady focus to keep and remove any bias of the researcher will be maintained, after using any experiences necessary to gain complete confidence from participants. Significance Overdose deaths increased at a more rapid rate in the state of Georgia than the national average last year (CDC, 2018). In 2016, 928 Georgia residents died in the circumstances related to substance use disorder (Cupit, 2018). During 2017, the number of overdose deaths reached 1,035 people living in Georgia (Cupit, 2018). The mortality rate in Georgia is now considered an epidemic crisis. Deaths relating to drug abuse in Georgia for 2018 reached 2000 people. This study will provide useful information benefitting women living in rural North Georgia battling substance abuse issues. The results from this study will provide a contribution to the literature on understanding addictions in women with less access to treatment (King et al., 2018). Significance will be seen through a reduction of barriers to treatment and recovery by improving the online ability to treat substance use disorders. The results gathered from this research will contribute to literature by revealing depths of substance abuse in women. Knowledge obtained from this study could promote social change through recommendations from collected information towards policy makers in rural areas (King et al., 2018) to increase availability of services for those suffering substance use disorders. The ripple effect of this information will reduce deaths in the community from addiction because more availability to recovery help will be available. Policy makers within the state of Georgia will be involved in positive changes for availability of treatment for women suffering from substance use disorder. This study will be fundamental in importance by reducing the number of deaths in the area thru online recovery options. Discussion: Impact of Telehealth on Women Summary *** IS THIS WHERE THE SUMMARY OF CHAPTER 2 GOES??*** Chapter 2: Literature Review History of drug abuse/addiction/dependency In the History of substance abuse research in the United States, VanGeest et al. (2016) ascertained that substance abuse is one of the most widely studied aspects of human health in the United States. Drug or substance abuse is the use of a drug in amounts that are harmful to individuals health or others. There are many reasons why people engage in the use of drugs irrespective of their background or age. According to Robinson (2019), people do experiment with recreational drugs out of curiosity to have some enjoyable time or because some other people like friends are doing it, reducing stress or other problems, or maybe as a result of depression. Substance abuse and addiction results not only from the use of illegal drugs like cocaine or heroin but also from prescribed medications, which include painkillers or sleeping pills. In the U.S, most people are addicted to prescribed drugs such as painkillers (Segal, 2019). In most parts of the United States, Opioid painkillers abuse has become so powerful and has paved the way for the use of more dangerous drugs (VanGeest et al., 2016). Substance abuse has been going on in the United States for a long time, but it was not until the last parts of the 19 th century that many scholars started taking an interest in the matter (Sarvet & Hasin, 2016). Development of Drug Addiction According to Melinda Smith (2019), drug use can easily lead to addiction based on various factors. Any person can develop problems of drug use, but vulnerability differs from one person to another. Some of the things that play a role in this include the individuals family, mental health, and the environment he/ she socialize from. Other factors include the history of addiction within the family, Abuse, traumatic experiences, depression and anxiety, and the method of administering the drug, which includes injection or smoking. *******NEED MORE**** Drug Use and Addiction in Georgia Alcohol use In Georgia, drug and substance abuse is one of the most felt health crisis, and this is a severe challenge that the population faces and which take distinct forms. According to Lakeview Health publication in 2019, Alcohol is probably the most abused drug in Georgia. Although it is widely accepted as a regular social activity, many people have become addicts in a way that is affecting them negatively. The rate of use of this substance varies with the geographic location of the residents, primarily rural and urban areas. There has been a lot of concern about Alcohol Use Disorder among these populations and there is a need for humanitarian help in addressing this problem. (WHO GHO, 2016). Alcohol use disorder is mainly a big concern among conflict-affected civilians (Ga Dept of health, 2019). This is because they are often exposed to traumatic and occurrences that bring about complications such as depression and anxiety. This exposure to traumatic events and violence result in alcohol use as a form of self-medication. Armed conflicts and related displacements of people arise to poor living conditions and poverty, and loss of properties. This makes alcohol a solution strategy to these stressors. Alcohol use and addiction is the leading cause of non-communicable diseases such as cirrhosis, heart conditions and diabetes to these populations (Almli & Lori, 2018). It also results in behavioral and other social impacts such as violence which is based on gender. This is a big problem in many areas affected by conflicts. Georgia has been marked by conflicts that involved secessionist movements in the 1990s and in 2008 which led to displacements and setting up internally displaced peoples camps (WHO, 2016). These displaced communities are faced with poverty, unemployment, poor living conditions, and limited access to other local communities. This is one of the reasons why they use alcohol in a big way. Limited access to good healthcare and health facilities results in continuous addictions. Alcohol use is more on the rural parts of the country as