The drug epidemic has plagued America for decades, with nearly 841,000 drug overdose deaths since 1999. However, the severity of this epidemic has only amplified through the COVID-19 pandemic. Though national overdoses have steadily been on the rise for years, recent reports from the CDC indicate that the highest number of overdose deaths ever recorded in a one year period occurred during the first year of the pandemic (March 2020-2021). During this year, over 96,000 people lost their lives to this drug crisis. New research indicates that struggles with addiction have heightened in the most vulnerable groups, but as more and more people fight the battle, less and less resources have become available.7
Just as the rest of the world shut down in March 2020, so did drug rehabilitation programs and facilities, leaving many people without the necessary resources they relied on for help. Group meetings such as Alcoholics Anonymous (AA) or Narcotics Anonymous (NA) could no longer host weekly in-person meetings to provide individuals with addiction the opportunity to discuss their battles with sobriety. People living in sober-living or halfway houses were now forced to limit their interaction with roommates – a vital lifeline keeping them clean. Even detoxifying and medical recovery centers were forced to use tele-health and Zoom as a means for treating their patients.
Telehealth is simply not an appropriate solution for all diseases, especially addiction, which requires much structure, support, and accountability to successfully overcome. Building new routines has been proven to help people replace their drug and alcohol dependencies with healthier practices, but it takes time to build these new habits. The NIH recommends that individuals with addiction remain in in-person treatment for at least three months to ensure the formation of these healthier replacement techniques, as on average it takes at least 66 days to build a new habit. One study found that patients who spend 90 days in treatment were 1.5 to 2.5 times more likely to create reliable change in their lives in overcoming addiction. Recovery from addiction is a complicated process that requires individualized attention and care to overcome. A variety of treatments, including psychotherapy, medications, family therapy, withdrawal management and educational services may be necessary in different combinations for successful recovery.
Though care centers have tried to create a sense of community and accountability online, it has been reported that treatment over video-conferencing platforms has been less effective in allowing people to build connections and support systems with other members of their programs. Additionally, individuals with addiction often also suffer from other mental health disorders. These dual diagnoses have been found to apply to about 37% of alcohol abusers and 53% of drug abusers, but can be very difficult to diagnose until the individual has detoxified from all substances. Without in-person care, these underlying mental illnesses can easily go undiagnosed. It is highly unreasonable to expect an individual to overcome their addiction while simultaneously failing to address and treat the underlying mental health crises likely driving them toward substance abuse.
Additionally, telehealth is not an entirely accessible form of care. Despite telehealth’s ability to reach individuals in more rural populations, it is still limited in its affordability. Insurance reimbursement for telehealth services still varies depending on location and insurance type, as well as peoples’ access to mobile devices and internet connection. Addiction already disproportionately affects lower-income communities, so placing additional financial burdens in the way of receiving addiction treatment only further limits the likelihood of people reaching out for help. Removing the presence of in-person sobriety communities and programs both prevents new patients from seeking and receiving help and leaves individuals with addiction lost without the necessary foundation and structure they so deeply need to stay sober.
Despite the many shortcomings of addiction tele-healthcare, some success has been found in online tools and resources for those struggling with substance abuse. In particular, online screening assessments to allow people to self identify whether they are experiencing the signs and symptoms of addiction have shown consistently positive impacts with few adverse outcomes. This tool is a great first step in encouraging people to pursue additional treatment, but should be followed up with connecting people to more intensive in-person services if applicable. Integrating virtual care systems after in-person treatment may also be of value, as indicated by research exploring the use of telephone counseling post in-person treatment. However, these telephone care systems are not proven to be effective when used as the primary tool in addiction intervention. Utilizing telehealth systems as complementary measures in addiction care could be of value moving forward, but relying solely on virtual care options is not effective in creating reliable outcomes of recovery.
In attempting to battle the immediate threat of the COVID-19 pandemic, we lost sight of the thousands of people fighting this nation’s drug epidemic everyday. Without in-person addiction treatment programs, individuals couldn’t access crucial tools from such treatment such as socialization, structure, and support – and so individuals with addiction were left to fight through their illness alone. We are just now beginning to see the horrific impacts the past year and a half of isolation has had on addiction-related death, and I think we will be dealing with the consequences of this pandemic on addiction for many years to come.