Online Drug Rehab: When is Telehealth The Right Choice for Addiction Treatment?

Online drug rehab has several names. You can refer to telehealth as telemedicine, virtual care, digital medicine, e-health. It was originally developed for folks in remote areas who couldn’t access care or had transportation challenges.

Digital approaches involve using technology to deliver services. Online therapy is currently available for a wide range of patients and conditions that include substance use disorders.

Telehealth treatment is a flexible way to address mental health and substance use disorders. It’s done at your own pace and in your own space through video conference meetings, texting, chat or email. It can be done over a smart phone, laptop or standard desktop.

Telehealth treatment methods include:

• Telephone services to speak with licensed providers over a landline or cell phone is available.
• Video conferences using one of the many video meetings platforms like Zoom or Teams. Face to face meetings are available through most providers.
• Video appointments are scheduled via various types of calendaring programs like Calendly, Outlook Calendar or Zoom Calendar.
• Texting with therapists is also available and up to the discretion of the provider.
• Virtual chat rooms and chatbots are available for brief questions and simple services. Chats and texts aren’t recommended for medication renewals or making diagnoses.
• Smartphone apps that use AI can help with simple questions.
• Email is commonly used for aftercare communication and follow up.
• Web based tools can feature psychoeducational sessions, peer support groups and individual sessions. The variety of online tools for treatment is numerous.

Online counseling is similar to in person therapy. You meet up with a counselor and talk through your life challenges and recovery issues. Online or telephone sessions usually take place weekly or biweekly. You and your therapist agree on a set schedule and stick with it.

Virtual counseling grew extremely common during the COVID-19 pandemic. Telehealth offered the opportunity for people to connect with qualified professionals from the safety and convenience of their own home.

Online counseling was available pre-pandemic but it exploded in popularity when many people couldn’t attend in person counseling sessions. Scientific American reported that in 2019 only 21% of psychologists reported offering videoconferencing as an option. But 96% said they were providing telehealth services by the end of the year.

Telehealth options for mental health and addiction treatment have since remained popular. Nearly a third of American adults say they’re using telehealth services more now than they did before the pandemic.

Core Components of High-Quality Virtual Care

Evidence based therapies online are the same as when meeting in person. Cognitive behavioral therapy (CBT), motivational interviewing and dialectal behavioral therapy (DBT) can be taught via telehealth. Even selected expressive therapies are available online like art therapy, writing and journaling and photo and drama therapy.

Contingency and voucher systems of reinforcement are successful in deterring repeated destructive behaviors and can be used via telehealth.

This allows therapists to reinforce positive behaviors with gift cards for online shopping. Vouchers allow participants to buy food or basic necessities without using the vouchers to secure illicit substances.

Medication Assisted Treatment via Tele-MAT

The Drug Enforcement Administration (DEA) has proposed rules for prescribing controlled substances via telemedicine that include requirements such as DEA registration and in many cases an in-person medical evaluation.

The rules are not yet finalized and temporary flexibilities remain in place. Providers must also comply with SAMHSA and state standards when prescribing medications for addiction treatment.

The Prescription Drug Monitoring Program is a database run by each state. It tracks prescriptions for controlled substances to help identify potential overprescribing, doctor shopping and substance misuse.

Pillbox technology employs Bluetooth to ensure compliance with medication administration. These products are smart medication and pill dispensers that offer reminders for patients to take their medications at the correct time and doses.

Integrated Dual-Diagnosis & Mental Health Services

Telepsychiatry and medication management to treat other mental health conditions follow strict guidelines governed by the Health Care Portability and Accountability Act (HIPAA). This is done through the use of electronic medical records.

The integration of medical record systems assists providers in knowing what other diagnoses and prescriptions are used to treat individuals’ medical and mental health needs. These services are offered in conjunction with substance use disorder treatment.

Family, Peer Support & Recovery Coaching Options

Peer support relationships can occur individually or in groups and are essential components of recovery. The online community provides 24/7 support lines with resources and assistance to find treatment.

