5 takeaways:
➀ Phone apps can improve patient outcomes compared to standard treatment. Dr. Lisa Marsch, who directs the Center for Technology and Behavioral Health at Dartmouth College, described one randomized, controlled trial conducted with adults who met criteria for an opioid use disorder. All patients were offered buprenorphine to stabilize brain neurochemistry. Some patients also received individual counseling three times a week in one-on-one sessions. Other patients received standard treatment offered in outpatient treatment programs. And the remaining patients were paired with clinicians they checked in with every other week while getting the bulk of their treatment through interactive software. The results? The three-times-a-week treatment and the digital treatment were essentially the same – and both were better than the standard treatment that people generally get in outpatient treatment programs. “There is now a pretty substantive literature that shows that digital treatments can produce outcomes that are as good as – or sometimes better than – clinician-delivered treatments,” Marsch said.
➁ Treatment apps are like “a therapist in your pocket.” Marsch said these digital tools for kicking substance use disorders can “extend the reach and the impact of clinicians,” offering doctors “another tool in the toolbox.” Addiction-busting apps are more complex than common wellness apps for smartphones. They take evidence-based, clinically validated models of care and make it available for patients. While the apps work differently, in general they gather data that can predict behavior. They gather information about a patient’s movement patterns, sleep, activity levels and heart rate, and they also ask questions about stress, current pain levels, withdrawal symptoms, mood and adherence to meds.
➂ After some hesitancy, addiction specialists have embraced such tools. Nobody likes the idea of being replaced by a machine – and an iPhone is just a fancy, albeit small, machine. “When we first started this work – probably the late ’90s – we did get a lot of perceived threat from clinicians. Like, ‘Are you trying to say that this technology can do what I’ve been specially trained to do?’” Marsch said. “That has changed dramatically, where now we see a lot of excitement, where people feel like this is another resource I can give to my patients when I’m not with them.” That 24/7 access is key: Addiction doctors know they can’t treat everybody and can’t be a constant presence for patients. The apps fill in the gaps.
➃ Some digital therapeutics can be prescribed for the substance use disorders. The U.S. Food and Drug Administration, which approves drugs and devices for medical use, gave the green light to a product from Pear Therapeutics in 2017 for treatment of substance use disorders, and then in 2018 for treatment of opioid use disorders. Since then, other companies have begun to seek FDA approval for prescription digital therapeutic status. FDA approval lets patients and doctors know which of the 200-plus wellness apps in the marketplace are backed by clinical evidence. Government health programs are still deciding whether to reimburse for digital treatments.
➄ Traditional and digital therapies can be complementary. Just as the COVID-19 has normalized online care, interactive digital care will likely become more and more accepted, Marsch said. “I really truly think one day we’re going to get to this place where we don’t even talk about digital health as its own thing,” she said. “I think it’s just going to be embedded more into the fabric of how we think about health and health care.”
This program is sponsored by the American Society of Addiction Medicine, with support from Arnold Ventures. NPF retains sole responsibility for programming and content.
