Abstract
Telehealth dramatically expanded during the COVID-19 pandemic, but there remains a dearth of literature examining how this service modality is utilized by individuals who use substances. This study examined patterns of telehealth use and individual level sources of variation among clients receiving counseling in an outpatient substance use clinic in early 2021 (n = 370). Univariate statistics described the percentage of counseling visits delivered via telehealth. OLS regression explored individual level demographic and clinical characteristics that predicted greater telehealth utilization. Overall, more than two thirds (86%) of counseling visits were conducted via telehealth. Individuals with unstable housing or with a co-occurring serious mental illness used less telehealth. Findings suggest that while telehealth appears to be an acceptable way to deliver substance use counseling, patterns varied among vulnerable subgroups. As telehealth becomes further integrated into behavioral health services delivery, it is critical to uncover sources of this variation and identify potential solutions.
Similar content being viewed by others
References
Bayers, T., Strohmaier, T., Shreffler, J., & Huecker, M. (2022). Perceptions of individuals in treatment for substance use disorder during COVID-19: Insight on mental health, sobriety, access to treatment, and telehealth. Journal of Addictive Diseases, 40(1), 111–113.
Bose, S., Dun, C., Zhang, G. Q., Walsh, C., Makary, M. A., & Hicks, C. W. (2022). Medicare beneficiaries in disadvantaged neighborhoods increased Telemedicine Use during the COVID-19 pandemic. Health Affairs, 41(5), 635–642. https://doi.org/10.1377/hlthaff.2021.01706.
Bronson, J., Stroop, J., Zimmer, S. & Berzofsky, M. (2017) Drug use, dependence, and abuse among state prisoners and jail inmates, 2007–2009. United States Department of Justice. https://bjs.ojp.gov/content/pub/pdf/dudaspji0709.pdf
Cantor, J. H., McBain, R. K., Kofner, A., Hanson, R., Stein, B. D., & Yu, H. (2021a). Telehealth Adoption by Mental Health and Substance Use Disorder Treatment Facilities in the COVID-19 pandemic. Psychiatric Services, 73(4), 411–417.
Cantor, J. H., McBain, R. K., Kofner, A., Stein, B. D., & Yu, H. (2021b). Availability of Outpatient Telemental Health Services in the United States at the outset of the COVID-19 pandemic. Medical Care, 59(4), 319–323.
Connolly, S. L., Sullivan, J. L., Lindsay, J. A., Shimada, S. L., Heyworth, L., Weaver, K. R., & Miller, C. J. (2022). Factors influencing uptake of telemental health via videoconferencing at high and low adoption sites within the Department of Veterans Affairs during COVID-19: A qualitative study. Implementation Science Communications, 3(1), 66.
Ecker, A. H., Amspoker, A. B., Hogan, J. B., & Lindsay, J. A. (2021). The impact of co-occurring anxiety and Alcohol Use Disorders on Video Telehealth utilization among Rural Veterans. Journal of Technology in Behavioral Science, 6(2), 314–319.
Friedman, J., & Gjersing, L. (2023). Increases in drug overdose deaths in Norway and the United States during the COVID-19 pandemic. Scandinavian Journal of Public Health, 51(1), 53–57.
Gainer, D. M., Wong, C., Embree, J. A., Sardesh, N., Amin, A., & Lester, N. (2023). Effects of Telehealth on Dropout and Retention in Care among treatment-seeking individuals with Substance Use Disorder: A retrospective cohort study. Substance use & misuse, 58(4), 481–490.
Garvin, L. A., Hu, J., Slightam, C., McInnes, D. K., & Zulman, D. M. (2021). Use of Video Telehealth Tablets to increase Access for Veterans Experiencing Homelessness. Journal of General Internal Medicine, 36(8), 2274–2282.
Haque, S. N. (2020). Telehealth Beyond COVID-19. Psychiatric Services, 72(1), 100–103.
Health Resources and Services Administration (2022). Telehealth for Behavioral Health Care. Retrieved from https://telehealth.hhs.gov/providers/telehealth-for-behavioral-health/billing-for-telebehavioral-health/.
Henwood, B. F., Madden, D. R., Lahey, J., Thomson, H. M., & Islam, N. (2021). Testing the feasibility of telemental health services in permanent supportive housing. Journal of Social Distress & the Homeless, 30(1), 1–5.
Huskamp, H. A., Riedel, L., Campa, I., Busch, A. B., Rose, S., Mehrotra, A., & Uscher-Pines, L. (2023). Long-Term Prospects for Telemedicine in Opioid Use Disorder (OUD) treatment: Results from a longitudinal survey of OUD clinicians. Journal of General Internal Medicine, 1–8. Advance online publication.
Kacha-Ochana, A., Jones, C. M., Green, J. L., Dunphy, C. D., Govoni, T. D., Robbins, R. S., & Guy, G. J. (2022). Characteristics of adults aged ≥ 18 years evaluated for Substance Use and Treatment Planning — United States, 2019. MMWR Morbidity Mortality Weekly Report, 71, 749–756.
Kingston, R. E. F., Marel, C., & Mills, K. L. (2017). A systematic review of the prevalence of comorbid mental health disorders in people presenting for substance use treatment in Australia. Drug and Alcohol Review, 36(4), 527–539.
