Telehealth a Game Changer for Addiction Treatment?

Megan Brooks

October 13, 2021

Providing addiction treatment remotely via telehealth has the potential to boost patients' engagement in treatment by improving access and convenience. However, whether telehealth results in better retention or other outcomes than in-person treatment remains an open question, new research indicates.

"Telehealth really might be a game changer for getting people into addiction treatment, but we still need more research to confirm the benefits of telehealth and to determine under what conditions telehealth is best used," study investigator Tami L. Mark, PhD, said during a press briefing held by the American Psychiatric Association.

The study was published online October 13 in Psychiatric Services ahead of the organization’s first-ever Mental Health Services Conference, which will be held online October 14–15.

COVID Turned On the Telehealth Light Switch

"COVID-19 was like turning on a light switch for telehealth," said Mark, with the nonprofit research institute, RTI International, in Rockville, Maryland.

"Before the COVID-19 public health emergency and stay-at-home order that the governor of California issued in March of 2020, only about 1 in 4 addiction service providers in California offered any type of telehealth. By July 2020, almost 100% were offering telehealth," she noted.

This was possible through relaxation of federal and state regulations that had previously constrained use of telehealth for addiction treatment. Policy makers and payers are now considering which of these changes should be maintained.

For the study, investigators used mixed qualitative and quantitative methods to assess the efficacy of telehealth for addiction treatment and to gain insights from practitioners regarding their experiences during the pandemic.

They reviewed eight published studies that compared addiction treatment via telehealth with in-person treatment.

Seven found telehealth treatment to be as effective but not more effective than in-person treatment in terms of retention, satisfaction with treatment, therapeutic alliance, and substance use. Most of the studies were small (<150 patients).

However, one large study from Canada showed that telehealth facilitated methadone prescribing and improved retention.

The researchers also conducted an online survey in 2020 of 100 California addiction treatment practitioners and interviewed 30 California addiction professionals and other stakeholders.

Survey respondents indicated that more than 50% of their patients were being treated via telehealth for intensive outpatient treatment, individual counseling, group counseling, and intake assessment.

They were most confident that individual counseling via telehealth was as effective as in-person individual counseling. They were less sure about the relative effectiveness of managing medication via telehealth, group counseling, and intake assessments.

Remote Challenges

Many of the practitioners interviewed for the study noted that telehealth reduces the time and cost to patients of participating in treatment and that it offers an opportunity for clinicians to observe patients' home environment and engage patients' families.

Others felt strongly that patients with substance use disorders need personal relationships and connectedness, which are hard to establish virtually.

They also noted that it is more difficult to sense how a patient is doing when meeting virtually and that it can be challenging to keep patients focused online.

"Providers seem to be moving to a hybrid approach where telehealth is used for some patients and some services but not others," Mark said.

"Additional research is needed to determine how best to tailor telehealth to each patient's circumstances and the best mix of in-person and telehealth services," she added.

Speaking at the briefing, Lisa Dixon, MD, MPH, editor of Psychiatric Services, said the research "tackles arguably the most important issue in psychiatry today ― telehealth.

"The pandemic brought it to the forefront more quickly than otherwise, but appreciation of its potential positive and negative impacts I think was inevitable," said Dixon.

"Research has taught us a lot, as has our experience, but we have a long way to go in understanding telehealth and addiction treatment. I really like this article because it appreciates some of the unique issues with the treatment for substance use as opposed to other mental health challenges," said Dixon.

Funding for the study was provided by the Patient-Centered Outcomes Research Institute. Mark and Dixon have disclosed no relevant financial relationships.

Psychiatr Serv. Published online October 13, 2021. Full text

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