Physical distancing guidelines during the COVID-19 pandemic disrupted treatment for patients globally. However, it is unknown how the pandemic impacted outpatient treatment for alcohol use disorder. This study examined outpatient alcohol use disorder treatment during the first year of the COVID-19 pandemic with a particular focus on telemedicine visits.
l
Alcohol use disorders are associated with myriad health issues including high blood pressure, certain types of cancers, and poor mental health. Alcohol use disorder is a chronic disease- managing this condition requires continuous monitoring from health professionals to maintain recovery and address acute relapses.
The COVID-19 pandemic resulted in widespread restrictions in public activities. As a result, healthcare visits among patients dropped precipitously. These restrictions lead to healthcare professionals pivoting from providing traditional in-person visits to relying primarily on telemedicine. This transition allowed patients that had access to broadband internet to continue receiving needed care while also following COVID-19 physical distancing guidelines.
It is unclear how alcohol use disorder treatment may have been impacted by this transition to remote visits. Given that the pandemic was associated with a rise in alcohol use in the US, and many health care institutions scaled up telemedicine access, there may have been an increase in alcohol use disorder treatment engagement. Conversely, because there were reductions to in-person service access, and some do not have access to broadband internet or smartphones with a data plan needed to engage with telemedicine, there may have been a decrease in alcohol use disorder treatment engagement Additionally, specific groups within the alcohol use disorder patient population have experienced more barriers to care than others (e.g., women, and those living in rural areas), so the pandemic may have hit them especially hard. To empirically test these questions, this study examined outpatient alcohol use disorder treatment during the first year of COVID-19 with a particular focus on telemedicine visits.
This study analyzed health insurance claims data from the OptumLabs Data Warehouse. Data were enrollees’ health care visits for services billed to the health plan for payment purposes (e.g., visit or procedure codes) across the US. These data included some demographic information on patients (e.g., age, assigned sex, and rurality). All data were de-identified (anonymous).
Participants in the current analysis (N=92,621) came from two cohorts of patients identified as having an alcohol use disorder (see below). The first cohort consisted of individuals from 2018-2020 (n=23,204) and the second was made up of patients from 2019-2021(n=23,445). The latter cohort was used to compare treatment utilization during the pandemic to treatment utilization pre-pandemic. Patients included in the analyses had to meet these criteria: 1) 18-64 years of age; 2) have continuous enrollment in medical, behavioral health, and pharmacy benefits for 2 years (i.e., 2018 and 2019 or 2019 and 2020); and 3) have a diagnosis of alcohol use disorder. Individuals were identified as having an alcohol use disorder if at least one of the following were present in their healthcare claims data within the first year of their cohort: a) 1+ hospitalizations where alcohol use disorder was the primary diagnosis, 2) 1+ emergency department visit where alcohol use disorder was in the first or second diagnostic field, or 3) at least 2 face-to-face visits (e.g., non-laboratory or imaging) on separate days in either outpatient, intensive outpatient, partial hospital, or residential care with a diagnosis of alcohol use disorder in the primary or secondary diagnosis field. As such, each of the 2018 and 2019 cohorts was made up of an established group of alcohol use disorder patients that sought care in that calendar year.
The main outcome of this study was use of any alcohol use disorder related outpatient treatment in the year following the index year. For the 2018 cohort, the study examined treatment in 2019 and for the 2019 cohort, the study examined treatment in 2020 (overlapping with onset of the COVID-19 pandemic). Such treatment was defined as any outpatient visit where an alcohol use disorder diagnosis was in the primary or secondary diagnostic field of the claim defined by using Current Procedural Terminology and Healthcare Common Procedure Coding System codes. Outpatient visit types were categorized as initial assessments, evaluation and management visits, or therapy (individual, group, or family) visits. In addition, this study examined usage of medications for alcohol use disorder. This included prescription fills, or facility administered administration for any of the following medications: acamprosate, naltrexone (also prescribed as a monthly injection known and marketed by the brand name “Vivitrol”), disulfiram (also known and marketed by the brand name “Antabuse”), or topiramate.
