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Telehealth Models

Telehealth is a promising tool for treating and supporting people with substance use disorders. It benefits rural populations, in particular, where there is a lack of specialized providers and resources. Telehealth uses technology to provide access to services for treating substance use disorders across distance. It connects patients and providers and makes it possible for patients to receive screenings, counseling, and other services without traveling to a provider's office.

Telehealth is not limited to a single form of technology. Potential telehealth platforms include telephone-based services, smartphone applications, videoconferencing, and web-based screening and treatment.

Telehealth is particularly beneficial in addressing barriers including distance to providers, privacy concerns, missed time from work, child care, and access to transportation.

While more research is needed to explore the effectiveness of telehealth in treating substance use disorders, early research has been promising. A study in the Journal of Substance Abuse Treatment found that participants in an internet-based methadone maintenance treatment program preferred the internet-based service because of its convenience and confidentiality. Another study from the Journal of Psychosocial Nursing and Mental Health Services found improved abstinence from alcohol among rural women, with no significant differences between standard and web-based treatment groups, suggesting that web-based treatments may be as effective as traditional treatment approaches. While the use of technology has been promising, a recent study from the National Institute on Alcohol Abuse and Alcoholism found that telehealth is still most effective when used in conjunction with face-to-face interaction.

Examples of Telehealth Models

  • Based in New Mexico, Project ECHO's Behavioral Health and Addiction (BHA) TeleECHO Clinic was created to increase access to healthcare and mental health treatment for substance use disorders. The program provides weekly clinic sessions and access to trainings for providers in rural areas across the country.
  • Madison Outreach and Services through Telehealth (MOST) Network in Madison County, Texas, connects counselors with patients in rural clinics. Clients are provided with either telephone or televideo counseling via the Texas A&M Telebehavioral Care (TBC).

Considerations for Implementation

Telehealth is a relatively new and quickly growing field relative to substance use disorders. A major component needed in order to pursue this model is access to high-speed internet, which remains a barrier in many rural communities. Additionally, telehealth requires access to equipment that may be costly to rural clinics with few resources. In addition to the costs of equipment, agencies that develop telehealth programs may need to establish new policies and procedures as well as training on the use of new equipment.

Some behavioral therapy models have tested computerized or web-based versions with promising results. A computer-based version of cognitive behavioral therapy called CBT4CBT has been developed and tested on its effectiveness for substance use disorders. Data suggest that this computer-based version provides an effective means of treatment. There is a computerized version of the community-reinforcement approach therapy known as therapeutic education system (TES) that has shown to be effective. Screening, brief intervention, and referral to treatment (SBIRT) has been adapted to use electronic devices such as computers and mobile devices to deliver screening and a brief intervention known as e-SBI (electronic screening and brief intervention), which is currently recommended by The Community Guide. A computer-assisted or web-based version of behavioral therapy could have significant benefits on their expansion to rural communities where transportation and access to care are barriers to treatment.

Telehealth programs must still adhere to the Health Insurance Portability and Accountability Act (HIPAA) regulations and federal confidentiality rules. For example, healthcare providers need to consider using private networks on encrypted software if choosing to use videoconferencing. And while a large percentage of the population is using traditional short message service (SMS) text messaging, this format is not secure and therefore would not be compliant with HIPAA regulations.

Reimbursement for substance abuse related telehealth services varies by state. As of May 2018, Massachusetts is the only state without a definitive telehealth reimbursement policy. The Center for Connected Health Policy maintains a collection of telehealth-related laws and reimbursement policies by state.

Resources to Learn More

Center for Technology and Behavioral Health
Provides information and reviews on various technology-based substance use disorder interventions.
Organization: Center for Technology and Behavioral Health

In Brief: Rural Behavioral Health: Telehealth Challenges and Opportunities
A review of current barriers and opportunities to implementing telehealth services in rural settings.
Organization: Substance Abuse and Mental Health Services Administration
Date: 11/2016

Telehealth in State Substance Use Disorder (SUD) Services
An introduction to telehealth in mental health and substance use disorders. Highlights key findings from a review of the literature on telehealth.
Organization(s): National Association of State Alcohol and Drug Abuse Directors
Date: 6/2009

Telehealth Resource Centers
Provides information on operation tools used in telehealth, reimbursement information, legal issues, training, and webinars on a variety of telehealth related topics.