Not surprisingly, since early 2020, there’s been a noticeable increase in substance use disorders. A study of American adults showed psychological distress related to the pandemic was strongly associated with alcohol use quantity and frequency, as well as heavy drinking, and the National Laboratory Services’ Millennium Health reported a 32% increase for non-prescription fentanyl, a 20% increase for methamphetamines, and a 10% increase for cocaine from mid-March to May 2020.
A recent survey by Quit Genius showed that over 1 in 4 employees that worked remotely during the reported going to work performed by drugs or alcohol. And just as those people needed help with substance use disorders, their access to help was curtailed, as the vast majority of assistance options were in-person programs that, at least temporarily, closed their doors.
Into the void came digital clinics for addiction — programs that could be delivered via telehealth (typically, mobile apps). In the US, the government took action to ensure that telehealth visits would be covered by insurance, and that was a key enabler to making addiction treatments accessible for those who needed them.
Patients who are eligible for virtual care (generally those who aren’t required to detox first) now have a plethora of options, ranging from DIY help apps to peer-reviewed programs endorsed and offered by health plans and employers. Patients appreciate that they can participate from the privacy of their homes, and health plans and employers value the high effectiveness rates — higher than traditional treatments, in many cases.
The gold standard in virtual care for addiction offer the following:
Peer-reviewed evidence of effectiveness. Peer review means that a program has gone through a rigorous scientific study managed by physicians, with results reviewed and accepted by other physicians. In other words, third-party validation. These studies involve the use of control groups to definitively measure the effectiveness of a treatment against another approach (a traditional approach or sometimes no treatment), to be able to measure the incremental impact of the treatment.
Longer-treatment programs for multiple types of addiction. Health plans and employee benefit leaders prefer to work with vendors who can fulfill multiple needs, assuming they can do so effectively. Substance use disorder programs designed to address multiple types of addiction are becoming popular for this reason. The fact is that it is very common to have multiple addictions; 70% of those with an alcohol use disorder are also addicted to tobacco, 22% of those with an opioid use disorder are also addicted to alcohol, and 18% of smokers have an opioid use disorder. Longer treatment programs are better for outcomes than shorter term programs because addiction is a chronic condition.
Harm reduction-focused programs, with Medication-Assisted Treatment options. For many years, substance use disorder programs focused on total abstinence. More recently, programs have emerged that instead focus on Harm Reduction – meaning, meeting the patient where they are. Many patients aren’t ready for total abstinence, but do wish to reduce their use of tobacco, alcohol or even opioids. Harm Reduction programs meet patients where they are – getting patients to start their journey – and reducing overdose fatalities, and acute life-threatening infections related to unsterile drug practices and diseases. Ultimately, many patients continue on to total abstinence.
One component of harm reduction is Medication-Assisted Treatment (MAT) — using FDA-approved prescription medications such as Buprenorphine and Naltrexone. Combined with counseling and Cognitive Behavioral Therapy, MAT has been proven to help people reduce or eliminate substance use, and maintain their recovery, yet, less than 8% of people with alcohol use disorder receive treatment, and <2% received MAT.
Integrated Cognitive Behavioral Therapy. There is much research on the effectiveness of CBT in many contexts, including for addiction. In fact, according to the National Institute of Drug Abuse, research showcases that skills learned through CBT remain long after the completion of the treatment.
What the experience is like for patients
Accessibility to treatment continues to be a major problem for patients. Right now, approximately 90% of people with an SUD don’t get treatment, and even then, many don’t stick with it. Traditional SUD programs see dropout rates up to 78%. With digital clinics, patients generally access them via their health plan or employer. An initial screening, conducted most often by a Nurse Practitioner (NP) by phone or telehealth visit in an app, assesses the patient’s needs. If they are eligible for the program, the patient goes through a more detailed screening by phone or app. If MAT is warranted, the patient also speaks with a physician for evaluation and may receive a prescription.
The program itself is accessed via an app, including periodic telehealth visits, calls and chat sessions with addiction counselors, nurses and physicians. Patients can also access telehealth support groups and interact with other patients. For patients concerned about privacy, accessing treatment via telehealth from the comfort of their home is a major benefit. Programs can range from 12 weeks to 12 months, after which a patient is assessed, and either graduates, or continues on in other phases throughout the program if needed.
Though the impact of the pandemic may be decreasing in some areas, its psychological effects will be felt for many years — and reflected in usage rates for tobacco, alcohol and opioids. Virtual care, which became the default when in-person programs shuttered, have continued to be popular because they are not only more convenient, but also more effective — and are now often selected over in-person options.