Telehealth helps overcome addiction stigma: Study

Telehealth could be the key to treating hard-to-reach patients experiencing addiction, with a new study finding it reduced feelings of stigma and increased autonomy.
 
The research, published in Harm Reduction Journal, has left its authors calling for doctors to adopt a more individualised approach to care, allowing patients to choose whether they receive treatment in person or via telehealth.
 
For the study, researchers conducted in-depth interviews with 30 people treated for substance use disorder between March 2020 and December 2021.
 
This was at the height of the COVID-19 pandemic when telehealth was becoming more available than ever before.
 
It found that while not every patient preferred telehealth, for many, it allowed them to seek care from within a known, safe environment, and to quickly end an uncomfortable encounter.
 
‘Especially in the beginning, I was very shameful … [so] to be able to speak to someone in the comfort of my own space… and not have to feel…the excessive anxiety that goes with all of that, was absolutely beneficial for me,’ one participant said.
 
‘Telemedicine … it’s not as interpersonal. You’re just a click away from no longer having the interaction and you feel you have more control. You can be in a comfortable environment surrounded by people who make you feel comfortable,’ said another patient.
 
Many participants said visiting an in-person clinic made them feel judged by strangers in waiting rooms, a feeling that is ‘closely tied to and compounded by internalised stigma’.
 
‘Being in the waiting room at every doctor’s office has always been the worst for me … It always feels like people are staring at me,’ a patient told researchers.
 
However, the research also states that some people still prefer an in-person consultation, leading senior author Dr Ximena Levander to call for more individualised, patient-centred approaches to care delivery.
 
‘You feel like you’re being watched or judged by everyone, and telehealth can reduce that sense whether it’s real or perceived,’ she said.
 
‘Telehealth can lower that barrier.’
 
Dr Paul Grinzi, a GP with a special interest in addiction medicine, told newsGP the research confirmed what many doctors see in practice, especially after the COVID-19 pandemic.
 
‘I’ve had a lot more engagement with new patients who are using the telehealth format to help bridge some of the gaps, as, initially, patients were very uncomfortable coming in to see a GP face-to-face,’ he said.
 
‘Particularly with alcohol and other drug issues, stigma is a big factor and any mechanisms that allow people to access care and get past that stigma barrier is excellent, because otherwise people don’t do it.
 
‘Sometimes the lead time between having a substance use problem and accessing care can be many, many, many years, even decades, in some cases, so anything we can do to reduce that time is of benefit for us and our broader society.’
 
According to the most recent Australian data, around 237,000 people use amphetamines regularly, and 283,000 people are addicted to opioids.
 
In 2020, around 2.6 million Australians had an addiction to drugs or alcohol during their lives, an increase of 25% in just three years.
 
Dr Grinzi said telehealth presents a viable treatment option for those millions of patients, many of which live rurally and may not have access to a GP they trust.
 
‘It helps to bridge the geographical gaps, and sometimes patients are less willing to disclose to their GP who’s known them since they were a kid,’ he said.
 
‘Then they can discuss this with their trusted GP because this is not a separate issue, it’s just another chronic health issue that GPs can assist with.’
 
The research also called for a need for increased training for medical professionals in best practice treatment for patients experiencing addiction.
 
It revealed that, in both in-person and telehealth appointments, some patients reported still feeling judged by their clinicians.
 
‘Our findings also highlight the need to further explore how clinicians perpetuate stigma through telehealth-based programs, and how training and clinical guidelines could mediate this,’ it said.
 
‘While some have framed telehealth for opioid use disorder treatment as a possible stigma intervention, it is critical to also explore the possibility that telehealth could potentially exacerbate or introduce unexpected stigma experiences.’
 
Moving forward, the study’s authors said questions remain about how patient characteristics, such as race, gender, or self-stigma, could predict a willingness to use telehealth.
 
Dr Grinzi said often this perceived stigma is not intended but can still be hurtful to patients.
 
‘You don’t have to be an expert to care for the patient, they can actually get expertise to help with that, but you can really take this on, because again, it’s a chronic disease that needs long-term care,’ he said.
 
‘It’s just a matter of reviewing the process, from bookings, to how the waiting room is set up, how patients perceive coming into the GP, and so there’s nothing that can block access to care.
 
‘When I’m seeing patients, often I congratulate them for getting through the hardest part of their treatment, which is the internal, emotional turmoil of acknowledging they’ve got a problem and then acknowledging they need help.’
 
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