Telemedicine is advancing how we treat drug and alcohol addiction. That’s good news for the 21 million people in this country with substance use disorders (SUDs). Here’s why, from my perspective as an addiction clinician.
Substance abuse is now a major public health crisis that demands urgent priority and the application of new and innovative solutions that can help close the treatment gap. At a time when drug overdose is the fastest-growing cause of accidental death, and when more people have SUDs than cancer, telehealth treatment for addiction promises to reach a whole swath of people in need of treatment, for whom geography or other factors — stigma can be another one — were once an obstacle to help. It still remains the case, for example, that patients in rural areas of the country have to drive long distances to get to a treatment center or to see an addiction specialist for medication-assisted treatment. Telemedicine is reducing the burden of such barriers.
There’s also the fact that telemedicine can provide quicker access to treatment resources, so those with substance abuse issues can more easily plug into a network of recovery supports. The web-based alcohol screening, assessment and feedback intervention tool, the “Drinker’s Check-Up,” has shown positive results in several clinical trials.
Because web-based telemedicine services can be accessed at any time, there is the added bonus of more regular follow-up and monitoring as needed — including at times when immediate help may be needed in order to cope with relapse triggers. It’s rare for drug and alcohol cravings to strike right in the middle of an already-scheduled counseling appointment, after all. (There are the exceptions, of course, like the time one client said the crystals in a colleague’s office were a cue to use meth.)
Mobile device applications like A-CHESS (Addiction Comprehensive Health Enhancement Support System) mean clients can access these critical relapse prevention supports 24/7 and when they are most urgently needed. And so far A-CHESS has proven successful at reducing risky drinking days and improving abstinence rates for those with alcohol use disorders. Among the app’s many helpful features are a “panic” button, a secure discussion board, and a web portal that allows clinicians to check up on their patients.
Videoconferencing is another area where telemedicine is opening up new forms of support to people in recovery. Remotely and from the privacy of their own home, clients can chat with a clinician, peer-support specialist or, in some cases, a hard-to-reach medical specialist, such as a physician certified to prescribe buprenorphine (a medication for reducing the cravings of opiate addiction). Some studies even suggest there is little to no difference in outcomes for clients receiving these services versus clients receiving in-person services.
Still, there are some inevitable limitations to how web- and telephone-based technologies can serve the unique treatment needs of people with SUDs. Most critically, it’s hard to downplay the importance of real (as opposed to virtual) human connection in the recovery process — yet that real human connection is the very thing that tends to get edged out by telehealth services. When a client meets with me one-on-one, or when a small group of clients sits across from one another in a circle, opening up about their struggles, the healing connections that form there cannot be replicated over the phone, via a text or web chat, or even in a videoconference.
Telehealth interventions have also been shown not to work for people with more severe addiction issues, such as those with co-occurring post-traumatic stress disorder.
Such limitations aside, telemedicine for addiction will only become more mainstream in the years to come — so we’ve only begun to tap into its vast potential to connect millions of underserved people with the help and treatment they need. Addiction is a disease of isolation, after all. Its polar opposite is not sobriety but connection, which is the very thing that telehealth advances can exponentially multiply.