The COVID-19 (coronavirus) pandemic has begun to have a dramatic impact around the world. It is apparent that things may get much worse before they improve. Many aspects of our lives are beginning to be affected, and addiction treatment and recovery activities will not be magically immune.
The impacts on substance abuse recovery and addiction treatment may include:
Residential programs, partial hospitalization programs (PHP), and intensive outpatient programs (IOP), suspending, limiting, or altering the delivery of services.
Hospital-based programs being suspended to provide additional space for medical treatment.
Meetings for social-support organizations — such as Alcoholics Anonymous (AA), Al-Anon, Narcotics Anonymous (NA), Recovery Dharma, SMART Recovery, and others — being canceled or suspended.
Recovery-related conferences, seminars, and workshops being canceled.
Emergency response times and emergency room waiting times increasing across the board and possibly delaying care for those who have overdosed or are in acute detoxification.
While these sound like doomsday scenarios, the possibility of these occurring is real. In some cases, they are already happening. We simply do not have enough hospital beds in the United States to care for those who may become critically ill from this virus. More severe measures to decrease the spread of the coronavirus are almost certain. The vast majority of treatment and recovery activities take place in-person, at meetings, or in centers with many participants. It’s not a question as to when the availability of treatment and recovery support will be affected, but to what degree and for how long. This crisis is, unfortunately, taking place during one of the most massive addiction epidemics in history. Telehealth will play a critical role and save lives in the weeks and months ahead.
For some time, telehealth services have been quietly beginning to take root in addiction treatment and recovery across the country. Independent addiction professionals have started offering counseling services by telephone and video, entire addiction treatment programs have adopted the telehealth format, and online meetings for many of the social support organizations have been occurring for years. Telehealth within addiction treatment is about to have its moment in the spotlight and fill a critical need during this global health crisis.
It is surprising to me that there still seems to be some apprehension and stigma on the part of individual clinicians, treatment programs, and public health administrators in offering telehealth services for addiction treatment and mental health. The current crisis demands we re-examine that bias and provide these critical services via telehealth to those in need. There is a multitude of studies and research being conducted on this very issue, and the existing data on telehealth is encouraging.
As an addiction counselor who has helped hundreds of clients over the past few years by providing addiction counseling via telephone and video sessions, I have witnessed how effective these services can be when delivered via telehealth. I have found that telehealth addiction services can reduce many barriers to treatment, including:
Reducing costs for both clinicians and clients;
Eliminating transportation issues;
Decreasing the anxiety and apprehension some clients experience before their first session;
Increased flexibility in scheduling and availability;
Increased honesty from clients;
Fewer sessions are missed due to illness or inability to attend a session physically.
In my practice, those factors have contributed to client success. I have not found that working with clients by phone or video has decreased the effectiveness of my counseling. I know that some clinicians fear they would miss valuable visual cues or subtle signs of relapse if they are not physically present with a client. I have not found these concerns to be an issue. There is almost no difference when conducting a session by video, and hearing clients can be as insightful as seeing them.
While programs may have additional obstacles to implementing telehealth services to program participants, it is relatively easy for individual clinicians. You only need a telephone, a secure video service such as FaceTime or Zoom, and an additional clause on telehealth services in your informed consent document. Encrypted video services like Zoom offer HIPPA-compliant encrypted video services with a very affordable monthly subscription. FaceTime video calls are also “end-to-end” encrypted and incredibly secure. The client forms package offered by APN includes a clause for telehealth services. I also recommend taking online CEU courses that provide information on protecting electronic communications and ethics related to telehealth.
There is no secret to providing counseling via telehealth. The content and process of my assessments and counseling sessions are the same as when I conduct them in-person. If a client needs to drug test, they can purchase oral drug tests from me. We then administer the test while we are in a video session. They hold the test up to the camera, and I can see the test results. The two additional assessment tools that I use, the SASSI-4 and ASI-MV, can also be administered online: you can read more about these tools in a previous blog article by clicking here.
I don’t believe telehealth addiction services will or should ever completely replace in-person services. It is merely one more tool that can reduce barriers to treatment and help more people in need. I have many clients who complete medical detox, participate in telehealth counseling, see a board-certified addiction physician for medication, and participate in 12-step and other types of social support with great success. With the outbreak of this global pandemic, telehealth may provide a critical link for people who may otherwise be unable to obtain services.
If you don’t currently offer telehealth services in your practice, I hope you’ll reconsider it and begin doing so immediately. If you need help getting started, join APN and send us an email. We’ll be happy to answer your questions and support you in getting started. If you offer telehealth services or addiction services in private practice, please set up your profile in our professional’s directory. Membership and the profile are free, and we will launch the directory on March 15th. We will begin directing the public to the directory when they request referrals to addiction professionals. We are receiving a substantial number of requests. You can set up your profile by clicking here.
Here are some links to more information on research and the effectiveness of telehealth for addiction and other mental health issues:
"Does psychotherapy via the Internet work? For the first time, clinical researchers from the University of Zurich have studied whether online psychotherapy and conventional face-to-face therapy are equally effective in experiments." Psychotherapy via the internet as good as if not better than face-to-face consultations (Article)
"The University of Florida’s Counseling & Wellness Center has launched a novel program that provides therapy to patients with anxiety disorders — all over a computer screen. The Therapy Assisted Online (TAO) program, started in the fall, has had staggering results, showing that it is, so far, more successful than individual or group therapy sessions offered face to face."
"Researchers compared home-delivered prolonged exposure therapy - which helps patients confront memories and situations that trigger their symptoms - to the same treatment given in U.S. Veterans Affairs clinics, and found no difference in effectiveness."
"Cognitive behavior therapy (CBT) delivered online is effective for treating depression in adults concludes a new meta-analysis presented at the Annual Meeting of the American Psychiatric Association in San Diego."
Use of Telemedicine in Addiction Treatment: Current Practices and Organizational Implementation Characteristics https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5866865/
Trends in telemedicine use in addiction treatment https://ascpjournal.biomedcentral.com/articles/10.1186/s13722-015-0035-4
Written by: Michael O'Brien, CADC II, NCAC I, SAP