Is Telehealth a viable alternative to in-person treatment?

In addition to my private practice in New Canaan, Connecticut,  I am a Professor and treatment researcher at the University of Massachusetts Medical School Department of Psychiatry.  Here are some interesting results we found in a recent National Institute on Alcohol Abuse and Alcoholism funded study (NIAAA, R34AA023589) testing a telehealth delivery platform.      

My team and I developed an alcohol risk reduction manual to support psychological and family health for National Guard Service Members and Veterans. We adapted our existing, 12-session, evidence-based Alcohol Behavioral Couple Therapy manual to create a 6-session Motivational /Cognitive Behavioral Alcohol Risk Reduction manual.

This was a “pilot” study, meaning  that it was an initial small study piloting a new protocol, with a relatively small sample size. Because it is a pilot study, results need to be interpreted with caution and are generally used to determine if a larger study, is indicated.  However, results are results, and getting positive results with such a small sample is a very good sign!  

This is what we did:   25 National Guard Members or Veterans attended the outpatient research program individually or with a significant other, and were seen in-person or via an “analogue” telehealth platform. Analogue means that we used a situation that would test the value of telehealth while also keeping the study participants safe in the event of a problem. In this study, the individual or couple received the sessions  “remotely”  in our offices via telehealth videoconference (i.e. a laptop, using ZOOM), but the study facilitator who was delivering the treatment was located, unbeknownst to the participants,  in the same suite, different office.  Data were collected at baseline, during, and immediately after the 8-week protocol.

14 National Guard members were treated in-person (9 individually and 5 in dyad with Significant Other) and 11 were treated via telehealth (6 individually and 5 in dyad).  The National Guard sample was 88% male, all risky drinkers and 82% with Alcohol Use Disorder, average age 31, 76% white, 68% employed full time. 14 in-person subjects completed more sessions (average 5.5 of 6) than the 11 telehealth subjects (4.6 of 6).  The treatment was cognitive behavioral and personalized so that each client received treatment for alcohol use as well as other issues he/she was struggling with such as depression, anxiety, relationship problems, etc.

In both telehealth and in-person study conditions, percent drinking days and percent heavy drinking days reduced, as did psychological distress and positive attitude toward drinking.  Coping skills to deal with drinking situations increased. In an exit interview, 85.7% of service members said telehealth is something they would do in the future. 100% of NG members in both telehealth and in-person conditions reported the program was either somewhat or greatly helpful and would recommend the program to someone else. 

Summary: There were no differences in positive drinking outcomes or other outcomes like improved psychological distress and coping skills across telehealth versus in-person delivery, and participants found the program  helpful and would recommend regardless of platform. In this pilot study, telehealth appears to be a viable alternative for CBT risk reduction therapy for alcohol use disorder or risky drinking, and additional research to confirm these findings is indicated.