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Enacting 'more-than-human' care: Clients' and counsellors' views on the multiple affordances of chatbots in alcohol and other drug counselling.

  • Barnett, Anthony1
  • Savic, Michael2
  • Pienaar, Kiran3
  • Carter, Adrian4
  • Warren, Narelle5
  • Sandral, Emma2
  • Manning, Victoria2
  • Lubman, Dan I2
  • 1 Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, VIC and Turning Point, Eastern Health, Richmond, VIC, Australia. Electronic address: [email protected] , (Australia)
  • 2 Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, VIC and Turning Point, Eastern Health, Richmond, VIC, Australia. , (Australia)
  • 3 School of Humanities and Social Sciences, Deakin University, Melbourne, VIC, Australia; and School of Social Sciences, Monash University, Melbourne, VIC, Australia. , (Australia)
  • 4 School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Melbourne, VIC, Australia and University of Queensland Centre of Clinical Research, University of Queensland, Brisbane, QLD, Australia. , (Australia)
  • 5 School of Social Sciences, Faculty of Arts, Monash University, Melbourne, VIC, Australia. , (Australia)
Published Article
The International journal on drug policy
Publication Date
Aug 01, 2021
DOI: 10.1016/j.drugpo.2020.102910
PMID: 33059955


Forms of artificial intelligence (AI), such as chatbots that provide automated online counselling, promise to revolutionise alcohol and other drug treatment. Although the replacement of human counsellors remains a speculative prospect, chatbots for 'narrow AI' tasks (e.g., assessment and referral) are increasingly being used to augment clinical practice. Little research has addressed the possibilities for care that chatbots may generate in the future, particularly in the context of alcohol and other drug counselling. To explore these issues, we draw on the concept of technological 'affordances' and identify the range of possibilities for care that emerging chatbot interventions may afford and foreclose depending on the contexts in which they are implemented. Our analysis is based on qualitative data from interviews with clients (n=20) and focus group discussions with counsellors (n=8) conducted as part of a larger study of an Australian online alcohol and other drug counselling service. Both clients and counsellors expressed a concern that chatbot interventions lacked a 'human' element, which they valued in empathic care encounters. Most clients reported that they would share less information with a chatbot than a human counsellor, and they viewed this as constraining care. However, clients and counsellors suggested that the use of narrow AI might afford possibilities for performing discrete tasks, such as screening, triage or referral. In the context of what we refer to as 'more-than-human' care, our findings reveal complex views about the types of affordances that chatbots may produce and foreclose in online care encounters. We conclude by discussing implications for the potential 'addiction futures' and care trajectories that AI technologies offer, focussing on how they might inform alcohol and other drug policy, and the design of digital healthcare. Copyright © 2020. Published by Elsevier B.V.

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