Moving Addiction Treatment Online is the Right Thing to Do, but Could Leave the Most Vulnerable Without Care

Dr. Elizabeth Salisbury-Afshar
An iPhone displaying the meeting app Zoom, with headphones and a laptop. Photo by Allie Smith for Unsplash

As many cities and states implement physical distancing and shelter-in-place orders due to the coronavirus, people are working to identify a new sense of normalcy.

For many, their work and family lives are moving online, from video chats and conference calls to live-streamed religious services.  Similarly, medical services, including mental health and substance use disorder (SUD) treatment, are increasingly being transitioned to online, telehealth platforms whenever possible. Many behavioral health treatment providers are now offering individual and group counseling services, through a variety of mobile apps and web-based platforms. Opportunities for positive social support, including mutual aid group meetings like AA, NA, and SMART Recovery are increasingly available online.

For patients and providers, these transitions can feel different and uncomfortable, particularly at a time when many are feeling increased anxiety, stress, and isolation.

As a public health professional, I believe that moving as much as we can to web and phone-based interactions is the best way to keep everyone safe. This is particularly important as our hospitals are becoming overwhelmed and personal protective and medical equipment is limited in supply. It is more important than ever that we do everything we can to limit in-person interactions to reduce COVID-19 transmission.

Virtual treatment and recovery programs are working well for many patients.

I have seen patients who have access to smartphones and the internet find ways to effectively engage in online outpatient and intensive outpatient programs, peer-led recovery support meetings, and medical visits, all remotely. In some cases, utilizing online meetings allows patients to join new types of groups that they wouldn’t normally have access to, thereby providing increased flexibility and allowing exposure to new ideas and peer connections.

But moving recovery and treatment programs online does create obstacles for some, especially those who are most vulnerable.

As someone who provides treatment to individuals experiencing homelessness, I know that there are many patients with SUDs who do not have consistent access to a phone, let alone a smartphone with a data plan. Historically, many of these individuals would access the internet in public libraries, but now these community cornerstones are closed. The places where these patients usually go for support—addiction treatment programs, drop-in centers, soup kitchens, and community centers—have similarly closed or offer limited services. These individuals, already impacted by poverty and lack of stable housing, now face additional barriers to in-person or online behavioral health services amidst the COVID-19 pandemic.

It is critical that behavioral health and social service agencies consider these individuals when developing COVID-19 response plans.

Financial aid and emergency funds are needed to support free behavioral telehealth services that provide mobile devices and appropriate data plans to individuals who will otherwise not have access to services. Acknowledging these realities upfront is critical to mitigating further disparities that may result from the existing broadband/digital divide.

Additionally, I have significant concerns that if people experiencing homelessness and those with substance use disorders get sick, they will not receive the limited existing services. Already, hospitals in Detroit are having to make very difficult decisions about how to ration supplies and intensive care services. People experiencing homelessness have higher rates of substance use disorders, mental illness, and other chronic medical conditions as compared to the general population and, because of stigma and bias, will not fare well should rationing occur. I fear these patients will have the worst outcomes during this pandemic and existing inequities will be exacerbated.

As a researcher and a physician who works in the field, I urge governmental, health system, and social service systems to consider this vulnerable population when planning service alternatives and discontinuation during this public health crisis.

Elizabeth Salisbury-Afshar is a Chicago-based, board-certified public health, family medicine and addiction medicine physician and researcher who leads the Center for Addiction Research and Effective Solutions at the American Institutes for Research.

Man in a support group

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