Telehealth addiction treatment rose rapidly during pandemic; but potential benefits still unclear

Prior to the COVID-19 pandemic, only about 27% of specialty addiction facilities had telehealth capabilities and telehealth was used in about 0.1% of addiction treatment visits. Addiction treatment services faced many restrictions on telehealth use. During the pandemic, state and federal agencies temporarily eased many of the restrictions to maintain access to treatment and use of telehealth expanded rapidly. Policymakers are now considering which of these changes to keep.

Researchers from RTI International and UCLA -- University of California, Los Angeles reviewed studies of the efficacy of synchronous delivery of telehealth addiction treatment relative to in-person treatment. Eight published studies were identified that compared addiction treatment via telehealth with in-person treatment. Most of the studies were small (N < 150 patients). Seven found telehealth treatment as effective but not more effective in terms of retention, satisfaction with treatment, therapeutic alliance and substance use. One large Canadian study found better retention with telehealth methadone medication management.

The researchers also conducted an online survey of addiction treatment organizations in California and held interviews with addiction professionals and other stakeholders. Addiction professionals were most comfortable with using telehealth for one-to-one counseling. Survey respondents were almost equally split with about 46% saying telehealth individual counseling was equally or more effective than in-person and 45% saying telehealth was less effective. When considering use of telehealth for intake assessment, 40% said telehealth was equally or more effective while 49% said it was less effective. Telehealth group counseling had less support with 25% reporting it was equally or more effective than in person and 62% reporting it was less effective than in person.

Interview participants highlighted that telehealth reduces the time and cost to patients of participating in treatment and offers an opportunity for clinicians to observe patients' home environment and engage patients' families. On the other hand, many participants felt strongly that patients with substance use disorders need personal relationships and connectedness which are hard to establish virtually. Additionally, they noted that it is more difficult to sense how a patient is doing when meeting via telehealth and it can be challenging to keep patients focused online. Interviewees also noted that telehealth may work better for some patients and for some clinicians than for others.

"Telehealth health may allow patients to more easily begin and stay in addiction treatment, which has been a longstanding challenge," said Tami L. Mark, Ph.D., M.B.A., lead author on the paper. "However, research is needed to confirm this benefit. As providers pivot to hybrid telehealth models -- offering both telehealth and in-person treatment -- they need information to help target telehealth to the most appropriate services and patients."

"This research underscores the importance of offering telehealth for addiction treatment and the dramatic need to conduct more empirical work to test out the concerns regarding telehealth articulated by agency staff and on surveys," said Lisa Dixon, M.D., M.P.H., editor, Psychiatric Services.

Mark is senior fellow, Behavioral Health Financing and Quality Measurement at RTI International, an independent nonprofit research institute dedicated to improving the human condition. The study's coauthors include Katherine Treiman, Ph.D., M.P.H., Howard Padwa, Ph.D., Kristen Henretty, M.A., Janice Tzeng, M.P.H., and Marylou Gilbert, M.A., J.D.