While telehealth became the norm as of spring 2020 for physical and mental ailments, one area of health remained behind:
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Into the void came digital clinics for
Confidential, anonymous care navigation: The first step for a patient is a confidential screener, accessed via an employer or health plan benefits site. The screener includes the DSM-5, is the official diagnostic tool recommended by the American Society for Addiction Medicine. These are 11 short questions to risk stratify the person and determine whether they might benefit from a treatment program. Questions on the DSM-5 include, “In the past year, have you had times when you drank more or longer than you intended?” The questions also explore what impact a habit is having on a person’s personal and working life, and are intended to identify symptoms that might imply a mental health comorbidity, or withdrawal symptoms that can’t be managed safely at home and require a specialist acute detox center.
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Initial conversation with a counselor: Within 24 hours of completing the questionnaire, patients have their first conversation with a board-certified counselor via video conference. The counselor continues the patient’s assessment process using the American Society of Addiction Medicine’s (ASAM) six dimensions to help develop a personalized care plan. In that initial consultation, the counsellor explores any mental health issues, readiness to change, their recovery or living environment, risks of relapse or severe withdrawal. This initial consultation typically takes about 45 minutes.
Once they confirm the person’s symptoms, they then present possible treatment options. A good digital clinic will identify where the patient lies on the continuum of addiction care. In some circumstances, the patient may initially require inpatient or supervised detox, in which case a care coordinator will refer them to an in-network treatment facility, after which they are invited to enroll in the digital clinic.
Goal formation: Once enrolled, the next step is goal formation. For alcohol addiction, for instance, goals might be “quit alcohol completely” or “reduce alcohol consumption.” The latter goal follows what’s known as a
Patient downloads digital clinic app and begins program: A cognitive behavioral therapy journey, available through a mobile app, delivers personalized content based on the patient's individual triggers, pain points and journey stage. Patients work through the mobile sessions and videos at their own pace.
The app typically features push notifications (e.g., “You have a call with your coach in 5 minutes”), medication reminders, and exercises. It also helps patients track their progress, in terms of number of drinks consumed (for an alcohol program) and daily journaling. Patients may be asked to take a periodic breath test to confirm their progress. These are voluntary, though the vast majority of patients participate. Breathalyzers can connect to the person’s phone via Bluetooth so results are transmitted directly to the digital clinic app.
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Telemedicine appointments and review of medication options: Many people with substance use disorders can benefit from medication. At a digital clinic, a prescribing clinician (Physician or Nurse Practitioner) conducts a telemedicine appointment via an app and reviews medication options with the patient — for instance, Naltrexone for easing alcohol withdrawal symptoms. Patients can choose to add medication to their program, or decline. If they choose medication, the clinician will evaluate the patient's needs and prescribe medication if needed.
Ongoing coach and clinician support: Coaches and counselors typically schedule weekly calls to help patients stay on top of their triggers and answer any questions that come up during their journey. Coaches help patients work through their cravings as they get them. Patients can also reach out anytime they need help. Programs typically include unlimited coaching support for up to a year (the programs themselves generally last 12 weeks).
Patients who chose Medication-Assisted Treatment also have periodic telemedicine visits with their prescribing clinician.
Progress tracking and insights: The app helps track progress against goals during what’s typically a 12-month program delivered in three stages: initiation, stabilization and maintenance. Patients together with their counselor and clinician determine whether the goals have been achieved, or the patient needs additional time in the program.
Digital clinics for addiction have been proven to be as effective as (or more effective than) traditional in-person programs. One recent single-blinded randomized controlled trial compared the Quit Genius digital clinic for tobacco cessation against usual care for 530 participants. Carbon Monoxide verified outcomes demonstrated a 52% quit rate in the digital program versus 32% in the Usual Care arm at 28 days post-quit date. Another study found that on average, members enrolled specifically in the Quit Genius alcohol program, had a 62% reduction in alcohol use frequency within the first 30 days of care. In general, Medication-Assisted Treatment programs result in a 73% abstinence rate (or drinking below a safe limit) within three months, and 51% negative opioid drug tests at six months. Patients often receive more support and therapist time in a digital program than they would in person. This may account for the higher success rates.
Employers who don’t already offer a digital clinic for addictions should consider adding the option for 2022 — even with the world slowly reopening after the pandemic, digital options are here to stay, offering both higher efficacy and greater convenience for employers and employees.