Participants in both cohorts were predominately identified as male (64.2% and 64.3% for the 2018 and 2019 cohorts respectively). The majority of patients lived in non-rural regions of the US (97.9% and 97.3% for the 2018 and 2019 cohorts respectively). Most participants were between the ages of 35-64 (71.8% and 68.1% for the 2018 and 2019 cohorts respectively). Roughly 25% of participants from each cohort were diagnosed with a cooccurring substance use disorder during the first year of their cohort.
Outpatient alcohol use disorder treatment during the pandemic initially declined, later rebounded.
During the first weeks of the pandemic (mid-March through mid-April) there were 23% fewer outpatient visits for alcohol use disorder across all types of treatment relative to the same weeks in 2019. This began to change by early August 2020, however, when the number of people receiving outpatient treatment was nearly identical to the same period in 2019. The similar rates of treatment attendance remained when controlling for participant characteristics (e.g., age and gender assigned in the patient record). Use of medications for alcohol use disorder was the same before and during the pandemic.
After an initial dip in visits, the total number of outpatient visits for alcohol use disorder during the pandemic was roughly the same as before the pandemic.
Telemedicine use helped treatment rates overall keep up or increase during the pandemic, but not for group therapy.
Telemedicine use increased from 2% of alcohol use disorder outpatient visits before the COVID-19 pandemic, to 30% in the first week after the public health emergency declaration in March 2020, to a peak of 60% in May 2020. Following early July 2020, the percentage of individual therapy visits conducted via telemedicine ranged from 48.4% to 59.9% and for group therapy ranged from 39.4% to 51.6%.
Alcohol use disorder treatment attendance was stable, overall, between 2019 and 2020, a pattern generally similar across gender, rural vs. urban location, alcohol use disorder severity, and co-occurring mental health disorders. Of note, this stability was carried primarily by individual therapy attendance. For those with alcohol use disorder, 8.21% attended individual therapy in 2019 compared to 8.60% in 2020, a nonsignificant 5% increase. For group therapy, however, 2.19% attended treatment in 2019 and 1.67% in 2020, a significant 24% decline.
The results of this study demonstrate that despite an initial drop in visits, patients continued receiving outpatient treatment for alcohol use disorder during the COVID-19 pandemic, and for individual therapy even increased engagement, descriptively, compared to pre-pandemic rates. It is important to mention that these findings only tell us about rates of telemedicine engagement, not about treatment outcomes.
Results of the present study suggest that telemedicine may be better suited to individual therapy compared to group therapy for alcohol use disorder. The researchers found that although the number of outpatient visits for alcohol use disorder rivaled or outpaced pre-pandemic levels, the lion’s share of these visits consisted of individual therapy sessions. The number of group therapy sessions was lower during the pandemic relative to pre-pandemic. These trends were concurrent with a dramatic rise in the use of telemedicine technologies- suggesting conducting group therapy for alcohol use disorder via telemedicine technology may be more challenging than individual therapy.
Of note, this study also found that participant characteristics did not significantly impact receiving alcohol use disorder treatment during the pandemic. This is surprising as past research has shown that subpopulations within the larger group of alcohol use disorder patients face unique barriers to care. For instance, women with alcohol use disorders are less likely to access treatment than men and are more likely to report stigma as a barrier to accessing care. Similarly, those living in rural areas are less likely to access alcohol use disorder care relative to those in urban areas. It is not clear why the current study’s findings differ. One possible explanation for this divergence from past research may be that the sample was derived exclusively from those with consistent commercial health insurance for two years pre- or during the pandemic. The exclusion of those without such coverage (e.g., those on Medicaid) may have excluded populations who face barriers to alcohol use disorder treatment.