Krawczyk, N., Feder, K. A., Saloner, B., Crum, R. M., Kealhofer, M., & Mojtabai, R. (2017). The association of psychiatric comorbidity with treatment completion among clients admitted to substance use treatment programs in a U.S. national sample. Drug and Alcohol Dependence, 175, 157–163.
Leach, R., Carreiro, S., Shaffer, P. M., Gaba, A., & Smelson, D. (2022). Digital health interventions for mental health, substance use, and co-occurring disorders in the criminal justice population: A scoping review. Frontiers in Psychiatry, 12, 794785.
Liu, J., Storfer-Isser, A., Mark, T. L., Oberlander, T., Horgan, C., Garnick, D. W., & Scholle, S. H. (2020). Access to and Engagement in Substance Use Disorder Treatment over Time. Psychiatric Services, 71(7), 722–725.
McCray, S. H., Uhunoma, O., Starr, R., Manyibe, E. O., Koissaba, O., Ward-Sutton, B. R., Lewis, C., A. N., & Moore, C. L. (2022). Factors in utilization of Telehealth Treatment by Rural African-Americans with Opioid Use Disorder and Disabilities. Journal of Rehabilitation, 88(1), 87–95.
Mittal, D., Owen, R. R., Ounpraseuth, S., Chekuri, L., Drummond, K. L., Jennings, M. B., Smith, J. L., Sullivan, J. G., & Corrigan, P. W. (2020). Targeting stigma of mental illness among primary care providers: Findings from a pilot feasibility study. Psychiatry research, 284, 112641.
National Center for Health Statistics. (2018). Health, United States, 2017: With Special feature on Mortality. Hyattsville (MD): National Center for Health Statistics.
Onyeaka, H., Ajayi, K. V., Muoghalu, C., Eseaton, P. O., Azuike, C. O., Anugwom, G., Oladunjoye, F., Torous, J. (2022). Access to online patient portals among individuals with depression and anxiety. Psychiatry Research Communications, 2(4):100073.
Qian, A. S., Schiaffino, M. K., Nalawade, V., Aziz, L., Pacheco, F. V., Nguyen, B., Vu, P., Patel, S. P., Martinez, M. E., & Murphy, J. D. (2022). Disparities in telemedicine during COVID-19. Cancer medicine, 11(4).
Saeed, S. A., & Masters, R. M. (2021). Disparities in Health Care and the Digital divide. Current psychiatry reports, 23(9), 61. https://doi.org/10.1007/s11920-021-01274-4.
Saloner, B., Bandara, S. N., McGinty, E. E., & Barry, C. L. (2016). Justice-involved adults with Substance Use Disorders: Coverage increased but Rates of Treatment did not in 2014. Health affairs (Project Hope), 35(6), 1058–1066.
Shah, D. A., Sall, D., Peng, W., Sharer, R., Essary, A. C., & Radhakrishnan, P. (2022). Exploring the role of telehealth in providing equitable healthcare to the vulnerable patient population during COVID-19. Journal of telemedicine and telecare, 1357633X221113711. Advance online publication.
Spencer, M. R., Curtin, S. C., & Garnett, M. F. (2022). Alcohol-induced death rates in the United States, 2019–2020. NCHS Data brief, no 448. Hyattsville, MD: National Center for Health Statistics.
Thompson, R. G. Jr., Wall, M. M., Greenstein, E., Grant, B. F., & Hasin, D. S. (2013). Substance-use disorders and poverty as prospective predictors of first-time homelessness in the United States. American Journal of Public Health 103 Suppl, 2(Suppl 2), S282–288.
Toseef, M. U., Armistead, I., Bacon, E., Hawkins, E., Bender, B., Podewils, L. J., & Hurley, H. (2022). Missed appointments during COVID-19: The impact of telehealth for persons experiencing homelessness with substance use disorders. Asian Journal of Psychiatry, 69, 102987.
Tsai, J., & Gu, X. (2019). Utilization of addiction treatment among U.S. adults with history of incarceration and substance use disorders. Addiction Science & Clinical Practice, 14(1), 9.
Yang, J., Landrum, M. B., Zhou, L., & Busch, A. B. (2020). Disparities in outpatient visits for mental health and/or substance use disorders during the COVID surge and partial reopening in Massachusetts. General Hospital Psychiatry, 67, 100–106.
Young, L. B. (2012). Telemedicine interventions for substance-use disorder: A literature review. Journal of Telemedicine and Telecare, 18(1), 47–53.
Zhang, D., Shi, L., Han, X., Li, Y., Jalajel, N. A., Patel, S., Chen, Z., Chen, L., Wen, M., Li, H., Chen, B., Li, J., & Su, D. (2021). Disparities in telehealth utilization during the COVID-19 pandemic: Findings from a nationally representative survey in the United States. Journal of telemedicine and telecare, 1357633X211051677. Advance online publication.
Zhao, X., Innes, K. E., Bhattacharjee, S., Dwibedi, N., LeMasters, T. M., & Sambamoorthi, U. (2021). Facility and state-level factors associated with telemental health (TMH) adoption among mental health facilities in the United States. Journal of Telemedicine and Telecare, 27(4), 244–257.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors have no conflicts to report.
Additional information
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Matthews, E.B., Lushin, V. & Rzewinski, J. Patterns & Predictors of Telehealth Utilization Among Individuals Who Use Substances: Implications for the Future of Virtual Behavioral Health Services. Community Ment Health J 60, 148–153 (2024). https://doi.org/10.1007/s10597-023-01166-2
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10597-023-01166-2