Certified recovery coaches deliver text-based micro-interventions. They serve as sponsors while connecting you to your local community or an online group.

Online rehab offers several advantages for folks who need treatment.

Here are some listed advantages to online drug rehab:

• Rural access: Online addiction treatment allows communities in the countryside to access quality treatment and practitioners.
• Reduced cost: Online rehab often costs less than outpatient addiction treatment. Even if virtual outpatient addiction treatment costs the same as in person services you won’t have to contend with transportation or childcare. Virtual options may offer scheduling flexibility so you don’t miss work.
• Insurance coverage: Online addiction treatment is covered by most insurance providers. Video conferencing is considered face to face treatment.
• Convenience: You can meet with an online counselor to receive treatment from the convenience of your phone or computer without traveling to a facility.
• Availability: If some professionals or specialists aren’t available in your area you can access more treatment providers nationwide through online rehab.
• Effectiveness: Online counseling can be as effective as in person treatment. One study found no difference in patient satisfaction if therapy is online or in person. In any case satisfaction increases with the number of sessions received.
• Enhanced Privacy: Online treatment can offer privacy in small, rural communities for patients and clients alike. Many treatment providers offer online groups for intensive outpatient care (IOP) and aftercare to sustain your long term sobriety.
• Reduced Stigma: Online communities offer more autonomy than groups in areas where people are familiar with one another. Community is essential in recovery but not necessarily the community in which you’re known by neighbors.

The main difference between online and in person treatment programs is the means of communication. Rather than meet up in a therapist’s office or a rehab clinic to chat in person, you use technology to attend sessions online. You see and hear the therapist and your peers in group sessions but do so remotely from your location.

The pros of telehealth are greater accessibility and convenience.

Disadvantages of telehealth is access to WiFi and privacy concerns if a system isn’t secured.

The pros of in person meetings are increased therapeutic connections that occur in person.

Online counseling can address many topics to include substance use disorders. It’s also appropriate for mental health disorders such as depression and anxiety, stress or bereavement or trauma or relationship challenges. But sometimes online treatment isn’t the best option.

What Issues are Not Appropriate for Online Counseling?

Even though it’s advantageous in many circumstances online counseling isn’t suitable for all situations.

It is not recommended for the following conditions:

• When a person needs inpatient treatment for psychosis or other serious psychiatric conditions online tools can help direct them to a facility but won’t address the need for hospitalization.
• Any indication that a person might hurt themself or someone else is difficult to address if they don’t want to give location information.
• If a person is overdosing, with someone who’s overdosing or is potentially going to overdose on substances in-person medical intervention is essential to saving a life.
• Eating disorders must be clinically treated through nutritional and therapeutic intervention. Aftercare follow up may occur through Telemed but stabilization through inpatient care is essential.
• Many personality disorders are necessary to treat in person due to the nature of dishonesty, delusional thinking and psychosis.
• Active and unmedicated schizophrenia, bipolar or other conditions that need medical stabilization for a person to respond to therapy.

Engagement & Tech Barriers

People sometimes get tired of meeting online and disengage before their programs are completed. When this happens it’s beneficial to have an in-person option to remain engaged.

It became obvious during the COVID 19 pandemic that not every rural community had the same access to WiFi to participate in telehealth services. Some people aren’t tele savvy and end up being discouraged from seeking care.

Most providers offer tech support to get people set up to use equipment and programs.

No two demographic groups are the same. Treatment usually differs when you consider age, gender, and occupation. Telehealth options often have different tracks that depend on the target population. Here are some common telehealth groups.

Adolescents & Young Adults

Adolescents and young adults may need to have a guardian or parent sign consent forms to participate. Some programs are specifically designed to include gaming addiction and work around school schedules.

Professionals & Executives

Professionals and executives have tailored programs that address the unique stressors faced in individual professions like air traffic controllers, CEOs and medical providers. Online treatment provides the autonomy necessary for continued practice without exposure.

Employee assistance programs often use telehealth for coaching, treatment and ongoing support for the retention of licenses.

