In a recent article in The Atlantic, the former head of the National Institutes of Mental Health, psychiatrist Tom Insel, pinned the future progress of mental healthcare on one small but transformative piece of technology: the smartphone. Insel is reportedly convinced that “the smartphone can be a diagnostic instrument and, through the links it gives us to others, a life-saving mode of connection and treatment.”
Insel is on to something—and, as an addiction clinician, I am persuaded that telehealth initiatives (like smartphone apps) can also be an essential, life-saving resource for the substance abuse population. Proper legal and ethical training is key for therapists who plan to offer telehealth services, but that extra effort can have powerful results.
First, addiction’s chronic nature makes ongoing assessment and regular follow-up critical factors in effective care—for those in early recovery especially. Accumulated research has shown that like other chronic diseases, SUDs can be characterized by relapse, and rates of relapse tend to be highest during the first year following treatment. Yet outcomes are better among those who make regular and more frequent use of a supportive network in their recovery (such as ongoing individual therapy among others).
Inevitably, the ease and convenience with which these supports can be accessed are therefore crucial. Many of the clients who leave my care go back to full-time jobs, parenting roles and other responsibilities (including recovery commitments like weekly 12-step group attendance). Many clients return to areas of the country where therapists like myself are in overwhelmingly high demand but painfully short supply. Even in clinically well-resourced regions of the country, addiction therapists tend to carry heavy caseloads, and burnout remains a common feature of the SUD treatment landscape.
Such factors can often preclude regular, in-person follow-ups with a therapist—even when the long-term support and accountability these sessions provide may be critical to recovery (depending on the client and their treatment needs). The reality is that the necessary demands of life can dampen even the most dedicated commitment to follow-up therapy. There’s little utility to seeing a therapist weekly if it means you can’t hold down a job, after all (especially when job retention itself tends to support long-term recovery). On the other hand, virtual therapy apps like Talkspace make it easier and more convenient to keep in regular, even frequent touch with a therapist.
Telehealth also provides near-instant support for a disease that, unlike any other chronic disease, is distinguished by cravings. When left to their own devices (without immediate intervention), these compulsive desires to drink or use drugs can often drive and precede relapse. They also don’t always follow therapist work hours or take the same vacation days. A craving may strike in the middle of the night or on the weekend, at which point the more old-fashioned method—of leaving a voicemail for one’s therapist—proves useless.
That’s where videoconferencing and instant text messaging are part of the solution, as are innovative apps like the A-CHESS mobile app. The app provides users with a “panic button” for when cravings hit. Press it and presto: within a matter of minutes, users can access help and support that is individually customized to their needs.
But telehealth is probably most urgently needed as a bridge to treatment for the millions of Americans who would never darken the door of a therapist’s office because of the enduring stigma of substance abuse. That stigma is arguably worse in rural and underserved areas, where an in-person appointment with the only therapist in town likely means you’ll run into your next-door neighbor or a familiar business patron. Videoconferencing apps that allow clients to connect with a properly trained therapist in a secure, online meeting room from the privacy of their own home provide that assurance of anonymity. For many with SUDs, that’s a non-negotiable prerequisite to getting help and beginning the journey to recovery.
Candice Rasa, LCSW, is Clinical Director of Beach House Center for Recovery, a drug and alcohol addiction rehabilitation center in Juno Beach, FL. She has more than 10 years’ experience in the mental health and substance-abuse arena, and supports healing in the clients she serves from a solution-focused, strengths-based approach.