Ultimately, these results imply that telemedicine may be a viable alternative treatment modality for alcohol use disorder therapy if in-person options are not available. To be clear, this study did not examine outcomes during the pandemic and how they compared to pre-pandemic levels. Therefore, it is unknown how effective the telemedicine used by enrollees was (although other research suggests that telemedicine in general is effective). Nevertheless, eliminating barriers to telemedicine in the US could be an invaluable way to reduce the impact of alcohol use disorder in the population at large. Efforts to ensure access to telemedicine (e.g., access to affordable high-speed internet) should be expanded.
This study found that patients continued to receive treatment for alcohol use disorder despite challenges posed by the COVID-19 pandemic. Treatment was provided via the use of telemedicine, where rates of treatment seeking outpaced pre-pandemic levels by September 2020. This pattern, however, was accounted for by greater rates of individual therapy which was likely easier to deliver to individuals than across multiple patients in group therapy. Understanding how this shift in treatment modality may have impacted the trajectory of alcohol use disorder (e.g., relapse rates) for these patients is important. Given that barriers to treatment access predated COVID-19 and will persist well beyond the pandemic, understanding telemedicine and other innovative ways to engage individuals with alcohol use disorder in care will allow for more effective treatment beyond the COVID-19 pandemic.
Busch, A. B., Mehrotra, A., Greenfield, S. F., Uscher-Pines, L., Rose, S., & Huskamp, H. A. (2023). A cohort study examining changes in treatment patterns for alcohol use disorder among commercially insured adults in the United States during the COVID-19 pandemic. Journal of Substance Abuse Treatment, 144, 108920. doi: 10.1016/j.jsat.2022.108920
l
Alcohol use disorders are associated with myriad health issues including high blood pressure, certain types of cancers, and poor mental health. Alcohol use disorder is a chronic disease- managing this condition requires continuous monitoring from health professionals to maintain recovery and address acute relapses.
The COVID-19 pandemic resulted in widespread restrictions in public activities. As a result, healthcare visits among patients dropped precipitously. These restrictions lead to healthcare professionals pivoting from providing traditional in-person visits to relying primarily on telemedicine. This transition allowed patients that had access to broadband internet to continue receiving needed care while also following COVID-19 physical distancing guidelines.
It is unclear how alcohol use disorder treatment may have been impacted by this transition to remote visits. Given that the pandemic was associated with a rise in alcohol use in the US, and many health care institutions scaled up telemedicine access, there may have been an increase in alcohol use disorder treatment engagement. Conversely, because there were reductions to in-person service access, and some do not have access to broadband internet or smartphones with a data plan needed to engage with telemedicine, there may have been a decrease in alcohol use disorder treatment engagement Additionally, specific groups within the alcohol use disorder patient population have experienced more barriers to care than others (e.g., women, and those living in rural areas), so the pandemic may have hit them especially hard. To empirically test these questions, this study examined outpatient alcohol use disorder treatment during the first year of COVID-19 with a particular focus on telemedicine visits.
This study analyzed health insurance claims data from the OptumLabs Data Warehouse. Data were enrollees’ health care visits for services billed to the health plan for payment purposes (e.g., visit or procedure codes) across the US. These data included some demographic information on patients (e.g., age, assigned sex, and rurality). All data were de-identified (anonymous).
Participants in the current analysis (N=92,621) came from two cohorts of patients identified as having an alcohol use disorder (see below). The first cohort consisted of individuals from 2018-2020 (n=23,204) and the second was made up of patients from 2019-2021(n=23,445). The latter cohort was used to compare treatment utilization during the pandemic to treatment utilization pre-pandemic. Patients included in the analyses had to meet these criteria: 1) 18-64 years of age; 2) have continuous enrollment in medical, behavioral health, and pharmacy benefits for 2 years (i.e., 2018 and 2019 or 2019 and 2020); and 3) have a diagnosis of alcohol use disorder. Individuals were identified as having an alcohol use disorder if at least one of the following were present in their healthcare claims data within the first year of their cohort: a) 1+ hospitalizations where alcohol use disorder was the primary diagnosis, 2) 1+ emergency department visit where alcohol use disorder was in the first or second diagnostic field, or 3) at least 2 face-to-face visits (e.g., non-laboratory or imaging) on separate days in either outpatient, intensive outpatient, partial hospital, or residential care with a diagnosis of alcohol use disorder in the primary or secondary diagnosis field. As such, each of the 2018 and 2019 cohorts was made up of an established group of alcohol use disorder patients that sought care in that calendar year.
