Telehealth: A Boon for Treating Substance Use Disorder? Or a Risk?

A new study in JAMA Psychiatry touts the benefits of telehealth in treating people with opioid use disorder. According to the study, virtual care during the pandemic reduced individuals’ risk of overdose and boosted the use of medication-assisted treatment. The American Telemedicine Association called the survey results “a strong signal to policymakers that telehealth can and should be a permanent part of healthcare delivery.” ​​

Although telehealth has had an impact on how people with substance use disorder (SUD) receive treatment, the technology’s advantages concentrate in specific areas. The primary way that telehealth has improved treatment is by increasing access. Since the start of the pandemic, telehealth has opened the door to treatment for many individuals who may have been struggling to get care, such as those who had a tough time traveling into an office due to distance, transportation, or physical health constraints.

In addition, the technology has been valuable in making inroads with at-risk populations. This may include someone new to treatment or who has been in treatment but has missed appointments. In the latter case, telehealth gives the counselor, physician or care coordinator a way to connect with the at-risk individual that is better than an audio-only phone call. The provider can get a sense of how the person is doing, their environment, and whether they’re safe.

Telehealth appointments may be a more comfortable alternative to in-person visits for a patient that is on the fence as to whether to engage in treatment.

Recognizing the technology’s risks

Although there are advantages to telehealth, there are also risks in relying solely on virtual solutions to treat people with SUD. Such solutions can be isolating, and isolation is one of the biggest risks for relapse in this population. Being alone for extended periods can trigger a cycle that’s hard to break. Over time, this can worsen an individual’s condition.

Establishing personal connections is also more difficult via telehealth, and personal connections play a significant role in SUD treatment. The social aspect of coming to a group session and chatting with others by the coffee maker — or just coming into the clinic or medical office for a visit — can play a key role in recovery. Those social interactions are difficult to duplicate over a telehealth platform.

With virtual appointments, providers may miss subtle cues that indicate an individual may be struggling. While providers can get a general sense of how a person is doing and feeling over a monitor, they can’t always see the gestures and other fine details that become apparent as they sit with the individual in person. There’s an intangible connection that comes from being in the same room.

Safety is also a concern with telehealth, and providers can better ensure a person’s safety with an in-person visit. In a clinic, a provider can control who does — or doesn’t — accompany an individual into the room during their visit. With a telehealth appointment, the provider is not always aware of other people who may be in the room. At best, these people could be a distraction or impact an individual’s ability to be transparent about what they’re experiencing. At worst, they may pose a safety threat. Sometimes, the clinic is the only safe, calm environment an individual with SUD experiences.

Finally, it can be difficult to promote accountability with a virtual platform. Conversely, with the in-person visit, an individual knows people expect them to show up, provide a urine sample, connect with others, discuss their situation, and so on. It is harder to hide or minimize challenges in the in-person setting versus a virtual interaction.

Marrying virtual and in-person treatment 

By using a hybrid treatment model that relies on a combination of onsite visits and telehealth appointments, providers can deliver the best possible care for individuals on their recovery journey. The convenience of telehealth can improve care access and support frequent touch points while the warmth of in-person visits can foster safe, personal connections and greater accountability.

Within a hybrid approach, a provider can balance the amount of telehealth versus in-person care based on the individual’s treatment and psycho-social needs. Being thoughtful about when to use which type of care modality can ensure an individual is set up for success and has the best chance for optimal outcomes.

As part of a hybrid approach, providers should treat the mind, body and spirit, helping the individual tackle the challenges of SUD more holistically. Once they can clearly see a path forward, they can start to make progress. As a person’s circumstances change, providers can work with them to find the right combination of treatment options for their unique conditions.

A hybrid approach offers the best of both worlds

While telehealth has provided many benefits throughout the pandemic, it can be a lonely and sterile way of receiving treatment. Individuals experiencing SUD who only receive treatment through telehealth may miss opportunities to connect with others in support of the recovery process. By embracing a hybrid approach that tackles the addiction holistically, people with SUD can receive the appropriate level of care as quickly as possible, while engaging with a community and being held accountable on their recovery journey.

Photo: sorbetto, Getty Images

Leave a Comment

Your email address will not be published. Required fields are marked *