After an unprecedented year for treatment, can we improve clinical and financial outcomes as COVID continues to disrupt the lives of individuals in recovery? Things may never be the same…
Today: The dark before the dawn
As COVID continues, addiction issues deepen
We are nearly two months into 2021. The last of our New Year’s resolutions have now been broken or forgotten. We have a new president, a promising set of vaccines — and Tom Brady wins yet another Super Bowl. But while we look hopefully ahead, it’s clear that the damage done in 2020 to the lives of so many may take years — or much longer — to overcome. The world has changed, and for those working to achieve recovery — and for the dedicated professionals who treat them — their very foundations have been shaken.
In January of this year, The New York Times ran a story about the heartbreaking difficulty of trying to overcome addiction during a pandemic. It described the situation this way: “People are relapsing left and right.”
It is an understatement to say that the pandemic has had a devastating effect on patients and care professionals. Today, there is dire need for increased support for SUD, Eating Disorders and Behavioral Health treatment, which has been overshadowed by the virus. Opioid overdose deaths (up sharply, more on that in a moment) sparked the push to ease rules on dispensing Buprenorphine and to enact other emergency measures, but the root of the problem — lack of structured, in-person counseling, and a reliable continuum of care — compounded by the continued stress of COVID-19 — still drives far too many relapses. Many in need of care simply have no hope of getting it. Even those receiving treatment are struggling. Things seem to be getting worse for many as we await widespread vaccination and — hopefully — a return to some form of normal. In a nutshell, that’s where we are right now.
Short Term Future: The Reckoning
The Final Overdose Death Toll Will Be Shocking
The people of planet Earth will slowly emerge from the months of fear, loss and anxiety as the vaccine makes its way into the population (with reported protection against the vicious new strains that have already reached our shores). Experts estimate that it will be late summer or early fall before the vaccine will be available for everyone in the United States. Until then, the short term future will look much like it does now. For a while longer. But for many, it’s already too late. Individuals working to achieve recovery now face the risk of relapse, overdose and death. Nationally, suspected overdose submissions to the Overdose Mapping Application Program (ODMAP) in 2020 rose by 18% in March, 29% in April, and 42% in May, based on a 30-day rolling comparison to these months in 2019. To be sure, 2020 was a deadly year. And we’re not even done calculating the final numbers.
Early predictions of a troubled future
According to an estimate from a report from the Well Being Trust and the American Academy of Family Physicians, the economic recession resulting from the COVID-19 pandemic may lead to a large increase in deaths from drug overdose, alcohol abuse, and suicide — in coming years. Sadly, projections for excess deaths from these causes over the next 10 years range from 27,644 to 154,037 (with 75,000 excess deaths being the most likely). How many of those “excess” deaths can be avoided?
As the need for (more) treatment increases, will it be available? We’ve said many times here that the biggest challenge associated with addiction treatment in the coming years — and decades — is to ensure that everyone who needs treatment receives it. Currently — and shamefully — only about 10 percent of people with substance abuse disorders receive comprehensive addiction treatment. Improving the situation for so many lives means making treatment more accessible to more people. It must be affordable, so that anyone with the need can receive high-quality addiction treatment.
Long Term Future: Disruption
Reduced stigma, more access to care, better data
Insurers, treatment providers, employers, and government policymakers must face the considerable challenges in addressing the large scope of the addiction treatment and behavioral health crisis that‘s on the horizon. All pursuing the goal of preventing relapse and promoting sustained recovery.
So what needs improvement — or change?
Deeper understanding of SUD and behavioral health disorders
Research into understanding behavioral health disorders is still in an emerging phase. Behavioral disorder classifications deal with multiple causalities, and diagnoses often have less discrete categorizations, unclear thresholds between disorder and non-disorder markers, and frequent comorbidities where patients suffer from multiple conditions.
