By Pat Matuszak
Telehealth is an emerging field that allows patients to see a healthcare provider or attend a group therapy session from a remote location via their computer or mobile device. Instead of physically going to an office or meeting place, patients can talk with their group, counselor or doctor over a secure internet connection, usually with a video camera.
Many healthcare plans and practices have already set up a telehealth physician option for their patients’ everyday care like colds and rashes. In the addiction services community, some providers are trying the same type of interface for people with substance use issues.
Some services that are provided by addiction therapy groups may actually be more suited to telemedicine than the usual sore throat or skin irritation. Since many addiction-related treatments rely on communication therapy, rather than strep cultures or skin samples, they can easily be done by teleconference. For times when a medical test is necessary, such as a drug test, patients can perform an instantly readable saliva test during a video chat with their therapist.1
Therapists and patients like telehealth for the same reasons students and professors or business colleagues do. Saving time, meeting space and personnel by using telehealth can also extend the healthcare system’s resources and even make treatment more affordable, as it is doing in business, college and general medicine. They bridge distance, they allow patients to remain in their comfortable home setting, and they save time and resources.
How Telehealth Can Further Treatment’s Reach
One of the main benefits of telehealth treatment is that it allows recovery to reach people who might otherwise have stayed in the shadows because of distance from resources, pressing life responsibilities or privacy concerns.
“More than half of Lionrock’s clients are women – with an average age in the early 40s – usually working moms in small towns or suburbs,” says Peter Loeb, founder of telehealth treatment provider Lionrock Recovery. “They come to us for privacy, so that was something we didn’t necessarily expect. We knew that privacy was going to be important, but it’s turned out to be the most important thing.”1
If the person seeking addiction help lives a great distance from their best treatment option, the telehealth service may help them save travel time and be more consistent in attending appointments. Some telehealth providers offer private and group sessions on 24-hour schedules for those who have work hours that keep them from attending daytime meetings. Transportation can be a major obstacle in getting to meetings and appointments, and telehealth eliminates the need to set up rides or spend money on transportation.1
Where healthcare resources are scarce, either because there are not enough therapy professionals and venues to meet the needs of a large city or because the patient lives in a remote area, telehealth helps give more access to care. The opioid epidemic has stressed addiction treatment resources so that care is not always available when and where it is most needed.1
Want to learn more from Peter Loeb about how teleheath treatment can help people who might not be reached by traditional treatment programs? Listen to his full interview on the Recovery Unscripted podcast.
For patients who feel uncomfortable going to a treatment center because of privacy issues, telehealth offers them complete confidentiality, especially for patients in rural areas. “It’s not urban centers and it’s not necessarily the first ring of suburbs, but it’s the second ring and the third ring and then smaller towns where things are a little bit far away,” explains Loeb. “And they’re certainly not going to drive and park their cars somewhere where their friends or their friends’ friends’ friend is going to see them, ‘What are you doing here? Why are you at the hospital? What are you going to?’”1
Another concern that telehealth may soothe is that some people feel uncomfortable in a live group setting. The comfortable home surroundings and distance between participants in an online group may help them start treatment and, eventually, ease those fears. Consistent attendance is so important in therapy and for some it is a requirement for funding or legal reasons. Telehealth reduces the stress on those patients and their families, giving them more time and enhancing their quality of life.1
A telehealth provider may offer a phone app or a social network similar to Facebook, but within a secure group that’s accessible only to clients and treatment providers. They may also have an added feature to allow participants to check in during trigger encounters and get instant help or report successfully avoiding a trigger. If stopping at a bar while driving home from work was an issue, a participant could post their success when they made it home without a detour.1
Challenges of Telehealth Treatment
Like anything else, telehealth has its difficulties. Many people with addiction prefer face-to-face time with counselors and groups for their recovery. Those who require close supervision and a restricted schedule might not do well with the open format of telehealth. They might also feel more isolated in an online setting.2 Just as some college students mature socially from becoming immersed in the environment on campus and meeting new people, some patients need the social interaction of going to counseling and group events in person.
Technology can also be an asset or an obstacle to treatment. If a patient can’t afford the equipment or if the funds aren’t there to provide it, that’s a barrier. Training to use the software and hardware can also be a deterrent to telehealth for patients unfamiliar with technology. Some patients might be stressed by needing to learn computer skills and others may not have the ability to learn it.
One participant said she was confused when the videoconference would freeze, and she didn’t know if her counselor could see or hear her talking.2 Such service issues could be disruptive to critical moments in therapeutic conversations when creating an environment of security and vulnerability is vital.
Another frequent question about telehealth is the matter of drug testing. If patients are taking helpful prescriptions that could be sold instead of used, careful testing is part of live participation. When telehealth is employed, the patients must still be monitored, so various methods are being tried. Many situations require in-person testing, so in those cases that part of the program can’t be replaced by telehealth.3
Funding can also become an issue, whether the counselor is working in person or on a videoconference. Billing takes time, and the complications of accounting may seem daunting to a staff working in a system of care that may already be overwhelmed. Patients who have to adjust to a new system of billing may also consider that an obstacle. Government and private insurance coverages have gaps related to what they will cover and those may take time to respond to this new technology.3
Choosing the Best Treatment Option for You
While telehealth treatment presents an exciting new opportunity to help unreached people, residential and in-person outpatient treatment still offer many benefits. It comes down to what’s best for each individual’s needs and goals.
“I don’t think that online [treatment] is going to replace residential treatment. We’re very specific about what we can and can’t do,” explains telehealth treatment CEO Peter Loeb. “It’s crazy for us to think that we can do detox; it’s crazy for us to think that we can take care of every problem that there may be … When we come up against things that are beyond our capabilities, we always refer to other folks.”1
1 “Turning Technology into a Lifeline with Peter Loeb.” Recovery Unscripted, June 7, 2017.
2 Forman, Emily. “Telemedicine For Addiction Treatment? Picture Remains Fuzzy.” NPR, November 24, 2017.
3 Molfenter, Todd; Boyle, Mike; Holloway, Don; Zwick, Janet. “Trends in Telemedicine Use in Addiction Treatment.” ASC Journal/Biomed Central, May 28, 2015.