Videoconferencing Treatment During COVID-19 Social Distancing Measures Versus In-Person Therapy, A Non-Inferiority Comparison of Three Cohorts

Aims: The social distancing measures during the COVID-19 pandemic forced an abrupt transformation of treatment provision for mental health care: mid-March 2020, nearly all in-person contact was replaced with videoconferencing. COVID-19 thus offered a natural experiment and a unique opportunity to investigate in an observational study whether alcohol use disorder treatment through videoconferencing is non-inferior to in-person treatment.Method: In a large urban substance use disorder treatment center in the Netherlands, treatment evaluation is routine practice. Outcome data are regularly collected to support shared decision making and monitor patient progress. For this study, pretest and posttest data on substance use, psychopathology, and quality of life were used to compare outcomes for three cohorts: patients who received treatment for a primary alcohol use disorder performed prior to, partially during, and entirely during the COVID-19 lockdown.Results: Outcome was similar across the three cohorts: No inferior outcomes were found for treatments that were conducted predominantly through video conferencing during lockdown or treatments which started in-person, but needed to be continued through video conferencing, compared to in-person treatments prior to COVID-19. Also, the number of drop-outs were similar between cohorts.Conclusions: Treatment for a primary alcohol use disorder, provided partially or predominantly through videoconferencing during the COVID-19 pandemic resulted in similar abstinence rates and similar secondary outcomes compared to traditional in-person care, in spite of the potential negative effects of the COVID-related lockdown measures themselves. These results from everyday clinical practice corroborate findings of randomized controlled studies and meta-analyses in which videoconferencing appeared non-inferior to in-person care in terms of clinical effectiveness.