Butler Center for Research | December 2018 Download the Using Telehealth for Addiction Treatment Research Update Telehealth involves the use of technologies such as telephone-based services, videoconferencing, texting, smartphone applications and web-based tools to provide care over a distance without requiring patients to travel to a clinic or provider's office. For some, the term telemedicine is considered the clinical use of technology while telehealth refers to a more widespread approach that includes products or services aimed directly at consumers. More recently, these terms are used interchangeably. Telehealth Applications for Substance Use Disorders A variety of electronic delivery methods are increasing the use of telehealth in addiction treatment and recovery including: Telephone-based support: One of the earliest methods of delivering telehealth services, telephone-based care has been used to provide continuing care for substance use disorders.1, 2 Study results for telephone-based continuing care generally show better results than traditional continuing care.3, 4 Videoconferencing: Videoconferencing occurs through secure portals on personal computers or dedicated telemedicine equipment. Studies on videoconferencing for addiction services have found equivalent results and patient satisfaction compared with care provided in person or by video.5, 6 Meta-analyses of videoconferencing for psychiatry services have found similar positive results.7, 8 Texting: Texting is the transmission of short electronic messages between mobile devices. Positive results have been attributed to texting interventions using mobile device apps.9 Text messaging-based addiction treatment is inexpensive and has the potential to be widely accessible in real time.10 Mobile apps: A mobile app is a software application developed specifically for use on computing devices such as smartphones and tablets. An early analysis that examined several studies on mobile device use in overall health care determined it is too early to generalize the effectiveness of this technology.9 However, research on one smartphone app found reduced risky drinking days and higher abstinence rates than usual care.11 Research on another mobile app showed reduced hazardous drinking days and drinks per day.12 Web-based treatment supports: Patients access web-based services over a network connection. These applications are typically "asynchronous," meaning that people can access them any time, at their convenience. Overall, web-based telemedicine services have been found to be more effective at reducing alcohol consumed per week than comparison conditions.13, 14 For web-based alcohol screening, assessment, and feedback or brief intervention, the Drinker's Check-Up (DCU) has demonstrated positive results in several clinical trials.15, 16 The Therapeutic Education System (TES) is a web-based substance-use disorder (SUD) treatment consisting of 65 modules based on the Community Reinforcement Approach (CRA). Studies are showing that TES results are comparable to those for the CRA delivered in person by highly trained clinicians.17, 18 Another web-based treatment approach that has been examined in research studies is Computer-Based Treatment for Cognitive Behavioral Therapy (CBT4CBT). Research has shown positive outcomes for CBT4CBT compared to treatment as usual or treatment provided solely by clinicians.19 Virtual reality: Virtual reality allows an individual to explore and interact with a computer-generated experience that simulates a real-life environment. Research using virtual reality has shown that drug-dependent people react with strong cravings to specific cues (e.g., cigarette packs, liquor bottles) as well as environments or settings (e.g., bar, party) that are associated with drug use.20 The ability to bring forth feelings of cravings could mean that virtual reality has the potential to be successfully used in treatment, though this has not yet been rigorously demonstrated.21 Use of Telehealth in Behavioral Health Settings Research that assessed the interest in and use of 11 telemedicine applications in a sample of 363 substance use disorders organizations in the United States found that the top three self-reported telemedicine applications being used were (1) computerized screening/assessment (44.6%), (2) telephone-based recovery supports (29.5%) and (3) telephone-based therapy (28.37%).22 The same study found that the greatest gaps between interest and actual use were for (1) texting appointment reminders (55.2% differential), (2) mobile apps for posttreatment recovery (46.6% differential) and (3) recovery support chats (46.6% differential).22 To understand the utilization of telehealth among behavioral health providers, data were collected from 329 behavioral health provider organizations representing all 50 states. Nearly half of the respondents (48%) reported that they used telehealth for behavioral health services.23 The most common type of telehealth format was direct videoconferencing.23 Psychiatrists were the most common behavioral health professionals to use telehealth, followed by mental health counselors.23 Benefits and Disadvantages of Telehealth The chronic nature of substance use disorders calls for methods for clinicians to stay connected with patients over extended periods of time.24 Telemedicine can increase access to addiction treatment services by removing the barriers of geography and stigma.25 Data analyzed from state Medicaid programs revealed psychiatrists to be the behavioral health provider most commonly authorized to perform telehealth, followed by social workers and then psychologists, with addiction counselors being the least likely to have authorization.26 This low representation of addiction counselors may be due to the variety of licensing tracks required and the several levels of credentials existing in each state.26 Despite having great potential for assisting recovery and treating patients with substance use disorders, telemedicine is underutilized in addiction treatment centers.22 Telemedicine is an attractive option despite the existence of potential barriers to implementation, including legal issues, financial aspects, patient privacy and health information protection.27 Conclusion The prevailing format of SUD treatment is via face-to-face therapy sessions that may be provided in combination with SUD pharmacotherapies. Telemedicine applications can potentially broaden access to addiction and recovery information, services and support.