Getting rid of the stigma, creating pathways to health
The stigma of addiction can make people with SUD or behavioral health problems less willing to seek treatment or to share their personal information with others, including clinicians. We applaud governments that are actively helping to lower stigma by increasing investment in SUD and behavioral health issues, which helps to call attention to the pressing need. They are also elevating challenges and opportunities into public discussions and protecting individuals against behavioral health-related discrimination. That’s good news.
Improving Health care data management
The negative impact of siloed health care data extends to behavioral health data and limits clinicians’ insight into clinical decision-making.
Although telehealth and app-based access to behavioral health support are expanding, there is a need for diagnosis and care data to be more readily accessible and integrated with all medical and social services. In the future, consumers will be able to systematically access and control all their data. Advanced governance standards and a secure centralized database can drive an efficient, safe data environment to guarantee privacy.
Data sharing will be underpinned by fully interoperable health data built on universal standards and carry a personal life record. It‘s already underway: Apple, Amazon, Google, and Microsoft all committed to supporting data interoperability in health care by publishing open-source, cloud-based software solutions to support greater interoperability for sharing information.
Adopting new technological breakthroughs
New treatments, including cost-effective therapeutics, along with a variety of revolutionary tools will bring down costs and improve treatment. In turn, organizations offering care will be able to tailor treatments to individuals’ personal needs and genetic profiles.
Increasing access to care (Repeat: More care)
Cultural change and increasingly cost-efficient scientific breakthroughs will together lead to better access to care for everyone. Insurance coverage will expand to greater and greater numbers of individuals to enable this access. Emerging digital care modalities and health tools will augment face-to-face, in-person care, and behavioral health treatment will increasingly become a part of primary care—ensuring that scientific and technological treatment modalities are available for everyone.
The emergence of telehealth
At Kipu, we have implemented an embedded ZOOM application for Telehealth including virtual Group Sessions. Since rollout, we’ve seen it being used more than seven times our initial expectations – proving the need and popularity of Telehealth. It’s here to say, and will continuously improve.
Living in a strange new post-COVID-19 world
The pandemic will end. The question is, of course, when? And what will the landscape look like when all patients can safely return to in-person treatment? Will facilities be ready? Will funding and other resources become more readily available in the post-COVID-19 era? With a presumed increase in demand for treatment as a result of the pandemic, will more individuals seek help — some for the first time? Will the stigma of addiction finally end — and we agree that it is truly a disease?
And what opportunities lie ahead for providers? Will the end of the pandemic mean a rush to recovery? Will apprehensive employees return to an in-person workplace?
The Foreseeable (but not too distant) Future: The Algorithm
More disruption. More innovation. Improved outcomes
An array of disruptive technologies are already emerging to support—or compete with—big players and old ideas in the behavioral health world.
Virtual assistants Artificial Intelligence-based chatbots and emotion-based algorithms will provide psychological support (often based on clinical techniques) and information. Resources use a natural interaction that is low stigma and scalable.
Digital consumer experience technologies Easy-to-use digital platforms that manage the patient relationship, monitor and exchange health information between patient and caregivers, and connect the patient with available tools to enhance their experiences.
Diagnostic support technologies Digital screening tools, both self-guided and assisting medical diagnosis, will gather diagnostic data and provide psychological assessments — to identify symptoms for early detection and improved classification.
Neurological interventions Improved, new surgical, ingestible, and non-invasive interventional tools to observe and affect brain and body function.
Physical, augmented, and virtual reality Psychological intervention using hyper-realistic virtual environments and real-world robotics for companionship, experiential treatment sessions, and enhanced cognitive experiences.
Perhaps we‘ve gained wisdom and perspective?
The year 2020 brought many changes and taught us many lessons. Such lessons from the world of behavioral health and SUD treatment are also a window into what it means to be human. Maybe it’s as simple as our returning to the things we’ve recently lost: a life grounded in meaningful connections and fulfilling relationships with others — and with oneself. A life driven by a purpose and passion greater than itself is, in many ways, “a good life.”