From Crisis to Care: Advances in Telemedicine Transform Addiction Treatment

From Crisis to Care: Advances in Telemedicine Transform Addiction Treatment 

By Olatunde Oshikoya, DMSc-S, MPAS, PA-C 

The world of addiction treatment is changing rapidly, especially since the COVID-19 pandemic reshaped the health care landscape, prompting innovative approaches to addition treatment.  

Here’s what you need to know about the latest advancements and how they might help you or a loved one seeking treatment. 

At our practice, we leverage technology to increase access to medication-assisted treatment (MAT) and reach patients across the entire nation from the comfort of their homes. With licenses in multiple states, we can treat hundreds of patients each month through synchronous and asynchronous communication, electronic prescriptions, and remote monitoring of compliance with randomized urine drug screen testing.  

Medication-Assisted Treatment (MAT) 

MAT is a comprehensive approach to treating substance use disorders, particularly opioid and alcohol dependence. It combines the use of medication management with counseling and behavioral therapies to provide a holistic approach to treatment. MAT is effective because as the medication we introduce is restoring normal brain chemistry, behavioral therapies can address the psychological aspect of addiction, helping individuals change their attitudes and behaviors related to drug use and develop a new way of being. 

In addition to my full-time work, I am pursuing my doctoral degree, where I am currently exploring novel strategies to increase access to MAT as a part of my capstone project. I am excited to know that while we have made great strides in the field of addiction medicine, the best is yet to come! 

Addressing Misconceptions About Addiction 

“We are not bad people trying to be good. We are just sick people trying to get better.”  

I believe starting this important conversation with this phrase that I first heard from a patient in recovery provides perspective. 

One of the biggest misconceptions about addiction is viewing it as a moral failing or lack of willpower within an individual. Unfortunately, this stigma fuels guilt and shame in those living with addiction. Many people believe that those who are in recovery can simply choose to stop using substances, which is untrue and minimizes the interplay of genetic, environmental, physiological, and psychological factors that contribute to dependence. 

Another common misconception is that addiction only affects certain demographics, such as those from specific socioeconomic backgrounds or with certain personality traits. In reality, addiction can impact anyone, regardless of background, education, or social status. As a PA, I have the privileged opportunity to combat the harmful rhetoric surrounding addiction by educating patients, colleagues, and the general public about the realities of the complex condition. We have a responsibility not just to treat those impacted by addiction but to serve as advocates. 

Initial Steps for Seeking Treatment 

While addiction may look different for everyone, the stages to seek treatment are often similar. When we consider the transtheoretical model of changed behavior, a patient must first acknowledge that their addiction is problematic during the contemplation stage before making the decision to pursue intervention. Unfortunately, this decision may not come until after they have suffered an insufferable loss (e.g., marriage, housing, employment, etc.). Once someone has mentally committed to seeking treatment, we begin an intake process to gather history and then place them with the appropriate health care provider while surrounding them with resources, such as peer support groups and therapy. 

Personalized Treatment Plans 

Effective treatment options for addiction vary depending on the type and severity. Whether it’s pharmacological or non-pharmacological intervention, the most effective treatment is the one that is most relevant to the needs of the patient. For example, someone who may lack sufficient resources or a strong support at home may fare better in the inpatient setting where there is structure and supervision. 

The best way to personalize treatment plans is to simply talk to people. With the use of motivational interviewing, we can identify shared goals that are unique to an individual to create sustainable change. As health care providers, we have the opportunity to connect with others in their greatest time of need and while we may be the experts of medicine, patients are experts of their mind, body, and soul so it’s important to step outside of ourselves and meet people where they are at. 

Integrating Therapy and Support Systems 

While pharmacological intervention can certainly help combat addiction, it is only one tool in the toolkit. Integrating wraparound services such as therapy and support groups can provide patients with an opportunity to explore why it is that they may have sought out illicit substances to begin with assuming there was not a medical reason. Therapy can provide new perspectives and uncover truths about ourselves we may have buried subconsciously, while support groups provide accountability and community.  

Shawn Carter, or Jay-Z, says, “You can’t heal what you never reveal.” I have shared this powerful quote with patients, and I believe it to be true. 

At our practice, we are sure to offer both as resources to patients and while not everyone feels a need to engage, studies have shown that those who have access to similar services typically experience long-term success and less likelihood for future relapse in comparison to those who don’t. 

Coping with Relapse  

Relapse is a common part of the recovery process and does not mean that treatment is entirely ineffective or that someone is a failure. More likely, it indicates that treatment plans and expectations may need to be adjusted. I often share with patients that success is not a linear journey but we can choose to learn from these setbacks rather than be defined by them. Failure may be an inevitable part of success but suffering through it is a choice that is fortunately well within our control. Relapses often occur in response to a stressor or trigger so I believe it is important to understand what coping mechanisms may currently exist and potentially explore new ones. I also encourage patients to journal how they feel following a relapse so they have a tangible reminder that they can reference should they experience similar cravings in the future. 

Collaboration with Primary Care Physicians 

Collaboration with primary care physicians (PCPs) is vital in managing addiction, as it often co-occurs with other physical and mental health conditions, necessitating a comprehensive and integrated care plan.  

For instance, when a patient is undergoing MAT with our practice, their PCP monitors their overall health, manages any chronic conditions and provides routine preventive care. Meanwhile, I focus on the addiction treatment, ensuring that they are responding well to our recommendations and addressing any addiction-specific issues that may arise. Regular check-ins and shared care plans allow us to adjust treatment as needed and provide the best possible care, supporting their long-term recovery and well-being. 

Addressing the Opioid Crisis 

PAs are playing a crucial role in addressing the opioid crisis through clinical work, research, advocacy, and policy reform. Although, I primarily combat America’s opioid crisis from a clinical perspective in my current capacity, there are PAs who are also doing their part in the non-clinical arena. PAs are involved in research efforts to evaluate the effectiveness of different treatment modalities for addiction, identify barriers to care and develop innovative approaches to addiction treatment. PAs also advocate for policy reform that can improve access to addiction treatment, reduce stigma, and support funding for addiction services. In lobbying, PAs often collaborate with professional organizations and policymakers to drive legislative changes that benefit individuals living with the condition. 

Supporting Families of Addicted Individuals 

Recovery is a long and often challenging process. Family is a critical component because this support system often serves as the first line of defense. It may be difficult to understand but there is a difference between helping and enabling. Although, we may love someone, we can’t ignore harmful behaviors or take them on as our own. It’s important to be patient with your loved one and with yourself. Education about substance abuse can help families recognize signs and intervene appropriately. The world already judges them for their condition and the last thing they need in this moment is to feel that same condemnation at home.  

Families can contact the Substance Abuse and Mental Health Services Administration (SAMHSA) that offer valuable support, and their hotline, 1-800-662-HELP (4357), provides 24-hour assistance.