The global pandemic has meant a major shift in medical care with more physicians and patients turning to telemedicine for treatment of non-urgent conditions.
In the last 18 months, telemedicine has been used for much more than simple check-ins with the primary care physician, it’s now being used to help with addiction treatment via virtual rehabs.
When you hear the term “rehab,” you may picture clinics where people with addiction go to remove themselves from triggers and focus their energy on 24/7 care and recovery.
But with the rise of telemedicine has come the introduction of telehealth centers that focus specifically on addiction.
With virtual rehabs, patients who live with addiction dial into secure platforms to access their treatment, therapists, group sessions, and other types of recovery treatment — all from the comfort of their own homes.
An estimated 20 million people over age 12 in the United States have a substance use disorder, according to a 2019 survey from the Substance Abuse and Mental Health Services Administration. About 4.2 million people get help in a given year.
“Teletherapy, telehealth, and other methods of providing addiction treatment via virtual means have been very successful, and much of the efficacy of this method was highlighted during the pandemic,” explained Dr. Lawrence Weinstein, chief medical officer at American Addiction Centers.
“Treatment in a virtual manner, as expected when factors of time and distance are eliminated, increases the reach and availability of addiction services to those who may face challenges in accessing them — like those who reside in rural areas, which have increasing rates of methamphetamine, opioid, and alcohol addiction.”
For many people living with addiction, working through substance use disorders virtually can be a welcome change of pace compared with other types of intensive, in-person treatment.
However, other people may ask: Can a virtual rehab really work, and what exactly does it involve?
The COVID-19 pandemic drove the demand for telehealth in 2020, but experts say that telehealth will likely become a permanent fixture in both the tech and healthcare landscapes.
In fact, global venture capital funding for digital health companies hit a record $15 billion in the first half of 2021, according to a report by Mercom Capital Group.
“Research on telehealth use conducted during the pandemic showed that there was a 1400-percent increase in substance use care in telehealth,” said Weinstein.
“Additionally, a survey found that 81 percent of addiction treatment providers in California said that telemedicine use had increased since stay-at-home orders, and 78 percent said that telemedicine had moderately or completely addressed barriers to treatment.”
One of the biggest virtual rehab companies is Lionrock Recovery. Licensed in 47 states, they’ve been providing private treatment to thousands of people through video conferencing technology.
Now other virtual rehabs are cropping up. The new startup company Quit Genius recently raised $64 million for its telehealth addiction treatment.
While every program is different, the concept remains the same. People who are living with addiction can access recovery treatment and counseling from the privacy of their own homes.
Lionrock, for example, begins its treatment with a deep assessment, which is performed by a client’s primary counselor. These counselors are licensed master-level and PhD-level psychotherapists.
The counselors gain an understanding of each client’s situation through an assessment. Once concerns and problem areas are addressed, the counselor and client develop specific goals together.
This assessment helps the psychotherapist make a diagnosis that will guide the treatment plan.
“Depending on all of this, a client might start treatment at the intensive outpatient (IOP) level of care and 6 to 8 weeks later step down to outpatient care, spending 12 to 14 weeks total on this phase of recovery,” explained Peter Loeb, co-founder of Lionrock.
“At the IOP level of care, clients meet in group sessions three times each week, each session lasting 3 hours. They meet with their primary counselor once weekly in individual sessions, during which they mark progress against treatment plan goals, and work on issues more appropriate for individual sessions than group sessions.”
Titus Gardner, a current client with the Lionrock program, has been sharing his experience on Instagram to help people who may be hesitant about virtual rehab.
“I was admitted into the online intensive outpatient treatment program, which was 100 percent virtual through Zoom video conferencing,” said Gardner. “This included my group and one-on-one therapy sessions.”
Gardner said that the program required 44 hours per month for 12 weeks. His sessions took place 3 days per week, with a one-on-one, hour-long session with his therapist on Saturdays.
After this phase, Lionrock recommends that clients continue with mutual support groups, whether it be Lionrock’s own CommUnity format, or more traditional formats like the 12-step programs of Alcoholics Anonymous.
“Substance use disorders are chronic disorders, and while the first phase of recovery — treatment — is an excellent way to get started building a life in recovery, recovery is a lifestyle and one that benefits greatly from ongoing support,” said Loeb.
Outside experts say virtual rehabs can be a helpful addition to treat addiction.
“The answer is yes. They can work. I have seen them help, and I know they work,” said Dr. Scott Krakower, a psychiatrist at Zucker Hillside Hospital in New York.
“It provides many advantages, especially for people who are afraid of going into [inpatient programs] and mixing with other people. People who are worried about the stigma or want things to be kept more anonymous feel better than ever after virtual rehab.”
Krakower pointed out that for some people, virtual rehab won’t be as helpful as inpatient treatment. He explained the lack of in-person experience may make virtual rehab feel like parts of the puzzle are missing — that it may not be the same experience without the group setting.
Weinstein said that the pandemic has revealed how much can be done by trying out new ways of approaching addiction treatment.
“The last year has shown that amending certain guidelines, regulatory requirements and other necessary interventions can result in a greater number of people with the disease of addiction receiving the help they need,” said Weinstein.
“While the parameters of virtual addiction treatment need further revision, the pandemic has shown that this is a viable and effective method of treatment delivery.”
One of the most glaring differences between telehealth rehab and inpatient rehab is the absence of the 24/7 monitoring, which may be helpful for some clients but a deterrent to others.
How do virtual rehabs ensure accountability for patients and maximize success, without having the patient under supervision in a controlled environment?
Loeb says that, whether in an inpatient facility or via virtual treatment, the successes are highly dependent on each individual and that they have to commit to all aspects of treatment. He added that they do use some testing when treating people for substance use.
“About a decade ago, we created processes to hold clients accountable for abstinence, when that is the goal, though the use of oral swab tests, which are performed randomly by clients live in video conference with their counselors,” Loeb said.
“By social convention, we cannot watch clients perform urine tests, and thus we have developed processes that ensure the integrity of tests that use oral swabs, rather than urine.”
Twelve-step programs and substance use disorder treatment are different things, though they can complement each other.
“Participation in a 12-step program does not include professional-led therapy sessions, assessments, diagnosis, treatment plans, or therapy protocols like CBT, DBT, or Motivational Interviewing, or Medication-Assisted Treatment drugs,” said Loeb.
“Professional [substance use disorder] treatment provides people seeking a life in recovery with a deep understanding of their unique challenges and a rich set of tools for managing them.”
Telehealth can provide additional levels of privacy and flexibility, which can draw certain people to the treatment, especially if it’s early on in the progression of the addiction.
“As with any healthcare problem, early intervention generates better outcomes,” said Loeb.
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