The US is facing a substance abuse crisis which has been intensified by the isolation and stress caused by the COVID-19 pandemic. Across the country, waiting lists for mental health and substance abuse treatment mean vulnerable people are not getting the care that they need.

Almost 21 million Americans have at least one addiction, yet just 10% of them receive treatment. There are a number of barriers to treatment including the cost, geographical location, stigma, and the availability of co-occurring disorder treatment. One study showed that about 15% of the people cited financial barriers such as lack of insurance and concerns about cost were the main barriers to treatment. Almost 17% said they stopped treatment early as a result of treatment costs and their insurance not paying for further treatment.

An additional barrier to treatment is a dual-diagnosis, which refers to individuals who have a diagnosis of a mental illness in addition to a substance use disorder (SUD). Individuals with a dual-diagnosis are significantly less likely to enter treatment than people who are not dually diagnosed. Only 7.4% get treatment for both conditions, and 55% do not get treatment at all. One of the barriers for those with a dual diagnosis is a lack of recovery programs providing adequate holistic treatment. Only 18% of substance abuse programs and 9% of mental health programs are equipped to treat co-occurring disorders. In fact the percentage of adults with a mental illness who report unmet need for treatment has increased every year since 2011. In 2019, 24.7% of adults with a mental illness report an unmet need for treatment.

As appointments with addiction specialists are needed more than ever before, and those in urgent need of care so rarely get the treatment that they need, an alternative solution is desperately needed. A new tool has arrived aiming to aid in the fight against America's substance abuse crisis - digital therapy.

What is Digital Therapy?

Digital Therapeutics (DTx) are evidence-based therapeutic interventions that are operated by software to prevent, manage, or treat a disorder. They help patients by treating, preventing, or managing a medical problem using a range of technology including mobile devices, apps, sensors, virtual reality, and other tools to encourage positive behavior changes.

DTx products are held to the same standards of evidence and regulatory oversight as traditional medical treatments. DTx products work in a variety of ways, assisting with a wide range of health issues. These products can range from delivering cognitive behavioral therapy (CBT) to calculating insulin and other drug doses. Digital therapeutics have been shown to help manage symptoms of illnesses in addition to improving medication adherence.

How are Digital Therapeutics Different from Wellness Apps

Digital therapeutics may at first seem a simple extension of the thousands of wellness apps available. However, there are distinct differences. First, there are over 350,000 digital wellness apps available for download that range from tracking your sleep cycle to managing screen time. There are currently only 48 commercially available digital therapeutics apps. Differing from wellness or health apps, digital therapeutics must provide a specified form of clinical intervention. In order to be recognised as a digital therapeutic, a product must be software driven, evidence-based, and make a claim to prevent, manage, or treat a medical disease or disorder.

The Digital Therapeutics Alliance is a global non-profit trade association aiming to set standards in the digital therapeutics market and promote integration into health care. Since 2017, the Digital Therapeutics Alliance has been working to broaden the understanding, adoption, and integration of clinically evaluated digital therapeutics and provide patients, clinicians, payors, and policymakers with the right tools to evaluate and utilize digital therapeutic products. They currently list at least six companies offering digital therapeutic products for mental illnesses and substance use.

Digital Therapeutics for Substance Abuse Disorders

Among the first approved therapies for substance use disorders (SUD) were reSET for the treatment of nonopioid use disorders and reSET-O for the treatment of opioid use disorders. Now FDA approved, both of these products are interactive-based therapies intended to provide CBT adjunct to a contingency management system for patients over 18 who are participating in outpatient treatment under the supervision of a clinician. Studies show reduced dropout from treatment and increased abstinence when the digital therapeutic was used.

These digital therapies have a number of advantages. They delegate additional responsibility and autonomy to patients, allowing them to move through treatment at their own pace and access it at any stage in their recovery. Treatment can be accessed 24/7, and critically, is available at the swipe of a finger when patients may need it most. They also reduce therapist intervention time, allowing therapists more time to engage with a wider number of patients. Finally, they significantly reduce barriers to seeking care through the reduction in fear of judgment through social stigma as treatment can be done privately.

Although there are currently only two FDA-approved digital therapies for substance abuse disorders, many working in the field of substance abuse are confident that more will emerge in coming years. Moreover, increased rates of success coupled with cost savings to the system show promise of broad insurance coverage including digital therapies, removing additional barriers to use and implementation.

Limitations of Digital Therapies

Despite being around for a significant time, digital therapeutics have not yet entered the mainstream. This is seen to be caused by two main factors: the challenge of distinguishing digital therapeutics from the more general health and well-being applications, and uneven incentives in the healthcare environment. Separating unproven or low-value applications from those with clinically-proven therapeutic value can be time-consuming. Additionally, a number of digital therapeutics require changes in healthcare provider workflows, which have not yet become integrated to mainstream medical settings. This lack of integration increases the workload on some physicians with an overload of data and required interpretation.

For some applications, including therapy for complex problems such as addiction, digital solutions might not be able to replace face-to-face therapy and inpatient care. However, mental health experts in favor of such products state the goal is not for digital therapeutics to replace traditional face-to-face therapy but to ensure therapists have the time available to see patients who most urgently require care.

As the substance abuse and addiction field works tirelessly to battle the stigma of seeking treatment, waiting lists for substance abuse care are rapidly filling up. Digital therapeutics aim to lessen the load on therapists, offering CBT and other behavioral interventions to those in recovery from addiction.

Despite these limitations, it appears that digital therapeutics are here to stay. They present an innovative category of emerging treatment approaches, aiming to address chronic and other difficult-to-treat conditions. The value of the global digital therapeutics market is expected to reach USD 7.1 billion by 2025, and millions of dollars have already been invested in developing digital therapeutic technology. The NHS in Scotland already offers free access to a number of DTx providers, setting a trend across Europe. Some digital therapies are covered by US private health insurance companies, but the hope is that this becomes more mainstream, in order to address inequalities in access to medical care.