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Access to effective treatment for substance use disorders (SUD) is a longstanding concern in the United States with estimates that only about 10% of adults who need treatment for SUD receive specialty treatment. The COVID-19 pandemic made matters much worse, with social distancing guidelines, self-quarantine requirements, decreased access to healthcare providers, and increased risks of infection from face-to-face clinical encounters. To address these new and significant barriers to treatment, programs are finding it necessary to introduce alternative approaches to care including telemedicine services delivered via telephone, video teleconferencing, and mobile phone apps.
The good news is that telemedicine, or technology-based treatment interventions, have been developed and evaluated. There is growing evidence showing that when treatment is delivered remotely, for example, by phone or computer, the outcomes are comparable to standard, face-to-face clinic-based delivery of treatment. Moreover, remotely delivered treatment has the clear advantage for reaching populations for whom access to treatment is limited.
The UTHealth Center for Neurobehavioral Research on Addiction (CNRA) has responded to COVID-19 challenges by transitioning to tele-based treatment as an option for patients who cannot or prefer not to attend clinic visits. The SAMHSA-funded HEARTS@UTHealth program has paved the way in this regard, with good results to date.
Trained drug counselors have switched to conducting therapy sessions via telephone or videoconferencing with Zoom. This affords patients the flexibility and convenience of participating in therapy from a location and time of their choice. Transportation-related costs are eliminated, which is significant in a big city like Houston.
With any new approach, there are pros and cons to consider. We explored these issues in a recent Q&A with the leadership of HEARTS@UTHealth, Angela Heads, PhD, (Project Director) and Adrienne Thomas, PhD, (Program Manager):
What have you observed to be the biggest benefit of offering therapy through telehealth to clients?
COVID-19 has resulted in many clients and therapists having very valid concerns about risk associated with face to face visits. Telephone and videoconferencing methods allow the HEARTS program to continue providing valuable services while reducing risk of spreading COVID-19. That reduction in risk to our clients, clinic staff, and therapists is one of the greatest benefits. Beyond that, many clients enjoy the benefits of therapy without the challenge of navigating traffic or public transportation. There is also more flexibility in scheduling when the travel time is removed from the equation and cost savings due to the elimination of fuel and parking fees.
On the other hand, what have you observe to be the biggest challenge in making this transition?
The lack of reliable internet or cellular service is a big challenge to some of our clients. This is the biggest drawback to telehealth. Those who do not have access to a smartphone, tablet, computer, or other device with internet access will not be able to engage in videoconferencing. They can, however, call in if they have access to a telephone. Another challenge is that some clients are just not comfortable with having therapy delivered this way. Most who are skeptical at first grow to like it if they try it. There are, however, a few “hold-outs.”
What feedback have you received from clients so far regarding their satisfaction with the alternative treatment method?
We had the opportunity to survey a few of our existing clients when we initially started providing telehealth services. The majority of those who were engaged in remotely delivered services reported that they were comfortable using the telephone or videoconferencing platform for therapy. All respondents reported their interaction with their therapist in terms of thoroughness, carefulness, skills, courtesy and respect as excellent or good. We do not know when COVID cases will decrease to a level where most people feel safe with face to face services, however, most of our new clients have opted for remotely-delivered therapy options. Therapists report hearing from their once reluctant clients who express surprise about the effectiveness of remotely delivered counseling and their appreciation for the availability of this service.
Do you expect to continue offering telehealth services beyond the current COVID-19 pandemic?
Yes. Many clients can benefit from telephone-based and videoconferencing-based services even beyond COVID-19. The convenience along with the time and cost-savings makes it an attractive option for clients who have had difficulties consistently engaging in office-based service delivery options.
For more information or to enroll in the HEARTS@UTHealth program, please call 713-486-2736 or email: HEARTS@uth.tmc.edu