Substance misuse can cause major physical and mental health issues in adults as well as adolescents. While there are safe drinking guidelines promoted for adult alcohol use, there is no safe level of alcohol consumption for adolescents. Yet, more than half of the United States population over the age 12 drinks alcohol. A 2013 survey found that 28% of 12th graders report trying alcohol.1 Substance use in adolescents can, among other things, lead to school problems, social and relational difficulties, and legal problems. In light of such consequences facing such a large portion of today’s youth, addressing treatment and prevention actualities is at the forefront of healthcare conversations and development. A survey in 2013 found 1.3 million youth age 12 to 17 were in need of treatment, yet less than 10% received treatment in a specialty facility.
Rural populations specifically face even more difficulty accessing treatment. A 2003 study found that 2/3 of adolescents with co-occurring disorders, such as mental health disorders coinciding with substance use issues, did not receive the recommended dual treatment.
Telehealth and telemedicine have the capacity to address treatment accessibility in rural communities. Telehealth is “the use of electronic information and telecommunications technologies to support long-distance clinical health care, patient and professional health-related education, public health, and health administration.” Telemedicine is used to “describe the interaction between a patient and a provider when separated by geographic distance.”
Both have proven effective in providing high quality care at low cost. Technology based health care has allowed for isolated rural clinics to provide patients with access to medical specialists such as psychiatrists. Telepsychiatry is an area of telehealth that appears promising to address adolescent substance use and co-occurring disorders in rural populations. In comparison with traditional consultations, telepsychiatry has proven effective for treating children, adults, geriatric and ethnic populations for various mental health disorders that includes co-occurring mental health disorders and substance use issues.
In addition to providing accessible care to rural adolescents, studies on telehealth in rural school settings have shown positive outcomes related to decreasing the stigma associated with receiving mental health services and students positive perceptions regarding the use of technology.
While telehealth and telemedicine have shown promising outcomes for addressing adolescent substance use in rural populations, medical and behavioral health professionals are still faced with myriad of legal and ethical issues regarding distance treatment. Privacy issues, confidentiality, informed consent, licensure, malpractice liability, standards of care, and reimbursement are all legal issues under constant scrutiny in regards to technology-based delivery of care. Despite the many legal challenges not yet navigated by the health law field, professionals involved in telehealth services have not seen a rise in malpractice suits due to distance consultations and utilization of new technology.
While it is necessary to proceed with caution when developing and implementing more telehealth programs, the current low percentage of legal risk combined with the potentially positive impact on adolescent substance use rates supports the continued investment in telehealth development.
Sarah King is a May 2020 J.D. candidate at DePaul University College of Law. Ms. King has a Bachelor of Science in Psychology with a focus in gender, sexuality and women’s studies from the University of Pittsburgh. She currently works as a public health research manager for NORC at the University of Chicago.