The field of virtual substance use treatment has expanded rapidly, fueled by the COVID-19 pandemic and advances in telehealth technology. This transformation has made care more accessible to many patients, offering convenience and the ability to reach underserved populations. Yet, as providers take a closer look, caution flags are being raised about virtual care’s limitations and the risks of overreliance on digital-only treatment.
The conversation around virtual substance use treatment is evolving, emphasizing that while it is an important tool, it is not a panacea. Industry leaders urge a balanced approach, combining virtual treatment with in-person care to ensure the best outcomes for patients.
The pandemic as a catalyst for virtual substance use treatment
Prior to 2020, telehealth played a smaller, supplementary role in SUD treatment. The onset of the COVID-19 pandemic, however, forced providers to pivot quickly. Social distancing and lockdown measures shuttered many brick-and-mortar clinics, making virtual substance use treatment not just a convenience but a necessity.
Lynda Micheletti, chief operating officer at Praesum Healthcare Services, explains that the pandemic “put [virtual care] on steroids,” accelerating its adoption and embedding it more permanently into treatment models. Praesum Healthcare, which operates more than 30 SUD treatment centers across six states, saw firsthand how virtual substance use treatment became a primary treatment option virtually overnight.
Even as pandemic restrictions eased, the momentum behind virtual substance use treatment remained strong, with many patients preferring the flexibility and safety it offers. This shift has been especially important for rural patients who previously faced significant barriers in accessing in-person SUD treatment.
Key benefits of virtual substance use treatment
Virtual substance use treatment presents several compelling advantages:
- Increased accessibility: Patients in remote or underserved areas can connect with clinicians without traveling long distances, overcoming geographical barriers that once limited access to care.
- Convenience and flexibility: Patients can schedule appointments around work, family, and other commitments, reducing missed sessions and improving engagement.
- Reduced exposure to negative influences: Dr. Scott Weiner, director of research at Bicycle Health, notes that virtual therapy can shield patients from harmful environments they might encounter outside physical clinics, such as exposure to active drug dealers or individuals in relapse.
- Safety and efficiency for providers: Clinicians benefit from reduced risk of physical harm, which can be a concern in certain in-person treatment settings, while also fitting more appointments into their day without the constraints of office overhead and commuting.
- Patient comfort: Many patients feel more comfortable engaging from their own home, which can encourage openness and honesty during sessions.
Such benefits have made virtual substance use treatment an essential option, especially for those who might otherwise have no treatment access.
Challenges and limitations of virtual substance use treatment
Despite its many strengths, virtual substance use treatment is not without important drawbacks:
- Incomplete clinical assessment: Comprehensive SUD care starts with thorough patient evaluation. Dr. Steven Pratt, senior medical director at Magellan Healthcare, emphasizes that virtual assessments are only adequately performed about 80% of the time. Critical physical signs such as poor hygiene, tremors, or other health indicators can be missed without in-person observation.
- Patient suitability and safety concerns: Virtual substance use treatment requires certain prerequisites — patients must have reliable technology, a safe environment to store medications like buprenorphine, and the ability to participate actively in telehealth platforms such as Zoom. Those with more severe or complex addictions often need closer supervision and support not possible remotely.
- Risk of underreporting and noncompliance: Patients enrolled in virtual intensive outpatient programs (IOP) may present well during video sessions but engage in substance use when off camera. This “invisible” relapse risk requires providers to remain vigilant and cautious.
- Potential for overprescribing or inappropriate care: The case of ADHD treatment provider Cerebral, which faced scrutiny for questionable digital prescribing practices, serves as a warning. Micheletti cautions against repeating such mistakes in SUD treatment by overly relaxing standards for virtual medication management.
- Loss of therapeutic intensity: Some experts argue that the physical act of attending treatment, especially in early recovery stages, plays a crucial role in reinforcing commitment and fostering accountability. Virtual care alone may lack this powerful psychological element.
The provider and patient perspectives
The perspectives of both patients and providers reveal nuanced views on virtual substance use treatment.
Patients appreciate the convenience and anonymity virtual sessions can provide. Dr. Weiner notes that for the “vast majority” of patients, virtual substance use treatment is effective and life-changing.
On the other hand, providers express mixed feelings. Some value the flexibility and safety virtual care affords, but many worry that virtual-only treatment may compromise the quality of care. Dr. Pratt points out that some providers are reluctant to return to in-person care due to commute burdens and overhead, yet the patient demand for in-person options often exceeds provider availability.
Towards a hybrid model of care
Most industry insiders advocate for a hybrid approach — using virtual substance use treatment as an important component but not the entire foundation of SUD treatment.
- Initial in-person assessments: Many experts agree that the first three months of treatment, a critical period in recovery, benefit from regular in-person visits to accurately monitor progress.
- Complementary virtual services: Virtual appointments can serve well for follow-ups, quick psychiatric evaluations, and as a flexible option when illness or other barriers prevent physical attendance.
- Tailored treatment plans: Providers must assess each patient’s unique needs, addiction severity, comorbidities, and living situation to decide the right balance of virtual and in-person care.
- Safeguards and oversight: Even as regulatory bodies consider relaxing rules around digital prescribing, Micheletti stresses the importance of “checks and balances” to prevent misuse and ensure patient safety.
Alexandra Plante, senior advisor of SUD at the National Council for Mental Wellbeing, summarizes the consensus: treatment cannot be “one size fits all.” Instead, it requires thoughtful calibration to individual circumstances.
Conclusion: Virtual substance use treatment is here to stay — but so is caution
Virtual substance use treatment has revolutionized access to care, especially for patients who might otherwise fall through the cracks. Its convenience, safety, and reach have been vital in expanding the continuum of SUD services.
However, virtual care also has clear limitations that require ongoing vigilance and balance. The industry must resist the temptation to view telehealth as a complete solution and instead position it as a valuable complement to in-person treatment. Ensuring thorough clinical assessment, personalized care plans, and appropriate oversight will be essential in harnessing the benefits of virtual substance use treatment while safeguarding patient outcomes.
As the field continues to evolve, the challenge lies in integrating virtual care thoughtfully — blending technology and human connection to provide comprehensive, effective support for people on the road to recovery.
If you or a loved one are navigating SUD treatment options, understanding the strengths and limitations of virtual substance use treatment can help guide you toward a path that fits your unique needs. Always consult with qualified providers to tailor treatment plans that balance safety, accessibility, and effectiveness.
