Addiction Recovery Specialists Find Unexpected Advantages to Using Telehealth

Healthcare providers who focus on substance abuse and addiction recovery services are learning to use telehealth to improve access to care during a pandemic. Many are finding advantages to virtual care that they hadn’t expected.

At the University of Alabama in Birmingham (UAB), providers in the UAB Medicine Addiction Recovery Program turned to Zoom to continue personalized and group treatment and support programs, helping both patients and their families access virtual care and resources.

“Addiction is already a very isolating disease,” ARP Director Bronwyn McInturff, MSW, says in a news release recently posted by UAB. “Because of that, a large part of recovery involves reestablishing and maintaining connections with others. What we faced with COVID was an almost immediate move to isolation for everyone. This created a huge obstacle for people who wanted to begin or continue recovery. Most people can relate on some level to the problems of isolation due to COVID. But for people with substance use disorders, that kind of ongoing isolation has far higher stakes. It can be deadly.” 

UAB’s experiences mirror those faced by providers across the country, if not the world. In-person treatment was reduced or eliminated by the threat of COVID-19. Many saw attendance in therapy sessions decline, alongside reports of increased overdoses and risky behaviors by people on the brink of becoming addicted.

In response to those concerns, federal and state regulators expanded coverage for telehealth and mHealth services and enabled more care providers to use those platforms during the pandemic. Some studies have reported that more people were accessing telehealth during the height of the pandemic for mental or behavioral health services that for any other type of care.

But for a branch of healthcare accustomed to in-person sessions, the shift to virtual took some getting used to.

“We did a lot of coaching of those who were not used to this kind of communication, and they took to it quickly,” McInturff says. “As providers, we had to figure out ways to make videoconferencing as personally connective as possible, or at least more intimate than it might be for business meetings or presentations. We break out from the larger meetings into smaller groups, and we sometimes use visual aids to compensate for the lack of body language and cues that you have with in-person meetings. The main success is that we are providing the support networks you need in recovery, even if right now they are virtual networks.”

Many providers have said the shift to online session gives them the opportunity to reach more people, such as those who can’t travel to treatment or who are reluctant to seek help. The platform also gives them a chance to schedule treatments that fit better into people’s daily lives, and to react more quickly to help those in distress.

“We had to adjust some of our timeframes,” McInturff says in the news release. “It’s hard to sustain all-day meetings for hours and hours via technology. We moved services that meet three days, all day — for example — to every Monday at noon. What we discovered is that our no-show rate has dropped to almost nothing. Family therapy is often limited by work schedules, and most people can’t show up every day to support a family member who is in recovery. But with videoconferencing, we’ve seen an increase in family participation. That’s definitely been a win.”

And as they’ve become comfortable with using telehealth, providers are learning that an audio-visual connection can have its advantages.

“We’ve learned a few small but different ways to assess progress,” McInturff says. “We have videoconferencing guidelines, so that everyone keeps their cameras on, keeps the sound adjusted and makes sure the camera is aimed properly. Not doing so can sometimes signal that a patient may not be doing well or isn’t fully engaged with the program. We look for those signals to assess the level at which anyone is committed to recovery. We might have someone who wears certain clothing, such as a hoodie, to hide reactions, or may not look directly into a camera in the early stages. As they became more open and stop those behaviors, we can measure that progress. All of those small details were advantages we didn’t know videoconferencing would provide when we first decided to use it.”

As the nation works its way past the pandemic, healthcare providers and patients are looking toward a future that integrates in-person and virtual care.  And telehealth advocates and lawmakers are looking to improve coverage and access laws to make that happen.