By Hans Morefield, CEO of CHESS Health
Across the world, social distancing and local lockdowns have disrupted the treatment of, and recovery from, substance use disorder (SUD). There is a troubling uptick in opioid use during the COVID-19 pandemic in some regions of the country. Individuals cannot get to counseling or community support groups because in-person meetings have been canceled. They also are finding it difficult to get drug tested and to renew or refill medications. When much-needed treatment and support are less available, the challenge of sustaining recovery is harder. Social isolation increases the risk of relapse, as does heightened stress and uncertainties of economic pressures caused by the pandemic. If we do not address the treatment and recovery challenges of those with SUD, we may find ourselves amidst a worsening addiction epidemic once the pandemic has waned.
Telehealth goes only so far
As soon as lockdowns were implemented, SUD treatment providers quickly turned to telehealth, many for the first time. Video calls using Zoom and other tools enabled one-to-one counseling, group meetings, and, in some places, AA/NA meetings, to resume. We are fortunate this technology is now available, easily accessible and relatively inexpensive. As recently as three years ago, the industry would not have been as prepared.
Nevertheless, telehealth is no panacea. One of the challenges for SUD providers is that it is difficult to screen patients for signs of substance use before sessions. Group meetings are particularly challenging, as video conferencing can make personal engagement and cohesive discussions more difficult. Not all patients are comfortable with telehealth or using digital technology. Those who live within close quarters with others may find privacy difficult to come by. To achieve the best possible outcomes through therapy and support, SUD patients must feel comfortable and safe sharing their issues.
Telehealth is just one of several digital tools needed—tools that should be part of a more comprehensive, integrated digital care platform that:
- Supports the patient from inpatient through recovery
- Educates and supports family of the patient with SUD
- Facilitates and encourages early prevention
Comprehensive approach to leveraging tech in recovery
In 2010, Dave Gustafson, PhD, of the University of Wisconsin, recognized that smartphone apps could be leveraged to support SUD recovery, reduce relapse and enhance success by providing 24/7 access to support. This is of critical importance because, for many patients, a few hours of treatment a week is not enough, especially for those in early recovery who may experience doubt or weakness in their ability to succeed.
Today, deploying a digital strategy is much easier since nearly 90% of adults between the ages of 18 and 65 have a smartphone. In the U.S., entire states have made recovery apps available to their citizens with SUD as a way to keep them connected with providers and other recovery organizations.
While many SUD apps are available, not all are integrated into a full digital care platform that stays with the patient from inpatient to partial hospitalization (PHP) to intensive outpatient programs (IOP) and continued recovery at home. Transitions between these settings are where many patients fall through the cracks. To be more effective, digital tools such as smartphone apps need to follow the patient throughout the entire continuum of care. For instance, text reminders have been found to be an effective way to ensure SUD patients keep their appointments and maintain adherence to care plans. In one study, patients who chose not to receive text reminders attended 56% fewer treatment days. Another study revealed that a mobile-phone intervention strategy can be effective in helping improve patient motivation and that “regularly reminding patients of their short-term life goals resulted in higher likelihood of SUD treatment initiation and appointment adherence.”
Digital tools for the family
Addiction is a disease that impacts not just patients themselves, but also their families. Research shows that family members often suffer anxiety, anger, embarrassment and guilt, as well as economic consequences. Depending on the individual’s relationship with the person living with SUD, some family members may, unknowingly, even act as an enabler. In reality, families need help in recovering too and should be a part of the patient’s integrated program. There are digital tools to help family members better understand their role in their loved one’s recovery, as well as the situation’s impact on their own health. Digital tools can also enhance the effectiveness of support groups like Al-Anon by providing resources like individual coaching, group support and education right in the palm of their hand, 24/7.
Digital prevention tools
While treatment and recovery have been the primary focus for addressing the epidemic of substance use, prevention is, of course, ultimately the best solution. For more than a decade, there has been an effort to screen for substance use in primary care and other settings, including schools. For those identified to be at risk of developing SUD, the screener, usually a clinician, delivers a brief verbal intervention. The most common such clinical practice is called SBIRT (Screening, Brief Intervention, Referral to Treatment). Because of the manual nature of SBIRT, there is significant variation in the quality of the interventions. Too often, the clinician is not fully engaged, resulting in an intervention process that is far too brief to capture an adequate level of information to make an informed clinical decision on next steps.
From prevention to treatment to long-term recovery, an integrated digital strategy is a new imperative. In an age where nearly everyone has a digital device at their fingertips, SUD providers would be remiss in overlooking this opportunity. With a relatively small investment, they could leverage a fully integrated digital platform with tools that deliver critical new capabilities towards treating addiction and diminishing its toll on our communities.