compared to the urban area as a result of the above-highlighted factors. Although women in rural regions who engage in alcohol are less than men, about 16% of them engage in drinking (WHO, 2016). Discussion: Impact of Telehealth on Women Opioid Use These are mostly used as medicines, and mainly they are prescribed as painkillers for chronic pain. With their prolonged use, their ability to relieve pain can reduce, and the pain increase and this can make the body develop dependence. Their continued use develops withdrawal symptoms, and this makes it difficult to stop using them. According to the Georgia Department of Public Health (2020), the deaths caused by Opioid overdose have been on the rise in Georgia since 2010. This has been attributed to the increased use and misuse of prescription opioids, such as oxycodone and hydrocodone. From 2013, illicit opioids such as heroin and fentanyl led to a sharp increase in the deaths associated with opioid overdose (Abraham, Adams, Bradford, & Bradford, 2019). According to the National Institute of drug abuse in March 2019, there were 1014 deaths associated with opioid use. More cases involved synthetic opioids (mainly fentanyl). There was a massive increase in the number of related deaths by 358 between 2012 and 2017 (Ga dept of health, 2019). There was also a significant rise in the number of women who use opioid especially in the rural parts of the country, and this is attributed to the pain-relieving prescriptions (Ga dept of health, 2019). Adverse effects of drugs on women in North Georgia Addiction in Women According to Hardy, Fani, Jovanovic & Michopoulos (2018) there was an increase in the number of deaths for women, which resulted from addictions and overdoses as compared to men. The use of alcohol is on the rise, as well as other drugs such as opioids. The fact that opioid is given as a prescription drug, even increases more chances of women involvement, as they frequently feel chronic pain. Continued use is the one that brings about the addiction to a point where they cannot survive without using the substance (Hardy, Fani, Jovanovic & Michopoulos, 2018). This becomes serious because unlike men, women can transfer the effects to children in case they use them when pregnant or develop more severe problems in their health. This review focus on womens drug use in rural north Georgia and telerehabilitation (Salas-Wright, Vaughn, & González, 2016). Its better to understand that there are many negative impacts that women experience after opioid use and addiction (Salas-Wright, Vaughn, & González, 2016). One of them is Neo-natal Abstinence Syndrome. This occurs when a woman uses drugs such as opioids when she is pregnant (Darlington & Hutson, 2017). This may result in babies being born with such symptoms of drug effects. There is also a prevalence of cases such as HIV which has been attributed to Injection Drug Use (IDU) (Darlington & Hutson, 2017). Although most of the affected are male, about 2.3% of women cases were attributed to IDU. Other infections that arise include Hepatitis C (HCV) prevalence, which was attributed to injections (Mazure & Fiellin, 2018). According to Zibbell, Asher, Patel, Kupronis, Iqbal, Ward, and Holtzman (2018), the annual acute HCV infection incidence increased by more than two times from 0.3 to 0.7 cases per 100,000 from 2004 to 2014. This varied among different selected groups with the main cause being the injection of a drug such as heroin. Discussion: Impact of Telehealth on Women North Georgia drug problems In an article titled Time for Georgia to Admit It Has a Drug Problem, Soderstrom (2016) makes it clear that Drug abuse is rampant in the state, fueled primarily by the use of opioids such as prescription painkillers and heroin. There is no doubt that Georgia, as a whole, is facing a crisis. The level of substance use is high, and having adverse effects on the state. In the article, the writer makes it clear that North Georgia is one of the areas of Georgia that are adversely affected by this problem of drug use. The paper proceeds to indicate that In North Georgia, addiction to prescribed opioids such as OxyContin and Vicodin has crippled families and destroyed lives. Ten of the states 67 opioid addiction clinics are located in the region, despite only six percent of the population living there. (Soderstrom, 2016). From this data, there is no doubt that substance use is a major problem in North Georgia. The National Institute on Drug Abuse indicates that In Georgia, over 60% of drug overdose deaths involved opioids with 866 fatalities (a rate of 8.3) reported in 2018 (The National Institute on Drug Abuse, 2020). The data suggest that the rates of fatalities associated with substance abuse in Georgia are greater than the national fatality rates. Concerning the very high rates of substance use and related fatalities in North Georgia, one of the hypotheses that have been developed to help understand the cause of the trends in the region is that People in that area are very competitive and hard-working. There is a lot of pressure to keep up appearances and a lot of pressure on school kids to get good grades, so they qualify for certain scholarships (LakeView Health, 2020). Thus, this story suggests that social and economic pressures have contributed significantly to substance abuse challenges in North Georgia. Addiction in women In North Georgia, a significant number of women abuse a wide range of drugs. It is recorded that more than 41 percent of women (Rehab Center, 2015) were in treatment for substance abuse in Georgia during 2013, (SAMHSA, 2013). The data provided in the text suggests that the majority of these cases are in the northern region of Georgia (Rehab Center, 2015). It is unfortunate to find a situation where four out of ten women in a state are battling substance addiction (Rehab Center, 2015). Beginning of telemedicine/telerehab Technology has played an important role in the advancement of medical practices. The use of technology has enhanced the quality and s
