Effects of Telehealth on Dropout and Retention in Care among Treatment-Seeking Individuals with Substance Use Disorder: A Retrospective Cohort Study

Background: During the COVID-19 pandemic, telehealth became a widely used method of delivering treatment for substance use disorders (SUD), but its impact upon treatment engagement and dropout remains unknown. Methods: We conducted a retrospective analysis of adult SUD patients (n = 544) between October 2020 and June 2022 among a cohort of treatment-seeking patients at a nonprofit community behavioral health center in Southwestern Ohio. We estimated the likelihood of treatment dropout using survival curves and Cox proportional hazard models, comparing patients who used telehealth with video, telephone, or solely in-person services within the first 14 days of diagnosis. We also compared the likelihood of early treatment engagement. Results: Patients who received services through telehealth with video in the initial 14 days of diagnosis had a lower hazard of dropout, compared to patients receiving solely in-person services (0.64, 95% CI [0.46, 0.90]), while there was no difference in hazards of dropout between patients who received telephone and in-person services. Early use of telehealth, both via video (5.40, 95% CI [1.92, 15.20]) and telephone (2.12, 95% CI [1.05, 4.28]), was associated with greater odds of treatment engagement compared to in-person care. Conclusion: This study adds to the existing literature related to telehealth utilization and engagement in care and supports the inclusion of telehealth in SUD treatment programs for treatment-seeking individuals

The Very Important Patient

The Very Important Patient poses specific challenges to the treating psychiatrist. Whether it is fame, money, power or position that creates the VIP status, this type of patient can elicit similar feelings within the psychiatrist and create various treatment barriers. Boundary violations, accompanying entourage, presentation of gifts, devaluation, scheduling irregularities and transference/countertransference issues are some of the concerns that may arise within the psychiatric treatment of the VIP patient. This article will review the treatment dynamics created by the VIP patient as well as the approaches that the psychiatrist can utilize in a therapeutic manner

The Very Important Patient

The Very Important Patient poses specific challenges to the treating psychiatrist. Whether it is fame, money, power or position that creates the VIP status, this type of patient can elicit similar feelings within the psychiatrist and create various treatment barriers. Boundary violations, accompanying entourage, presentation of gifts, devaluation, scheduling irregularities and transference/countertransference issues are some of the concerns that may arise within the psychiatric treatment of the VIP patient. This article will review the treatment dynamics created by the VIP patient as well as the approaches that the psychiatrist can utilize in a therapeutic manner

Psychiatric Uses of Gabapentin

Objective: This article reviews evidence-based psychiatric uses of gabapentin, along with associated risks. Method of Research: An extensive literature review was conducted, primarily of articles searchable in PubMed, relating to psychiatric uses, safety, and adverse effects of gabapentin. Results: Evidence supports gabapentin as a treatment for alcohol withdrawal and alcohol use disorder. There is sufficient evidence to consider gabapentin as a third-line treatment for social anxiety disorder and severe panic disorder. Evidence does not support the use of gabapentin for bipolar disorder, major depressive disorder (MDD), posttraumatic stress disorder (PTSD), obsessive compulsive disorder (OCD), stimulant use disorder, or opioid withdrawal. Risks of gabapentin use are highest among those with a history of a substance use disorder and those concurrently taking opioids. Conclusion: While gabapentin has a place in psychiatry for a select few indications, the literature does not support its use for many studied diagnoses