The main outcome of this study was use of any alcohol use disorder related outpatient treatment in the year following the index year. For the 2018 cohort, the study examined treatment in 2019 and for the 2019 cohort, the study examined treatment in 2020 (overlapping with onset of the COVID-19 pandemic). Such treatment was defined as any outpatient visit where an alcohol use disorder diagnosis was in the primary or secondary diagnostic field of the claim defined by using Current Procedural Terminology and Healthcare Common Procedure Coding System codes. Outpatient visit types were categorized as initial assessments, evaluation and management visits, or therapy (individual, group, or family) visits. In addition, this study examined usage of medications for alcohol use disorder. This included prescription fills, or facility administered administration for any of the following medications: acamprosate, naltrexone (also prescribed as a monthly injection known and marketed by the brand name “Vivitrol”), disulfiram (also known and marketed by the brand name “Antabuse”), or topiramate.
Participants in both cohorts were predominately identified as male (64.2% and 64.3% for the 2018 and 2019 cohorts respectively). The majority of patients lived in non-rural regions of the US (97.9% and 97.3% for the 2018 and 2019 cohorts respectively). Most participants were between the ages of 35-64 (71.8% and 68.1% for the 2018 and 2019 cohorts respectively). Roughly 25% of participants from each cohort were diagnosed with a cooccurring substance use disorder during the first year of their cohort.
Outpatient alcohol use disorder treatment during the pandemic initially declined, later rebounded.
During the first weeks of the pandemic (mid-March through mid-April) there were 23% fewer outpatient visits for alcohol use disorder across all types of treatment relative to the same weeks in 2019. This began to change by early August 2020, however, when the number of people receiving outpatient treatment was nearly identical to the same period in 2019. The similar rates of treatment attendance remained when controlling for participant characteristics (e.g., age and gender assigned in the patient record). Use of medications for alcohol use disorder was the same before and during the pandemic.
After an initial dip in visits, the total number of outpatient visits for alcohol use disorder during the pandemic was roughly the same as before the pandemic.
Telemedicine use helped treatment rates overall keep up or increase during the pandemic, but not for group therapy.
Telemedicine use increased from 2% of alcohol use disorder outpatient visits before the COVID-19 pandemic, to 30% in the first week after the public health emergency declaration in March 2020, to a peak of 60% in May 2020. Following early July 2020, the percentage of individual therapy visits conducted via telemedicine ranged from 48.4% to 59.9% and for group therapy ranged from 39.4% to 51.6%.
Alcohol use disorder treatment attendance was stable, overall, between 2019 and 2020, a pattern generally similar across gender, rural vs. urban location, alcohol use disorder severity, and co-occurring mental health disorders. Of note, this stability was carried primarily by individual therapy attendance. For those with alcohol use disorder, 8.21% attended individual therapy in 2019 compared to 8.60% in 2020, a nonsignificant 5% increase. For group therapy, however, 2.19% attended treatment in 2019 and 1.67% in 2020, a significant 24% decline.
The results of this study demonstrate that despite an initial drop in visits, patients continued receiving outpatient treatment for alcohol use disorder during the COVID-19 pandemic, and for individual therapy even increased engagement, descriptively, compared to pre-pandemic rates. It is important to mention that these findings only tell us about rates of telemedicine engagement, not about treatment outcomes.
