Telehealth Has Pros and Cons for Addiction Treatment

When it comes to substance use disorders, treatment via telehealth may not measure up to the efficacy of in-person treatment in all areas, but it may improve access and convenience during the COVID-19 pandemic, according to a recent literature review and survey study.

Four of eight studies that compared individual counseling delivered through telehealth versus in-person counseling found no significant differences in treatment adherence and retention, excessive alcohol consumption, drug-positive tests, treatment satisfaction, or therapeutic alliance, reported Tami Mark, PhD, MBA, of the nonprofit research institute RTI International in Rockville, Maryland, and colleagues.

However, survey results from 100 respondents found that 46% believed that telehealth counseling was just as effective or more effective than in-person counseling, while 45% said that telehealth was less effective, they noted in Psychiatric Services.

Additionally, 62% said that telehealth group counseling was less effective than in-person group counseling, while only 25% said telehealth was just as or more effective in this area.

Regarding medication management, three studies from the literature review found that telehealth can be effective for managing medications for opioid use disorder. In each of these studies, patients receiving medications via telehealth were also getting in-person services, like drug testing and counseling, Mark and colleagues noted.

However, 51% of survey respondents said that telehealth was less effective than in-person treatment for medication management, and 33% reported that it was equally or more effective.

Furthermore, 49% of survey respondents reported that intake assessments via telehealth were less effective than in-person assessments, compared with 40% who reported that telehealth was just as effective for intake assessments, if not more so. Breaking this down by medication, 42% said that telehealth was less effective for intake assessments for methadone, with 23% reporting the opposite, and 35% said they weren’t sure. For intakes for buprenorphine, 45% thought it was less effective, 40% thought it was equally or more effective, and 15% weren’t sure.

Insights from provider interviews and survey responses about access issues, however, uncovered the day-to-day benefits and drawbacks that telehealth can have for those struggling with substance use disorders. Providers highlighted the fact that telehealth services can eliminate the transportation challenges that may have previously prevented a patient from receiving treatment, and some said that patients missed fewer appointments when they were done virtually.

When asked how much telehealth mitigated barriers to access, 28% of survey respondents said it knocked down those barriers completely, 36% said moderately, and only 13% and 10% said “a little bit” or “not at all,” respectively.

Still, some providers said that gauging a patient’s well-being and state of mind can be much more difficult to accomplish over video than in person.

“Half of counseling and therapy is body language and visual,” one provider noted. Others also said that keeping their patients engaged — both in individual and group sessions — has been challenging.

Ultimately, the provider interviews showed the ways in which telehealth treatment can work for some, but not all, patients with substance use disorders. For example, individuals with social anxiety might feel more comfortable participating in group sessions virtually; others may need that in-person contact, and without it, they may feel more isolated, Mark and team noted. Many providers also expressed how hard it can be to establish solid personal relationships and connectedness among group members during a virtual counseling session.

For this analysis, Mark and colleagues used eight studies, responses to a 2020 online survey from 100 California addiction treatment providers, and interviews with 30 different California-based treatment providers and stakeholders.

According to the survey, the services with the largest percentages of patients being treated via telehealth were intensive outpatient programs (61%), individual counseling sessions (58%), group counseling (52%), and intake assessment (52%). The least likely to be conducted over telehealth were withdrawal management (39%), intake assessments for methadone (39%), and drug testing (17%).

That the study only collected data from California treatment centers was a major limitation, the authors said. They also acknowledged that not interviewing patients or payers was another limitation to their research. Regarding the literature review, Mark and colleagues said they did not conduct a formal meta-analysis that would account for the quality of the research.

“Telehealth may serve to improve addiction treatment access, initiation, and retention,” they wrote. “However, to date, only one study of telehealth-delivered addiction treatment has shown that benefit.”

More research is needed to understand the efficacy of telehealth treatment for substance use disorders, they concluded.