Virtual is Now Reality: Telehealth to Deliver Care for Substance Use Disorders

Models of care for substance use disorder (SUD) treatment have traditionally required face-to-face visits, since individuals receive a broad range of services including individual psychotherapy, group therapy, urine drug screens, laboratory testing, dispensation of Medications for Opioid Use Disorder (MOUD), and prescriptions for psychotropic or other medications. However, during the COVID-19 pandemic, telehealth became a more widely used method of delivering healthcare, including for SUD treatment. While the pandemic posed respiratory health concerns to all, individuals with a SUD were additionally vulnerable when attempting to access life-saving medications. An enforcement waiver of both federal and state telehealth rules during the COVID-19 public health emergency facilitated the use of ongoing telehealth, and allowed for previously prohibited practices in SUD treatment (i.e. first-dose prescribing of controlled substances without a face-to-face physical exam, periodic urine drug screens, etc). While this improved access to care for some, barriers and challenges to providing care via telehealth have remained.[1] Many scholars have noted that the implementation of telehealth potentially marginalizes patients from low socioeconomic status due to a possible lack of resources.[2] Despite this, however, the use of telehealth represents an important vehicle for achieving harm reduction goals for individuals with SUD. Given the shifting landscape of healthcare delivery, telehealth will remain integral and essential for SUD treatment in the future. During this session, we will explore the advantages and challenges associated with utilizing telehealth for the treatment of substance use disorders. Because of the socioeconomic complexities associated with SUD treatment, these patients often face unique disadvantages that require innovative approaches and extra consideration. Telehealth increases access to care by reducing barriers (e.g. transportation, time, stigma, childcare, etc.) which are especially important in this patient population.[3] We will discuss the “lessons learned” in our collective experience providing telepsychiatry in the treatment of other populations that we have now applied to the treatment of SUD. We will also share recently analyzed data which suggest a positive impact of telehealth upon engagement and treatment retention from our community mental health agency. During this session, we will also review the federal and some state telehealth guidelines and the changes that have occurred as a result of the pandemic, as well as discuss potential future directions.[4, 5] We will provide participants with case examples highlighting the challenges associated with telehealth for SUDs, including barriers faced by marginalized individuals. We will utilize active learning including audience polling, brief small-group discussions, and a question-answer portion at the conclusion of our session. Learning Objectives: Learners will be able to: Identify advantages and challenges associated with telehealth for the treatment of SUDs and demonstrate clinical skills for challenging cases and making clinical decisions in the context of treating SUDs via Telehealth. Navigate legal requirements that may impact treatment and the prescribing changes that have occurred during the COVID-19 pandemic and apply “lessons learned” from the use of telehealth in the treatment of other populations. Describe lessons learned from data collected from one treatment setting in addition to date from existing literature related to the impact of telehealth upon engagement and treatment retention

Virtual is Now Reality: Telehealth to Deliver Care for Substance Use Disorders

Models of care for substance use disorder (SUD) treatment have traditionally required face-to-face visits, since individuals receive a broad range of services including individual psychotherapy, group therapy, urine drug screens, laboratory testing, dispensation of Medications for Opioid Use Disorder (MOUD), and prescriptions for psychotropic or other medications. However, during the COVID-19 pandemic, telehealth became a more widely used method of delivering healthcare, including for SUD treatment. While the pandemic posed respiratory health concerns to all, individuals with a SUD were additionally vulnerable when attempting to access life-saving medications. An enforcement waiver of both federal and state telehealth rules during the COVID-19 public health emergency facilitated the use of ongoing telehealth, and allowed for previously prohibited practices in SUD treatment (i.e. first-dose prescribing of controlled substances without a face-to-face physical exam, periodic urine drug screens, etc). While this improved access to care for some, barriers and challenges to providing care via telehealth have remained.[1] Many scholars have noted that the implementation of telehealth potentially marginalizes patients from low socioeconomic status due to a possible lack of resources.[2] Despite this, however, the use of telehealth represents an important vehicle for achieving harm reduction goals for individuals with SUD. Given the shifting landscape of healthcare delivery, telehealth will remain integral and essential for SUD treatment in the future. During this session, we will explore the advantages and challenges associated with utilizing telehealth for the treatment of substance use disorders. Because of the socioeconomic complexities associated with SUD treatment, these patients often face unique disadvantages that require innovative approaches and extra consideration. Telehealth increases access to care by reducing barriers (e.g. transportation, time, stigma, childcare, etc.) which are especially important in this patient population.[3] We will discuss the “lessons learned” in our collective experience providing telepsychiatry in the treatment of other populations that we have now applied to the treatment of SUD. We will also share recently analyzed data which suggest a positive impact of telehealth upon engagement and treatment retention from our community mental health agency. During this session, we will also review the federal and some state telehealth guidelines and the changes that have occurred as a result of the pandemic, as well as discuss potential future directions.[4, 5] We will provide participants with case examples highlighting the challenges associated with telehealth for SUDs, including barriers faced by marginalized individuals. We will utilize active learning including audience polling, brief small-group discussions, and a question-answer portion at the conclusion of our session. Learning Objectives: Learners will be able to: Identify advantages and challenges associated with telehealth for the treatment of SUDs and demonstrate clinical skills for challenging cases and making clinical decisions in the context of treating SUDs via Telehealth. Navigate legal requirements that may impact treatment and the prescribing changes that have occurred during the COVID-19 pandemic and apply “lessons learned” from the use of telehealth in the treatment of other populations. Describe lessons learned from data collected from one treatment setting in addition to date from existing literature related to the impact of telehealth upon engagement and treatment retention

