Tele-treatment for substance use disorders
Substance use disorders impact a significant number of individuals, families, and communities.
When used in combination with other treatment methods, telebehavioral health interventions can be part of an integrated approach to treating substance use disorders. These interventions can include screening and diagnosis, online counseling, consults for prescriptions, and individual and group talk therapy. Treating substance use disorders via telehealth requires expertise and training in addiction care.
Benefits of substance use disorder tele-treatment
- Shorter wait times. This means faster access to care and prescriptions.
- Increased privacy. Patients can get care from their home without going to a public place like a clinic.
- Reduced stigma. Patients have access to providers who understand substance use disorder and are not judgmental.
- Continuity of care. Patients can continue treatment with their regular therapist or provider while receiving at home or in-person treatment.
- Home environment. Providers get more insight into the patient’s condition by observing the patient’s home or where they live.
- Digital tools. Apps and text messaging can supplement treatment plans by providing immediate support to cope with low-grade cravings.
Considerations for telehealth substance use treatment
- Use SBIRT. SBIRT stands for “screening, brief intervention, and referral to treatment,” and is a common way to assess a patient’s needs to determine and, if necessary, refer the patient for treatment for a substance use disorder.
- Familiarize yourself with medication-assisted treatment (MAT) and medication for opioid use disorder (MOUD) models. Medication-assisted treatment is an evidence-based approach that combines behavioral counseling or talk therapy with the use of prescription drugs to curb opioid or alcohol cravings. Medication for opioid use disorder is a treatment approach that focuses on the use of prescription medications without behavioral health therapy to treat patients with an opioid use disorder.
- Aim for integrated care. Coordinating primary care with behavioral health increases access and improves care coordination. Integrated care often combines in-person treatment with telehealth.
- Recognize individuality. Tailor and integrate your treatment approach to meet the needs and preferences of your patient.
- Reduce Stigma. Discrimination and judgment are major barriers to patients seeking treatment. Remember that substance use disorder is a health condition and the words you use and how you communicate with your patient will impact the effectiveness of treatment.
- Be conscious of language and educational barriers to accessing care. Offer materials accessible in different formats and multiple languages. Use both images and words in your materials to address different patient literacy levels.
- Prioritize patient monitoring. As with any vulnerable patient in your practice, conduct a suicide screen at every contact for those at elevated risk. There are a number of suicide prevention methods that can be used if a patient is at risk of suicide.
- Review rules and regulations for prescribing controlled substances via telehealth. Make sure you follow the correct steps and comply with the appropriate laws to prescribe suboxone or other drugs, which are commonly used to treat opioid dependence. Identify vendors and local sites for patient drug testing as needed.
- Hire support staff. Some patients with substance use disorder may not have access to a phone or a personal computer. Support staff such as case managers can provide more hands-on help such as calling in prescriptions and connecting patients to treatment centers and social services.
- Focus on long-term, continued treatment. Get permission to continue follow-up contact with your patients. Schedule the next session before ending each telehealth appointment, if possible.
More information on telehealth for substance use disorders
- Coalition Webinar - Telehealth and Substance Abuse (video) — from the National Consortium of Telehealth Resource Centers
- Telehealth Models — from the Rural Health Information Hub
- Barriers & Challenges to FQHC Use of Telehealth for Substance Use Disorder (PDF) — from the National Policy Center - Center for Connected Health Policy
- How to Prescribe Controlled Substance to Patient During the COVID-19 Public Health Emergency (PDF) — from the Drug Enforcement Administration
- Medication Assisted Treatment (MAT) and TeleMAT Standards — from the Mid-Atlantic Telehealth Resource Center
University of Maryland, Baltimore Mobile-Care-Unit
The University of Maryland, Baltimore’s Department of Psychiatry developed an RV mobile-care-unit. It provides mental health and substance abuse services to underserved and remote communities in and around eastern Maryland. The unit serves 15 to 30 patients a day and focuses on medication-assisted-treatment delivered in person and via telemedicine. To reduce barriers to care, the unit accepts walk-in patients and travels to different locations each week to reach patients who may not have access to reliable transportation. Read more on the University of Maryland, Baltimore’s Mobile-Care-Unit.