Emerging Treatment Technologies
According to Mario San Bartolome, MD, MBA, MRO, FASAM, National Medical Director, Substance Use Disorders at Molina Healthcare, Inc., digital therapeutics may hold the key to treating OUDs. Digital therapeutics leverage computer-based and mobile technologies to complement medical or psychological treatments. It is an additional tool to deliver evidence-based treatments in a convenient, familiar, and confidential form.
“Change is scary, but we need to provide access to care every way we can,” said Dr San Bartolome.
Digital therapeutics can improve the effectiveness of behavioral interventions like cognitive behavioral therapy (CBT) by pairing skills training to encourage behavior change using nondrug incentives that reinforce positive behaviors. This technology combines a community reinforcement approach with contingency management. The true opportunity for digital therapeutics, said Dr San Bartolome, lies in 3 areas:
• Standardization of quality and increased consistency
• Reduced variability, such as the variability inherent in face-to-face therapy that makes measurement difficult
• Optimization of the technology to personalize each patient’s tools to improve adaption
Because most Americans have a mobile phone, digital therapeutics are a unique way to reach previously underserved populations. By piercing that barrier to access, providers can deliver treatment the way it is needed by the patient, when it is needed by the patient, said Dr San Bartolome. Other benefits include:
• A fluency-based delivery method that allows patients to move through treatment at their own pace
• Reduced cost
• Increased engagement
• Longer commitment to treatment
• More positive patient experience
• Less therapist intervention time
• Reduced stigma because the solution can be done privately
A large-scale, multisite randomized controlled trial of digital therapeutics for patients with alcohol or illicit drug disorders not receiving MAT found:
• Increased treatment retention over a 12-week period
• Outcomes that were equally effective at supporting abstinence in patients abstinent at baseline as traditional treatment
• Double the odds of abstinence among patients not abstinent at baseline compared with traditional treatment
The first 2 FDA-approved digital therapeutics are 90-day reSET for substance use disorders and 84-day reSET-O, which is specifically for OUD. They are designed to support outpatient treatment therapies such as contingency management and transmucosal buprenorphine by providing CBT modules that enhance retention.
“There’s quite convincing evidence that digital therapeutics are impactful and should be embraced,” said Dr San Bartolome. “I think of treatment like a tool belt. You pick the right tool for your patient, and this is just one more tool to choose from.”
The key to adherence is completing the CBT modules. In fact, a study showed that patients who completed the recommended number of modules in the first 6 weeks were more than 3 times as likely to complete the full 12-week course of treatment, said Dr San Bartolome.
However, he said, adopting new technologies requires:
• Increased attention and accessibility
• Evidence of feasibility and effectiveness, including collecting and analyzing feedback
• Adequate resources for adoption, including developing a plan and using the principles of change management to continue to refine it
• Encouragement of organization-wide change by promoting a team effort
Other digital therapeutics tools include Addiction Comprehensive Health Enhancement Support System (A-CHESS), Computer-Based Training for Cognitive Behavioral Therapy (CBT4CBT), and virtual reality applications. Researchers are investigating the use of digital therapeutics in inpatient settings, according to Dr San Bartolome.
Das S, San Bartolome M. Advancing the integration of digital therapeutics into addiction management strategies: engaging multidisciplinary stakeholders for optimal application in practice. Webinar presented June 24, 2019.
This article originally appeared on Psychiatry Advisor