Virtual is Now Reality: Telehealth to Deliver Care for Substance Use Disorders

Models of care for substance use disorder (SUD) treatment have traditionally required face-to-face visits, since individuals receive a broad range of services including individual psychotherapy, group therapy, urine drug screens, laboratory testing, dispensation of Medications for Opioid Use Disorder (MOUD), and prescriptions for psychotropic or other medications. However, during the COVID-19 pandemic, telehealth became a more widely used method of delivering healthcare, including for SUD treatment. While the pandemic posed respiratory health concerns to all, individuals with a SUD were additionally vulnerable when attempting to access life-saving medications. An enforcement waiver of both federal and state telehealth rules during the COVID-19 public health emergency facilitated the use of ongoing telehealth, and allowed for previously prohibited practices in SUD treatment (i.e. first-dose prescribing of controlled substances without a face-to-face physical exam, periodic urine drug screens, etc). While this improved access to care for some, barriers and challenges to providing care via telehealth have remained.[1] Many scholars have noted that the implementation of telehealth potentially marginalizes patients from low socioeconomic status due to a possible lack of resources.[2] Despite this, however, the use of telehealth represents an important vehicle for achieving harm reduction goals for individuals with SUD. Given the shifting landscape of healthcare delivery, telehealth will remain integral and essential for SUD treatment in the future. During this session, we will explore the advantages and challenges associated with utilizing telehealth for the treatment of substance use disorders. Because of the socioeconomic complexities associated with SUD treatment, these patients often face unique disadvantages that require innovative approaches and extra consideration. Telehealth increases access to care by reducing barriers (e.g. transportation, time, stigma, childcare, etc.) which are especially important in this patient population.[3] We will discuss the “lessons learned” in our collective experience providing telepsychiatry in the treatment of other populations that we have now applied to the treatment of SUD. We will also share recently analyzed data which suggest a positive impact of telehealth upon engagement and treatment retention from our community mental health agency. During this session, we will also review the federal and some state telehealth guidelines and the changes that have occurred as a result of the pandemic, as well as discuss potential future directions.[4, 5] We will provide participants with case examples highlighting the challenges associated with telehealth for SUDs, including barriers faced by marginalized individuals. We will utilize active learning including audience polling, brief small-group discussions, and a question-answer portion at the conclusion of our session. Learning Objectives: Learners will be able to: Identify advantages and challenges associated with telehealth for the treatment of SUDs and demonstrate clinical skills for challenging cases and making clinical decisions in the context of treating SUDs via Telehealth. Navigate legal requirements that may impact treatment and the prescribing changes that have occurred during the COVID-19 pandemic and apply “lessons learned” from the use of telehealth in the treatment of other populations. Describe lessons learned from data collected from one treatment setting in addition to date from existing literature related to the impact of telehealth upon engagement and treatment retention

Treatment for Opioid Use Disorders and Dissociative Symptoms

Opioid use has been associated with numerous psychiatric symptoms, including dissociative symptoms. Medications that are used to treat opioid use disorder can potentially impact dissociative symptoms, but this has not been explored in the existing literature. We intended to examine the relationship between dissociative symptoms and opioid use disorders using the Dissociative Experiences Scale (DES). We studied subjects who were prescribed methadone, buprenorphine or naltrexone for opioid use disorder. Surveys were given to subjects in three substance use treatment facilities: TCN Behavioral Health Services, Inc., Project C.U.R.E., Inc. and Access Ohio. All data were analyzed using SAS version 9.4 (Cary, NC) and p-values \u3c.05 were considered statistically significant. Analysis of Variance (ANOVA) was conducted to examine associations between the study variables and the outcome. A multiple linear regression model was developed to examine the association between opioid medication type and dissociative symptoms. There were 116 participants included in the analysis. Approximately 55% of participants were prescribed buprenorphine. The majority of participants were female (51.7%), white (89.5%), and ≤ 40 years of age (64.7%). The average dissociative symptoms score was 16.1 (standard deviation = 14.9) and 80.9% were considered to have low dissociation (score \u3c 30). There was a significant association between medication type and dissociative symptoms (p = .01). Participants prescribed buprenorphine had higher mean dissociation symptom scores (18.8) compared to methadone (12.7) and naltrexone (12.8). Their last use of alcohol or other drugs (p = .006) was significantly associated with dissociation symptoms. Overall, the multiple linear regression model was significant (F = 3.54; p = .003) and explained 11.8% of the variance. Compared to buprenorphine, both methadone (β = -0.479; p = .01) and naltrexone (β = 0.266; p = 0.007) had significantly lower dissociation scores, controlling for the other variables

