September 23, 2014

Tech Support

by Frederick Jerant

If you live in a big metropolitan area, obtaining intensive outpatient therapy for substance abuse can be a breeze: Make a convenient appointment, and go.

What if you live far from a treatment facility, face transportation issues or have other impediments? Getting the necessary therapy can be a daunting task.

Teletherapy for substance abuse treatment is beginning to dismantle those barriers, bringing patients and therapists together in a virtual setting.

“Teletherapy has been around for several years,” says Peter Loeb, CEO of Lionrock Recovery in Mountain View, Calif. “It was pioneered by the Department of Defense as a way to treat efficiently its personnel in far-flung locations.”

“It appeals to [civilian] clinicians and clients,” adds Leigh Church, MS, a licensed alcohol and drug counselor and clinical professional counselor located in Reno, Nev. “For example, some people travel a lot, and teletherapy enables them to continue their sessions even when they’re on the road.”

It also helps eliminate the shame and stigma often associated with seeking addiction treatment by placing that treatment in the comfort and privacy of one’s own home.

Church adds, “Teletherapy can be really beneficial to substance abuse patients after they transition from residential treatment centers back into their communities. They might not otherwise have access to aftercare. And the longer you keep people engaged, the better they do in sobriety.”

At its most basic, teletherapy sessions are conducted over the internet, via one of several strongly encrypted platforms that ensure confidentiality beyond the usual HIPAA regulations. (Although some of these platforms can be expensive, offers a free version.)

Lionrock’s online group therapy sessions adhere to the standards of the U.S. Substance Abuse and Mental Health Services Administration (SAMHSA) and use hi-def streaming video. “People sometimes think it’s more intimate than real-world contact,” Loeb says. “You sit 12 inches from a screen, and can make eye contact with the counselor and everyone else in the session; it’s not the same as the typical circle of chairs.”

He adds that many counselors like it, too. “The hardest part of group therapy is getting people to open up,” Loeb says. “Sometimes, when online, patients really let their emotions flow.”

What’s the target audience for this treatment? Lionrock had expected its program’s early adopters to be young men, Loeb says, but middle-aged women outnumber them. “Typically, a treatment center’s clientele will be 75% men. With us, it’s about 80-85% women,” he says.

The reason? According to Loeb, male addicts often need major motivations—loss of a spouse or family, job endangerment—before seeking help. But, he adds, some SAMHSA research indicates that women tend to look for assistance before a serious crisis emerges and have a higher rate of self-referral. And teletherapy’s ability to mitigate the stigma, shame and privacy issues that often keep people from treatment makes it easier to get help.

Aging baby-boomers in particular can benefit. Advancing years can result in less tolerance for drugs that were easily handled in their youth. More aches and pains can lead to more pills and long-term use can sometimes cross the line into addiction.

But not everyone in those groups is automatically a candidate for teletherapy. “Some prefer sitting in a room with the counselor instead of talking to a computer screen,” Church says. “Others will use the technology as a way to avoid full participation.”

“Proper assessment is important in all cases,” Loeb says. “We like to meet potential clients during their discharge planning and stage a preliminary teleconference to gauge the technology’s appeal. If the clients are willing, we have them meet with a counselor and get into a group before they leave the facility.”

Church adds that dual-diagnosis patients (those with addiction issues and a mental-health disorder) must be screened to ensure stability of their condition before proceeding. Extra safety precautions may be necessary. “If a patient becomes suicidal in your office, you can call 911 and get prompt response,” she says. “When you’re online, you don’t always know exactly where your patient is.”                                                                                                                                           

Of course, there’s always the matter of payment. Not all health insurance or employee benefit plans cover teletherapy, so your best bet is to check with your own policy before embarking on a course of treatment. In Church’s experience, coverage is more likely for services provided in a hospital, urgent care center, mental heal clinic or other professional setting, than for treatment in a private office.

On the other hand, Lionrock eschews insurance coverage altogether, opting instead to be a private-pay facility. “I’ve heard that insurance—if it covers teletherapy at all—will cover only a fraction of the cost,” Loeb says. “I hope to develop an affordable model based on the reduced costs of internet-based treatment.”

As with any protocol, teletherapy for substance abuse isn’t ideal for everyone. But online treatment offers a safe, practical alternative to traditional modalities. Help can be just a few mouse clicks away.

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