Veterans & First Responders

Telemed for substance use, PTSD and other conditions unique to the high crisis professions are useful for those who aren’t willing to attend in person.

The VA Hospital system offers Chromebooks and other technology to veterans to use these services. First responders are also given access to employee assistance programs through telehealth.

LGBTQ+-Affirming Virtual Care

Services for alternative gender identity populations include specially trained providers who understand gender inclusive language and address the stigmas of minority stress. CBT and eye movement desensitization and repositioning (EMDR) are modalities used to address the trauma the LGBTQ+ population experience.

Telehealth may have fewer costs and more convenience than in person visits but this service still carries charges. Some common concerns for telehealth include insurance coverage and paying for program supplemental features.

Telehealth Coverage, Prior Authorizations & Parity Protections

Prior authorization and in network provision of services are the same for telehealth as they are for in-person treatment. Check your insurance provider for coverage prior to engaging in treatment. Medicaid and private insurance carriers cover addiction treatment through telehealth.

Comparing Program Pricing & Value

While some telehealth services are less expensive than in-person treatment there may be hidden costs. For instance, most treatment providers use onsite UA testing prior to creating accountability at no additional costs. But clients using telemed generally pay for testing and provide results to remain in a program.

Some online programs allow clients to purchase therapy sessions one at a time. These can be prerecorded or interactive but they allow clients to only pay for sessions as they progress.

Attending online sessions can have some additional challenges. Consider the logistics of arranging your schedule to attend all sessions while also setting up a comfortable space at home to present to your peers and your therapist.

Setting Up a Therapeutic Space at Home

Privacy and personal comfort are the most important elements of setting up your treatment space when engaging in telehealth. Remove distractions and anything that may trigger other participants if you’re in group settings. Use a noise cancelling headset if you share a space with other people present.

Building Support & Accountability

Peer support is essential to any recovery program. You can complement your online sessions by visiting additional websites that provide community. You can also create accountability via links with other members’ health apps. Sharing the experience of getting and staying in recovery ensures long term sobriety.

Tips for Staying Engaged & Managing “Zoom Fatigue”

Remember to take breaks during your telehealth sessions. Fatigue sets in after staring at the screen for a long time so getting up and moving around is essential. Therapists know this and often break up meetings with various activities like meditation, stretching and coffee breaks. Even many in-person sessions break every hour.

As with traditional office visits treatment doesn’t end when you graduate from a telehealth program. Online modalities now feature aftercare programs and digital tools so you can better maintain your sobriety.

Mobile Apps & Wearables for Relapse Prevention

Many mobile apps are available for smart watches and phones that can support accountability in recovery.

• Geofencing creates a GPS border around high risk zones where relapse is likely to occur.
• Push alerts for cravings can defuse the fear of missing out that motivates substance use.
• Monitoring your heart rate can build awareness around triggers and the physical responses that lead to relapse.

Stepping Down to Hybrid or In-Person Care

When a person has completed a program for substance use disorder through telemedicine it’s not uncommon for them to transfer into a sober living environment for aftercare.

Transferring to an in person environment from the virtual setting can often create anxiety. Fortunately therapists and doctors are adept at communicating with ongoing services to help clients continue staying sober.

Many sober living houses and communities provide telehealth mental health treatment follow up in private rooms to serve their residents.

Ongoing Monitoring, Urine Screens & Virtual Check-Ins

Depending on the virtual program ongoing urinalysis testing may be required. This is sometimes at the client’s expense.

Aftercare is designed to be more of a supportive process than the original therapeutic interventions. Some therapists also allow for text and email check-ins during aftercare. These contacts are usually reserved for crises only rather than regular appointments.

Clients are understandably anxious about care and usually bring up many questions when exploring telehealth. A provider can offer specific details so feel free to reach out before signing up.

By browsing through websites such as Rehab.com, finding a treatment program near you is easy.

Virtual programs are offered through hospital and treatment facilities and aren’t bound by location restrictions. Many options for treatment abound. Search the web and find what works for you. If you need additional resources, try SAMHSA for lists of agencies, or call the number below to speak with someone today!

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