Veterans’ telehealth use for alcohol use disorder varies across groups

Though telehealth supported alcohol use disorder (AUD) treatment delivery among veterans, telehealth use varied among demographic groups, suggesting the need for multiple telehealth options, new research reveals.

The study published in the journal Alcohol, Clinical & Experimental Research examined characteristics associated with telehealth use among Veterans Health Administration (VHA) patients receiving AUD treatment.

AUD is prevalent across the United States. Data from the National Institute on Alcohol Abuse and Alcoholism shows that 29.5 million people ages 12 and older were battling the disease in 2022. However, only 2.2 million people of this population received treatment. The problem is magnified among US veterans. According to a study published in May 2023, more than one in four veterans consumed alcohol at the at-risk-to-excessive level between 2011 and 2021.

The new study notes that AUD treatment typically includes psychotherapy and medications. Thus, the researchers set out to investigate whether telehealth could effectively deliver AUD psychotherapy and medication-based treatment.

They conducted a retrospective cohort study using EHR data from the VHA Corporate Data Warehouse. The study cohort included patients 18 or older with an AUD diagnosis in the year before or during March 1, 2020, through February 28, 2021.

Of 138,473 VHA patients who received any AUD treatment during the study period, 52.8 percent received one or more video visits, 38.2 percent received one or more telephone visits but no video visits, and 9.1 percent received only in-person care.

Researchers found that any telehealth-based AUD treatment was associated with a greater number of psychotherapy visits and a greater number of AUD medication coverage days compared to in-person care.

However, the study also shows differences in patient characteristics among those receiving telehealth-based treatment and those opting for in-person care.

AUD patients who received treatment via telehealth were more often younger, female, White, Hispanic, living in an urban area, and had co-existing mental health issues like depression or anxiety. On the other hand, those participating only in in-person visits were more often older, male, Black, non-Hispanic, rural, homeless, and had an opioid use disorder.

Not only that, but telehealth modality also varied across groups. Video visits were more common among patients who were younger, female, White, Hispanic, urban, and had co-morbid depression or anxiety. Conversely, patients more likely to engage in audio-only telehealth visits were older, male, Black, non-Hispanic, rural, homeless, and had opioid use disorder.

“Additional efforts to increase the engagement of certain VHA patient groups in telehealth use should be made, given its association with receiving more AUD treatment,” researchers concluded.

Telehealth is proving effective at extending treatment for substance use disorders among veterans.

A study published in 2022 revealed that telehealth visits for opioid use disorder (OUD) treatment among veterans during the COVID-19 pandemic skyrocketed. Researchers examined veterans’ access to buprenorphine treatment for OUD in the year before the pandemic (March 2019 to February 2020) and during the first year of the pandemic (March 2020 to February 2021).

The study shows that among patients receiving a buprenorphine treatment visit each month, the proportion of telehealth visits increased dramatically from 11.9 percent in March 2019 to 82.6 percent in February 2021.

However, unlike telehealth-based care for AUD, audio-only visits accounted for 50 percent of veteran visits relating to buprenorphine treatment for OUD in February 2021, far above the 32 percent of video visits and 17 percent of in-person visits. Further, among 4,720 patients newly initiating buprenorphine in the one year after the start of the pandemic, 64.4 percent received audio-only visits.