(35) Comparing In-Person and Remote Substance Use Treatment Outcomes Before and During COVID-19

Background: Individuals with substance use disorders (SUDs) have borne a disproportionate burden of the physical and psychosocial consequences of the Covid-19 pandemic (1,2). Amid repeated lockdowns and mandates for reduced in-person contact, substance use services across the United States have responded to the rising need for treatment by providing services remotely (3). This transition to telehealth services has presented an unprecedented opportunity to evaluate the effectiveness of hybrid (largely remote) services on patient outcomes (3), such as quality of life (4). To date, research on the provision of remote services for SUDs has been preliminary and limited (3).

Objective: To compare changes in multiple domains of quality of life (QOL) between new admissions before the Covid-19 Pandemic (2019), who received only in-person services, versus new admissions during the Pandemic (2020), who received predominately remote services. These comparisons will help assess whether patient outcomes were comparable across treatment modalities.

Method: To compare baseline and 3-month Quality of Life Enjoyment and Satisfaction5 (Q-LES-Q-SF) data during in-person (pre-pandemic, n = 298) and largely remote (pandemic, n = 316) services using a mixed repeated measures ANOVA. The present sample was drawn from four substance use clinics and one methadone clinic in New York state. All clinics transitioned from exclusively in-person to remote services. The methadone clinic continued to administer methadone in person (although patients did not attend in-person often), and all other services for all five clinics (e.g., individual and group therapy, psychiatric services) transitioned to being provided on telehealth platforms (e.g., Zoom) in the Spring of 2020.

Results: Both modalities were associated with similar QOL improvements. Analysis of the effect of condition (remote/in-person) on changes in QOL from admission to 3 months revealed a significant main effect of time (admission vs. 3-month follow-up), F(1, 612) = 90.82, p < .001. From admission, M = 50.10, 95% CI [49.33 - 50.96], to 3 months later, M = 53.58, 95% CI [52.85-54.31], Total self-reported QOL significantly improved. There was no main effect of condition (remote vs. in-person), F(1, 612) = .433, p = .51. There was no interaction effect F(1, 612) = .213, p = .65. Given that no differences emerged between the in-person and remote groups, the groups were collapsed and the individual items that comprised the Q-LES-Q-SF total score were evaluated utilizing paired samples t-tests to assess changes in sub-types of QOL. All domains of QOL (e.g., satisfaction with family functioning, mood) significantly improved at the p < .0001 level.

Conclusion: Both modalities appear equally effective in improving overall quality of life, as well as the individual domains that comprise this total score.

Scientific significance: Remote substance use treatment that includes evidence-based individual and group therapy delivered via telehealth platforms and limited, as-needed, in-person treatment (e.g., methadone administration) appears to be an effective and accessible option for this vulnerable, high needs, population.

References

1. Dubey MJ, Ghosh R, Chatterjee S, Biswas P, Chatterjee S, Dubey S. COVID-19 and addiction. Diabetes & Metabolic Syndrome: Clinical Research & Reviews. 2020;14(5):817-823. doi:10.1016/j.dsx.2020.06.008
2. Wang QQ, Kaelber DC, Xu R, Volkow ND. COVID-19 risk and outcomes in patients with substance use disorders: analyses from electronic health records in the United States. Molecular Psychiatry. 2021;26(1):30-39. doi:10.1038/s41380-020-00880-7
3. Coughlin LN, Bonar EE, Bickel WK. Considerations for remote delivery of behavioral economic interventions for substance use disorder during COVID-19 and beyond. Journal of Substance Abuse Treatment. 2021;120:108150. doi:10.1016/j.jsat.2020.108150
4. Pasareanu AR, Opsal A, Vederhus J-K, Kristensen Ø, Clausen T. Quality of life improved following in-patient substance use disorder treatment. Health and Quality of Life Outcomes. 2015;13(1):35. doi:10.1186/s12955-015-0231-7
5. Endicott J, Nee J, Harrison W, Blumenthal R. Quality of life enjoyment and satisfaction questionnaire: A new measure. Psychopharmacology Bulletin. 1993;29(2):321-326.

Diversity, Equity, and Inclusion: Individuals with substance use disorders (SUDs) have faced a disproportionately negative burden of both the physical and psychosocial consequences of this pandemic. Those with SUDs are more likely to contract the virus and experience significant secondary health complications; largely due to their overall increased risk of cardio-respiratory and metabolic ailments. They are also more likely to face increased psychosocial stressors (e.g., social, financial, occupational) compared to those without an SUD. The significant health inequity and health disparities faced by this population (e.g., significantly higher mortality) must be met by providing services which are more accessible, trauma-informed, and culturally sensitive.

The five clinics being evaluated in this brief report worked tirelessly to continue providing such accessible, trauma-informed, and culturally sensitive services from a non-judgmental, harm reduction framework during the Pandemic. The five clinics also eliminated the co-pay associated with our services, thus providing treatment without cost, as many patients lost their jobs during the Pandemic. By transitioning to remote services, rather than suspending services (or requiring patients to attend services in-person), we were able to continue supporting this vulnerable population, many of whom would have struggled to access the necessary transportation, to continue receiving services during this time.