Telemedicine for preventing substance abuse: What really works.
Written By: Jen Renae
When most people think of treatment for substance dependency, they imagine checking into rehab, going to an AA meeting, or visiting a therapist in-person to taper down from addicting medications. At first glance, telemedicine — treatment done over the phone or computer while the patient stays home — might seem like the opposite of that approach. But telemedicine can actually be very effective in treating medication dependency, an often-overlooked form of substance dependency. When done well, telemedicine offers many of the benefits of in-patient care — like real-time support — and avoids some of the drawbacks.
While the coronavirus and the ongoing crisis of police violence are dominating the headlines right now, the opioid crisis hasn’t gone away. If anything, the pandemic is increasing the risk for many patients, who are struggling with anxiety about their health and may be attempting to delay needed care to avoid exposure to the virus.
Every year, 50 million people are prescribed opioids, and 10 million are prescribed Benzodiazepines. Even a short period of opioid use comes with a high risk of long-term dependence: 60% of patients who use opioids for 90 days after surgery will become dependent, as will 70% of patients who regularly use opioids for pain before surgery. The risk is compounded because doctors typically aren’t trained in how to safely taper patients from these medications, and often don’t warn patients of the risks.
The risks of benzodiazepines like Xanax, Ativan, or Valium are less well-known than the risks of opioids, but they can also create lifelong dependency problems. Benzodiazepines very commonly create something called tolerance withdrawal, where the drug essentially stops working because the body has developed a tolerance for the substance. Suddenly, patients who were managing their anxiety well can be plunged into a nightmare world of sleeplessness, high anxiety, and even hallucinations.
Telemedicine can work even for these very severe cases. And telemedicine makes it easier to reach patients in rural areas, and to connect patients with specialized providers trained in medication dependency issues no matter where they live. Especially right now, when every visit to a doctor’s office comes with a risk of exposure to COVID-19, telemedicine can provide a lifeline to millions of patients at risk for medication dependency.
Here are six best practices for telemedicine for substance dependency:
1. Maintain the human touch.
While nothing can fully replace the experience of sitting across from a therapist face to face, videoconferencing goes a long way towards creating an equivalent. Over a video call, a therapist can observe a patient’s body language and tone of voice much the way they would in person. These nonverbal cues give the therapist essential information about how a patient is feeling — including some feelings they may not be totally comfortable sharing out loud.
2. Take the time to get comfortable with the technology.
Many opioid or benzo-dependent patients were high-functioning before they developed a medication dependency. They took these medications as prescribed by a doctor they trust; dependency comes as an unwelcome surprise. It’s common for patients who are in pain, who are having trouble sleeping, who are dealing with feelings of shame, to initially refuse to show themselves on video. Therapists should work with patients to get them comfortable with the often-new experience of discussing intensely personal issues over audio or video chat.
3. Look for a program with real-time contact.
One of the strengths of telemedicine is that you’re not just relying on weekly in-person visits to assess progress. A great telemedicine program should include daily check-ins where patients can rate their pain levels, their mood, and answer other quality of life questions, so the therapist gets a clear and detailed picture of their progress. A program built for telemedicine can also give patients the option to text their therapist in real time, between regular visits, if they are feeling vulnerable or have urgent questions.
4. Prepare for crisis moments in advance.
We have our smartphones on us all the time. But using telemedicine doesn’t mean that a therapist will be on call 24–7. Early in a telemedicine relationship, therapists and patients should establish some ground rules about when they can and can’t be expected to respond, and how quickly to expect a response during on-call hours. Therapists should also create a clear emergency plan that explains what patients can do if they need help outside of regular hours.
5. Make use of peer support.
Group therapy and peer support can be incredibly powerful for patients dealing with dependency. Group video calls or forums where patients can safely chat with one another and provide support offer a different perspective than a therapist’s. Peer support can also help patients feel more empowered — they may be struggling, but they can still offer support to someone else. Peers may also be available for texts, chats, or calls when therapists are off the clock.
6. Use AI to support human therapists.
Technology can’t replace the expertise and sensitivity of a human provider, but it can provide a back-up. For example, if patients are prompted to record brief audio answers to questions about their mood through an app like OhMD, an AI program can analyze their voice and alert the provider if that patient needs urgent support. As time goes on, AI algorithms can compare patient outcomes, uncover what works best for the patients with the best outcomes, and apply those learnings to new patients. AI can help take what good therapists do to achieve great outcomes and disseminate those best practices widely.
Telemedicine may initially seem like an odd choice for an issue as sensitive and complex as substance dependency. But a carefully designed program can actually replicate many of the strengths of face-to-face treatment while adding new benefits, including a greater geographic reach, the ability to provide real-time, personalized support, and the option to use new technological tools to support human therapists.
Visit us at Skyler Health, where we empower people to prevent and stop anxiety, pain, medication & substance dependence with professional, licensed, and vetted counselors that you can trust.