Treatment for Opioid Use Disorders and Dissociative Symptoms

Opioid use has been associated with numerous psychiatric symptoms, including dissociative symptoms. Medications that are used to treat opioid use disorder can potentially impact dissociative symptoms, but this has not been explored in the existing literature. We intended to examine the relationship between dissociative symptoms and opioid use disorders using the Dissociative Experiences Scale (DES). We studied subjects who were prescribed methadone, buprenorphine or naltrexone for opioid use disorder. Surveys were given to subjects in three substance use treatment facilities: TCN Behavioral Health Services, Inc., Project C.U.R.E., Inc. and Access Ohio. All data were analyzed using SAS version 9.4 (Cary, NC) and p-values \u3c.05 were considered statistically significant. Analysis of Variance (ANOVA) was conducted to examine associations between the study variables and the outcome. A multiple linear regression model was developed to examine the association between opioid medication type and dissociative symptoms. There were 116 participants included in the analysis. Approximately 55% of participants were prescribed buprenorphine. The majority of participants were female (51.7%), white (89.5%), and ≤ 40 years of age (64.7%). The average dissociative symptoms score was 16.1 (standard deviation = 14.9) and 80.9% were considered to have low dissociation (score \u3c 30). There was a significant association between medication type and dissociative symptoms (p = .01). Participants prescribed buprenorphine had higher mean dissociation symptom scores (18.8) compared to methadone (12.7) and naltrexone (12.8). Their last use of alcohol or other drugs (p = .006) was significantly associated with dissociation symptoms. Overall, the multiple linear regression model was significant (F = 3.54; p = .003) and explained 11.8% of the variance. Compared to buprenorphine, both methadone (β = -0.479; p = .01) and naltrexone (β = 0.266; p = 0.007) had significantly lower dissociation scores, controlling for the other variables

Treatment for Opioid Use Disorders and Dissociative Symptoms

Opioid use has been associated with numerous psychiatric symptoms, including dissociative symptoms. Medications that are used to treat opioid use disorder can potentially impact dissociative symptoms, but this has not been explored in the existing literature. We intended to examine the relationship between dissociative symptoms and opioid use disorders using the Dissociative Experiences Scale (DES). We studied subjects who were prescribed methadone, buprenorphine or naltrexone for opioid use disorder. Surveys were given to subjects in three substance use treatment facilities: TCN Behavioral Health Services, Inc., Project C.U.R.E., Inc. and Access Ohio. All data were analyzed using SAS version 9.4 (Cary, NC) and p-values \u3c.05 were considered statistically significant. Analysis of Variance (ANOVA) was conducted to examine associations between the study variables and the outcome. A multiple linear regression model was developed to examine the association between opioid medication type and dissociative symptoms. There were 116 participants included in the analysis. Approximately 55% of participants were prescribed buprenorphine. The majority of participants were female (51.7%), white (89.5%), and ≤ 40 years of age (64.7%). The average dissociative symptoms score was 16.1 (standard deviation = 14.9) and 80.9% were considered to have low dissociation (score \u3c 30). There was a significant association between medication type and dissociative symptoms (p = .01). Participants prescribed buprenorphine had higher mean dissociation symptom scores (18.8) compared to methadone (12.7) and naltrexone (12.8). Their last use of alcohol or other drugs (p = .006) was significantly associated with dissociation symptoms. Overall, the multiple linear regression model was significant (F = 3.54; p = .003) and explained 11.8% of the variance. Compared to buprenorphine, both methadone (β = -0.479; p = .01) and naltrexone (β = 0.266; p = 0.007) had significantly lower dissociation scores, controlling for the other variables