Results of the present study suggest that telemedicine may be better suited to individual therapy compared to group therapy for alcohol use disorder. The researchers found that although the number of outpatient visits for alcohol use disorder rivaled or outpaced pre-pandemic levels, the lion’s share of these visits consisted of individual therapy sessions. The number of group therapy sessions was lower during the pandemic relative to pre-pandemic. These trends were concurrent with a dramatic rise in the use of telemedicine technologies- suggesting conducting group therapy for alcohol use disorder via telemedicine technology may be more challenging than individual therapy.
Of note, this study also found that participant characteristics did not significantly impact receiving alcohol use disorder treatment during the pandemic. This is surprising as past research has shown that subpopulations within the larger group of alcohol use disorder patients face unique barriers to care. For instance, women with alcohol use disorders are less likely to access treatment than men and are more likely to report stigma as a barrier to accessing care. Similarly, those living in rural areas are less likely to access alcohol use disorder care relative to those in urban areas. It is not clear why the current study’s findings differ. One possible explanation for this divergence from past research may be that the sample was derived exclusively from those with consistent commercial health insurance for two years pre- or during the pandemic. The exclusion of those without such coverage (e.g., those on Medicaid) may have excluded populations who face barriers to alcohol use disorder treatment.
Ultimately, these results imply that telemedicine may be a viable alternative treatment modality for alcohol use disorder therapy if in-person options are not available. To be clear, this study did not examine outcomes during the pandemic and how they compared to pre-pandemic levels. Therefore, it is unknown how effective the telemedicine used by enrollees was (although other research suggests that telemedicine in general is effective). Nevertheless, eliminating barriers to telemedicine in the US could be an invaluable way to reduce the impact of alcohol use disorder in the population at large. Efforts to ensure access to telemedicine (e.g., access to affordable high-speed internet) should be expanded.
This study found that patients continued to receive treatment for alcohol use disorder despite challenges posed by the COVID-19 pandemic. Treatment was provided via the use of telemedicine, where rates of treatment seeking outpaced pre-pandemic levels by September 2020. This pattern, however, was accounted for by greater rates of individual therapy which was likely easier to deliver to individuals than across multiple patients in group therapy. Understanding how this shift in treatment modality may have impacted the trajectory of alcohol use disorder (e.g., relapse rates) for these patients is important. Given that barriers to treatment access predated COVID-19 and will persist well beyond the pandemic, understanding telemedicine and other innovative ways to engage individuals with alcohol use disorder in care will allow for more effective treatment beyond the COVID-19 pandemic.
Busch, A. B., Mehrotra, A., Greenfield, S. F., Uscher-Pines, L., Rose, S., & Huskamp, H. A. (2023). A cohort study examining changes in treatment patterns for alcohol use disorder among commercially insured adults in the United States during the COVID-19 pandemic. Journal of Substance Abuse Treatment, 144, 108920. doi: 10.1016/j.jsat.2022.108920
l
Alcohol use disorders are associated with myriad health issues including high blood pressure, certain types of cancers, and poor mental health. Alcohol use disorder is a chronic disease- managing this condition requires continuous monitoring from health professionals to maintain recovery and address acute relapses.
The COVID-19 pandemic resulted in widespread restrictions in public activities. As a result, healthcare visits among patients dropped precipitously. These restrictions lead to healthcare professionals pivoting from providing traditional in-person visits to relying primarily on telemedicine. This transition allowed patients that had access to broadband internet to continue receiving needed care while also following COVID-19 physical distancing guidelines.
It is unclear how alcohol use disorder treatment may have been impacted by this transition to remote visits. Given that the pandemic was associated with a rise in alcohol use in the US, and many health care institutions scaled up telemedicine access, there may have been an increase in alcohol use disorder treatment engagement. Conversely, because there were reductions to in-person service access, and some do not have access to broadband internet or smartphones with a data plan needed to engage with telemedicine, there may have been a decrease in alcohol use disorder treatment engagement Additionally, specific groups within the alcohol use disorder patient population have experienced more barriers to care than others (e.g., women, and those living in rural areas), so the pandemic may have hit them especially hard. To empirically test these questions, this study examined outpatient alcohol use disorder treatment during the first year of COVID-19 with a particular focus on telemedicine visits.
