Confronting Substance Use Disorder (SUD) Takes a Deft Mix of Traditional Therapeutic Models and New Technologies

Author: Murray Zucker, CMO, CHESS Health

As the nation confronts the opioid epidemic, which impacts more than 20 million Americans aged 12 and over[1], behavioral health has come under heavy fire. The sheer size of the epidemic, which claimed 174 lives each day in 2016[2], overwhelms current delivery models of care, and has prompted the search for alternatives. mHealth, or the practice of medicine and public health supported by mobile devices, is stepping forward to help combat the epidemic, not as an alternative to traditional models, but to extend their reach and provide a new dimension of support for patients in recovery.

Yet as the battlefront shifts, and the stakes grow ever higher, many are beginning to realize that traditional approaches may be insufficient. New research has provided some alternatives. A multi-pronged, evidence-based approach that extends traditional treatment methods with computerized versions, and combines them with mHealth solutions and Medication Assisted Therapy (MAT), shows great promise for what has become one of America’s greatest health crises.

Cognitive Behavioral Therapy

Cognitive behavioral therapy has long been considered the foundational treatment method for substance use disorder, including opioid abuse. Developed by psychiatrist Dr. Aaron T. Beck in the 1960s to treat depression[3], CBT is based on the theory that “maladaptive” behavioral patterns like substance abuse can be improved by learning to identify and correct problematic behaviors with the application of a range of different skills to stop drug abuse, and to address the range of other problems that often arise with the drug abuse itself.[4] CBT is preferred by clinicians as a primary counseling tool for treating SUD.[5]

mHealth solutions, including computerized CBT

CBT, primarily delivered via one-on-one counseling sessions with a qualified therapist, has its limits. Individual therapeutic treatment, via inpatient or community setting can be costly and difficult to find, especially if the patient lives outside a major metropolitan area.

In addition to access, how CBT is used in a clinical setting varies widely. Even with a plethora of training manuals, videotapes and other methods of instruction, there is no standardized means to train therapists in CBT practice so treatment is not consistent.

Whether it’s CBT or any other counseling orientation, performance monitoring, tracking and assessment in clinical practice is relatively low. With the opioid epidemic raging, relying solely on clinical settings to contain the epidemic isn’t a fair fight. To re-assemble broken lives, new treatment methods, propelled by technology, help improve the odds for recovery.

Computerized CBT modules, used as extensions of clinician-provided CBT, or in conjunction with Medication Aided Treatment (MAT) provide standardized CBT in a flexible, consistent delivery model. A wide range of studies have shown an improvement in terms of greater patient engagement, and longer-term sustainable recovery.

In 2014, the National Institute on Drug Abuse pointed to computer-based training for CBT as showing “promise in previous studies with various substance use disorders.” At the same time, a new clinical trial at Yale University School of Medicine showed how effective computer-based CBT could be as an addition to treatment for cocaine-dependent individuals receiving methadone treatment.[6]

In tandem with computerized CBT and MAT, emerging mHealth solutions surround the SUD patient with care when and where they need it. The combination provides continuous addiction treatment similar to an inpatient program. mHealth helps bridge the challenges of remoteness and, especially for those who may be alienated from their old social network, provides an opportunity to connect with others trying to envision a life without addiction. mHealth might include apps that connect patients and caregivers 24 hours a day, 7 days a week, as well as enable peer recovery networks to develop to offer mutual support.

To sustain recovery, SUD patients need a continuum of services and support that don’t end when they leave the treatment facility—if they ever arrive there in the first place. The range of mHealth solutions that combine the best of traditional and innovative approaches shows promise that long-term recovery is possible and sustainable for patients struggling with addiction.

[1] https://americanaddictioncenters.org/rehab-guide/addiction-statistics/

[2] http://www.addictionpolicy.org/single-post/2017/12/21/174-a-Day-Understanding-the-Numbers

[3] https://beckinstitute.org/about-beck/our-history/history-of-cognitive-therapy/

[4] https://www.drugabuse.gov/publications/principles-drug-addiction-treatment-research-based-guide-third-edition/evidence-based-approaches-to-drug-addiction-treatment/behavioral

[5] Ball et al, Substance Abuse Treatment, 2002.

[6]https://news.yale.edu/2018/05/29/online-program-outperforms-standard-addiction-treatment