A combination of stigma, lack of coverage, as well as not enough time, resources and training being given to physicians, all are creating barriers to treatment for individuals with substance use disorder. While they shouldn’t be considered a replacement, digital therapeutics should be viewed as the type of effective complement to medical or psychological treatments that can help start to break those barriers down, Smita Das, MD, PhD, MPH, and Mario San Bartolome, MD, MBA, MRO, FASAM, said on Friday at NCAD West.
In the first portion of their session, Das, a clinical assistant professor in the Department of Psychiatry at the Stanford School of Medicine, noted that there was been a 5% reduction in uninsured individuals in the U.S. between 2011 and 2014, but the rate of treatment over that period remained static. Das attributed this to workforce challenges—including inadequate training in addictions medicine and a lack of physicians offering treatment—and stigma.
San Bartolome, national medical director for substance use disorders for Molina Healthcare, discussed how digital therapeutics, the strategy of leveraging technology to augment traditional treatment, has provided additional ways to deliver evidence-based treatments in a way that is convenient, familiar and confidential for patients. This has served the dual purpose of lightening the burden on overworked physicians and reducing stigma among patients.
Digital therapeutics are well-suited to enhance the effectiveness of behavioral interventions, such as cognitive behavioral therapy, San Bartolome said. The tools have been shown to lend themselves to standardization, and they reduce variability, all of which makes for better studies of treatment and greater optimization of services.
San Bartolome shared studies highlighting the results of practices that have implemented digital therapeutics. In the first study, computer-based and therapist-based outpatient modalities produced similar results in continuous abstinent weeks among patients, while the computer-based model required less therapist intervention time, which cut down on costs.
A second study showed that patients in computer-based CBT therapy had more drug-free urine tests, stayed in treatment longer and evaluated their treatment more positively.
San Bartolome reviewed reSET, a 90-day prescription digital therapeutic tool for SUD patients, and reSET-O, an 84-day PDT for patients with opioid use disorder. The two therapeutics are the first to be FDA-approved. Other tools highlighted during the presentation:
- A-CHESS: For electronic referrals, digital CBT modules, messaging and motivation tools, and predictive relapse risk indicators
- CBT4CBT (Computer-Based Training for Cognitive Behavioral Therapy): Web-based program that is part of a professionally administered SUD treatment program
- Virtual reality applications: Interactive mindfulness, guided imagery exercises, experiential psychoeducation, and cue exposure therapy