This study analyzed health insurance claims data from the OptumLabs Data Warehouse. Data were enrollees’ health care visits for services billed to the health plan for payment purposes (e.g., visit or procedure codes) across the US. These data included some demographic information on patients (e.g., age, assigned sex, and rurality). All data were de-identified (anonymous).
Participants in the current analysis (N=92,621) came from two cohorts of patients identified as having an alcohol use disorder (see below). The first cohort consisted of individuals from 2018-2020 (n=23,204) and the second was made up of patients from 2019-2021(n=23,445). The latter cohort was used to compare treatment utilization during the pandemic to treatment utilization pre-pandemic. Patients included in the analyses had to meet these criteria: 1) 18-64 years of age; 2) have continuous enrollment in medical, behavioral health, and pharmacy benefits for 2 years (i.e., 2018 and 2019 or 2019 and 2020); and 3) have a diagnosis of alcohol use disorder. Individuals were identified as having an alcohol use disorder if at least one of the following were present in their healthcare claims data within the first year of their cohort: a) 1+ hospitalizations where alcohol use disorder was the primary diagnosis, 2) 1+ emergency department visit where alcohol use disorder was in the first or second diagnostic field, or 3) at least 2 face-to-face visits (e.g., non-laboratory or imaging) on separate days in either outpatient, intensive outpatient, partial hospital, or residential care with a diagnosis of alcohol use disorder in the primary or secondary diagnosis field. As such, each of the 2018 and 2019 cohorts was made up of an established group of alcohol use disorder patients that sought care in that calendar year.
The main outcome of this study was use of any alcohol use disorder related outpatient treatment in the year following the index year. For the 2018 cohort, the study examined treatment in 2019 and for the 2019 cohort, the study examined treatment in 2020 (overlapping with onset of the COVID-19 pandemic). Such treatment was defined as any outpatient visit where an alcohol use disorder diagnosis was in the primary or secondary diagnostic field of the claim defined by using Current Procedural Terminology and Healthcare Common Procedure Coding System codes. Outpatient visit types were categorized as initial assessments, evaluation and management visits, or therapy (individual, group, or family) visits. In addition, this study examined usage of medications for alcohol use disorder. This included prescription fills, or facility administered administration for any of the following medications: acamprosate, naltrexone (also prescribed as a monthly injection known and marketed by the brand name “Vivitrol”), disulfiram (also known and marketed by the brand name “Antabuse”), or topiramate.
Participants in both cohorts were predominately identified as male (64.2% and 64.3% for the 2018 and 2019 cohorts respectively). The majority of patients lived in non-rural regions of the US (97.9% and 97.3% for the 2018 and 2019 cohorts respectively). Most participants were between the ages of 35-64 (71.8% and 68.1% for the 2018 and 2019 cohorts respectively). Roughly 25% of participants from each cohort were diagnosed with a cooccurring substance use disorder during the first year of their cohort.
Outpatient alcohol use disorder treatment during the pandemic initially declined, later rebounded.
During the first weeks of the pandemic (mid-March through mid-April) there were 23% fewer outpatient visits for alcohol use disorder across all types of treatment relative to the same weeks in 2019. This began to change by early August 2020, however, when the number of people receiving outpatient treatment was nearly identical to the same period in 2019. The similar rates of treatment attendance remained when controlling for participant characteristics (e.g., age and gender assigned in the patient record). Use of medications for alcohol use disorder was the same before and during the pandemic.
After an initial dip in visits, the total number of outpatient visits for alcohol use disorder during the pandemic was roughly the same as before the pandemic.
Telemedicine use helped treatment rates overall keep up or increase during the pandemic, but not for group therapy.
