A recent article in JAMA Psychiatry points to a few unique challenges that mental healthcare providers face when practicing telehealth for substance use disorder versus other mental health practices. Notably, the authors point to the ways in which addiction treatment relies on in-person visits: “Compared with mental health, adoption of telehealth for SUDs has been limited because SUD treatment often relies on frequent visits, intense monitoring through urine toxicology, and other practices that pose additional barriers.” In a new era defined by distancing and virtual everything, we are especially interested in ways to cope with restrictions without compromising either the quality of addiction treatment care or our clients’ physical health and safety.
For a few months at New Paradigm Recovery, we implemented telehealth practices that were compliant with patient privacy standards with relative ease. When urinalysis was required, our clients were able to discreetly drop off samples with no face-to-face interactions. New clients came once face-to-face to complete paperwork, then quickly returned to the virtual world. Group and individual sessions continued online. We adapted to the challenges quickly and rather seamlessly. Our comprehensive and holistic addiction treatment program continued, giving life-saving help and resources to people seeking recovery and their families.
We did, however, return to in-person meetings, sessions, and groups as soon as public health guidelines allowed. You may ask why we would make the jump back to in-person treatment if the virtual treatment was working fine, and, as we all know, the pandemic is still raging on. The answer is twofold.
The first part of our decision to return to in-person treatment was practical: New Paradigm Recovery simply has the real estate to allow safe, distanced groups– we can safely seat masked clients more than 6 feet apart in a spacious group room with high-tech air purifiers there to keep the air clean. With screening protocols in place (like the ability to check client and staff temperatures and to order COVID-19 tests), distancing protocols possible within our facility, and safety and sanitation measures easily at our disposal, we were able to safely return to in-person treatment.
The second part, most important, of our decision to return to in-person treatment concerns the quality of care. Quality of care is always the most important factor behind our decisions at New Paradigm. While there is research that supports that telehealth can be as effective as in-person health for mental health services, the research is limited. Another recent article in Journal of Social Work Practice in the Addictions draws attention to some of the concerns: “There are obvious limitations to telemedicine for the treatment of SUD among patients that lack access to the internet or a device that can be used for audio-video conferencing… There may also be patients that have difficulty engaging in telemedicine appointments and may require in-person treatment due to the severity of their SUD and/or severe mental illness. Lastly, although most of a mental status exam can be performed adequately via telehealth, SUD populations often have an increased risk for medical comorbidities that are sometimes better assessed with an in-person physical exam.” These limitations pose threats to the quality of care. Imagine, for instance, you live with a spouse and children in a small house or apartment; even if you have the right devices and high-speed internet, you may resist sharing openly on the chance that you could be overheard by your family. Even when it seems like a client has access to all the right technology and resources, the perception of privacy is different in a shared home than it is in a professional therapeutic space. The limitations of telehealth for an individual client may not be immediately apparent and may negatively affect the outcomes of their course of treatment.
In addition, insurance, legal, and medical issues come into play with telehealth, with many policies having been created in years BC (“Before Covid”), making some aspects of the paperwork, prescriptions, and finances of treatment a bit more challenging in a virtual arena, even as the healthcare field has done its best to remove such barriers during the pandemic. We find that added obstacles to treatment do a disservice to our clients; it is hard enough to find the courage to seek treatment, and red tape does not help. Finally, there simply needs to be more research and more data about outcomes of telehealth in substance use treatment to give both clinicians and clients a deeper understanding of these practices.
While we are grateful that our clients continued to have access to addiction treatment at New Paradigm Recovery from the safety of their homes during quarantine, we are not ready to declare telehealth for addiction treatment the “new normal” just yet. Telehealth is an exciting field, one that promises to remove barriers, promote health, and bring wellness to people in traditionally underserved populations. With new data and more studies published, we look forward to better understanding the implications of new technologies in the treatment world. This pandemic will certainly provide ample data for academics and researchers to analyze and will almost certainly point to new pathways in which technology can be utilized for healthcare (and everything else in our lives). Until then, as long as we are able, we will be masked-up, temperatures-checked, six feet apart, and in the process of getting vaccinated, doing the best we can to continue safe in-person treatment.
References
Kleykamp, B. A., Guille, C., Barth, K. S., & McClure, E. A. (2020). Substance use disorders and COVID-19: the role of telehealth in treatment and research. Journal of Social Work Practice in the Addictions, 20(3), 248-253. doi:10.1080/1533256X.2020.1793064
Lin, L. (., Fernandez, A. C., & Bonar, E. E. (2020). Telehealth for Substance-Using Populations in the Age of Coronavirus Disease 2019 Recommendations to Enhance Adoption. Journal of the American Medical Association; Psychiatry, 77(12), 1209-1210. doi:10.1001/jamapsychiatry.2020.1698
