Telehealth Services for Substance Use Disorders During the COVID-19 Pandemic: Longitudinal Assessment of Intensive Outpatient Programming and Data Collection Practices

Abstract

Background The onset of the COVID-19 pandemic necessitated the rapid transition of many types of substance use disorder (SUD) treatments to telehealth formats, despite limited information about what makes treatment effective in this novel format. Objective This study aims to examine the feasibility and effectiveness of virtual intensive outpatient programming (IOP) treatment for SUD in the context of a global pandemic, while considering the unique challenges posed to data collection during an unprecedented public health crisis. Methods The study is based on a longitudinal study with a baseline sample of 3642 patients who enrolled in intensive outpatient addiction treatment (in-person, hybrid, or virtual care) from January 2020 to March 2021 at a large substance use treatment center in the United States. The analytical sample consisted of patients who completed the 3-month postdischarge outcome survey as part of routine outcome monitoring (n=1060, 29.1% response rate). Results No significant differences were detected by delivery format in continuous abstinence (χ22=0.4, P=.81), overall quality of life (F2,826=2.06, P=.13), financial well-being (F2,767=2.30, P=.10), psychological well-being (F2,918=0.72, P=.49), and confidence in one’s ability to stay sober (F2,941=0.21, P=.81). Individuals in hybrid programming were more likely to report a higher level of general health than those in virtual IOP (F2,917=4.19, P=.01). Conclusions Virtual outpatient care for the treatment of SUD is a feasible alternative to in-person-only programming, leading to similar self-reported outcomes at 3 months postdischarge. Given the many obstacles presented throughout data collection during a pandemic, further research is needed to better understand under what conditions telehealth is an acceptable alternative to in-person care.

Substance Use Disorders in the Geriatric Population: a Review and Synthesis of the Literature of a Growing Problem in a Growing Population

“…To counteract this, there has been a dramatic increase in telehealth availability, particularly in the treatment of SUDs [ 78 ]. Studies have shown virtual outpatient care for the treatment of SUD to be a feasible alternative to in-person-only programming [ 79 ]. However, access to these virtual programs can be limited by advanced age as older adults might have limited computer literacy, limited access to internet and technology, or hearing loss.…”

The Efficacy of Telepsychiatry in Addiction Patients: A Systematic Review

“…Four of the seven included publications dealt with opioid use disorder, another dealt with alcoholism, one dealt with tobacco, and the final one was on SUD. A longitudinal research conducted between January 2020 and March 2021 on 3642 patients with SUD found no significant differences in continuous abstinence, overall quality of life, financial well-being, psychological well-being, and confidence in one's ability to stay sober when treated by various health formats like in-person care only (n=957, 26.3%), hybrid, in-person and virtual care (n=541, 14.9%), and virtuosic care (n=2144, 58.9%) [15]. This study shows telepsychiatry is equally effective in the treatment and prognosis of SUD patients when compared to in-person treatment.…”

“…The overall studies, when combined, gave an overview that telepsychiatry/telemedicine treatment in the prognosis of addiction patients is similar to in-person treatment [15,17,[19][20][21]. In contrast, two studies have mentioned that telepsychiatry, combined with in-person treatment, produced higher retention rates and decreased premature dropouts [16,18].…”

The Evolution of Telepsychiatry for Substance Use Disorders During COVID-19: a Narrative Review

“…Another meta-analysis of 20 studies representing 1418 participants found no meaningful difference between those receiving internet-based CBT to face-to-face treatment (SMD 0.05 (95% CI − 0.09–0.20)). Simultaneously, a longitudinal study following 1060 patients in intensive outpatient addiction treatment in the USA found no significant differences in delivery format ( χ 2 = 0.4, p = 0.81), overall quality of life ( F = 2.06, p = 0.13), psychological well-being ( F = 0.72, p = 0.49), financial well-being ( F = 2.30, p = 0.10), and the patient’s confidence to stay sober between patients receiving virtual outpatient programming treatment for SUD as opposed to in-person ( F = 0.21, p = 0.81) [ 32 •]. In another narrative review, 7 out of 8 included studies comparing virtual and in-person provision of addiction treatment showed that telehealth was as effective but not better than in-person treatment in terms of retention, therapeutic alliance, and substance use [ 16 ].…”

“…As telehealth may not be suitable for all medication types for OUD patient, it is recommended that a hybrid care delivery model is developed that can manage both patient and provider needs [ 47 ]. Patients in hybrid in-person/virtual programs reported higher levels of general health than those in entirely virtual intensive outpatient programming treatment for SUD [ 32 •]. Hybrid delivery systems may offer flexibility and effectiveness in many circumstances.…”