New Study Offers Mixed Results for Telehealth in Addiction Treatment

The American Psychiatric Association is tapping the brakes a little bit on the use of telehealth for addiction treatment, saying the potential is there but more proof is needed that virtual care improves retention or outcomes.

Healthcare providers specializing in addiction treatment pivoted to telehealth in record numbers during the pandemic, when in-person treatments were curtailed or postponed and stress and anxiety soared. Recent research by the University of California at Los Angeles and research firm RTI International found that while the platform vastly improved access to care, it hasn’t yet delivered better clinical outcomes than in-person treatment.

“Telehealth health may allow patients to more easily begin and stay in addiction treatment, which has been a longstanding challenge,” Tami L. Mark, PhD, MBA, a senior fellow at Maryland-based RTI International and the lead author of the study, published online this month in Psychiatric Services, said in a press release issued by the American Psychiatric Association. “However, research is needed to confirm this benefit. As providers pivot to hybrid telehealth models - offering both telehealth and in-person treatment - they need information to help target telehealth to the most appropriate services and patients.”

“This research underscores the importance of offering telehealth for addiction treatment and the dramatic need to conduct more empirical work to test out the concerns regarding telehealth articulated by agency staff and on surveys,” added Lisa Dixon, MD, MPH, the editor of Psychiatric Services, the journal of the APA.

The research – and the reaction to it – says a lot about how connected health platforms and tools are viewed by those in substance abuse and addiction treatment circles. Some are hailing the results as a “game-changer” in that they’ve proven that telehealth can improve access to treatment, especially for those who face barriers to in-person care. But many providers – and especially payers - want more proof that telehealth can keep more people in treatment programs and can improve clinical outcomes.

The study by Mark and her colleagues was split into two parts. In the first part, they evaluated the results of eight published studies that compared telehealth to in-person treatment. Seven of those studies saw no difference in retention or outcomes between the two, while the eighth, out of Canada, saw improved retention rates through a telehealth-based methadone treatment program.

The researchers then conducted an online survey of treatment centers, providers and other stakeholders in California. The survey found that providers were evenly split on the value of telehealth for one-on-one counseling, but more (49 percent to 40 percent) said it was less effective for intake processing and a large majority (62 percent to 25 percent) said it was less effective for group counseling.

The respondents said telehealth did offer an opportunity to observe patients in their home setting and with family members, and it reduced the time and cost of participating in treatment, but they also said these treatment often rely on a connectedness that can’t be duplicated by virtual visits. They also noted the challenges by patients in accessing telehealth technology, including cost and digital literacy.

The study’s results pointed toward a platform that offers in-person and virtual services, depending on the patient.

“Providers in our study noted that the relative benefit of telehealth depended on a client’s circumstances and stage of treatment,” the study reported. “New patients, patients who are homeless, patients who are isolated, patients who are not comfortable using technology, patients with attention challenges, and patients without private spaces to talk may be better suited to in-person treatment. Conversely, patients with young children, patients who find it difficult to take time off and travel to appointments, and patients who prefer meeting online may benefit from telehealth treatment. There also may be times during treatment when the ability to observe the patient in person to better monitor symptoms and build rapport outweighs the convenience of remote treatment. These factors point to the benefits of a hybrid approach comprising both telehealth and in-person addiction treatment.”

The study concluded that more research is needed to prove the value of telehealth in addiction treatment. That’s important, because while providers are going to use telehealth more often in the future to connect with and treat patients, how far they go will depend on support from payers – especially the Centers for Medicare & Medicaid Services. CMS and others might loosen the regulations to improve access to care, but they’ll only improve reimbursement once telehealth has been proven to improve outcomes and reduce healthcare costs. That’s when the game will really change.