Telemedicine use increased from 2% of alcohol use disorder outpatient visits before the COVID-19 pandemic, to 30% in the first week after the public health emergency declaration in March 2020, to a peak of 60% in May 2020. Following early July 2020, the percentage of individual therapy visits conducted via telemedicine ranged from 48.4% to 59.9% and for group therapy ranged from 39.4% to 51.6%.
Alcohol use disorder treatment attendance was stable, overall, between 2019 and 2020, a pattern generally similar across gender, rural vs. urban location, alcohol use disorder severity, and co-occurring mental health disorders. Of note, this stability was carried primarily by individual therapy attendance. For those with alcohol use disorder, 8.21% attended individual therapy in 2019 compared to 8.60% in 2020, a nonsignificant 5% increase. For group therapy, however, 2.19% attended treatment in 2019 and 1.67% in 2020, a significant 24% decline.
The results of this study demonstrate that despite an initial drop in visits, patients continued receiving outpatient treatment for alcohol use disorder during the COVID-19 pandemic, and for individual therapy even increased engagement, descriptively, compared to pre-pandemic rates. It is important to mention that these findings only tell us about rates of telemedicine engagement, not about treatment outcomes.
Results of the present study suggest that telemedicine may be better suited to individual therapy compared to group therapy for alcohol use disorder. The researchers found that although the number of outpatient visits for alcohol use disorder rivaled or outpaced pre-pandemic levels, the lion’s share of these visits consisted of individual therapy sessions. The number of group therapy sessions was lower during the pandemic relative to pre-pandemic. These trends were concurrent with a dramatic rise in the use of telemedicine technologies- suggesting conducting group therapy for alcohol use disorder via telemedicine technology may be more challenging than individual therapy.
Of note, this study also found that participant characteristics did not significantly impact receiving alcohol use disorder treatment during the pandemic. This is surprising as past research has shown that subpopulations within the larger group of alcohol use disorder patients face unique barriers to care. For instance, women with alcohol use disorders are less likely to access treatment than men and are more likely to report stigma as a barrier to accessing care. Similarly, those living in rural areas are less likely to access alcohol use disorder care relative to those in urban areas. It is not clear why the current study’s findings differ. One possible explanation for this divergence from past research may be that the sample was derived exclusively from those with consistent commercial health insurance for two years pre- or during the pandemic. The exclusion of those without such coverage (e.g., those on Medicaid) may have excluded populations who face barriers to alcohol use disorder treatment.
Ultimately, these results imply that telemedicine may be a viable alternative treatment modality for alcohol use disorder therapy if in-person options are not available. To be clear, this study did not examine outcomes during the pandemic and how they compared to pre-pandemic levels. Therefore, it is unknown how effective the telemedicine used by enrollees was (although other research suggests that telemedicine in general is effective). Nevertheless, eliminating barriers to telemedicine in the US could be an invaluable way to reduce the impact of alcohol use disorder in the population at large. Efforts to ensure access to telemedicine (e.g., access to affordable high-speed internet) should be expanded.
This study found that patients continued to receive treatment for alcohol use disorder despite challenges posed by the COVID-19 pandemic. Treatment was provided via the use of telemedicine, where rates of treatment seeking outpaced pre-pandemic levels by September 2020. This pattern, however, was accounted for by greater rates of individual therapy which was likely easier to deliver to individuals than across multiple patients in group therapy. Understanding how this shift in treatment modality may have impacted the trajectory of alcohol use disorder (e.g., relapse rates) for these patients is important. Given that barriers to treatment access predated COVID-19 and will persist well beyond the pandemic, understanding telemedicine and other innovative ways to engage individuals with alcohol use disorder in care will allow for more effective treatment beyond the COVID-19 pandemic.
Busch, A. B., Mehrotra, A., Greenfield, S. F., Uscher-Pines, L., Rose, S., & Huskamp, H. A. (2023). A cohort study examining changes in treatment patterns for alcohol use disorder among commercially insured adults in the United States during the COVID-19 pandemic. Journal of Substance Abuse Treatment, 144, 108920. doi: 10.1016/j.jsat.2022.108920
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