In-Person or Virtual: How Flexible Treatment Works

The old tradeoff is gone

For a long time, getting real treatment meant showing up in person, on the program's schedule, no matter what that cost you at work or at home. Telehealth changed that. Today, quality outpatient care can be delivered in person, virtually, or in a blend, and that flexibility reaches people who would otherwise go without care entirely.

This is not a niche option anymore. In 2025, about 2.5 million people age 12 or older with a past-year substance use disorder received treatment through telehealth, which comes out to 5.7% of that population, according to SAMHSA's 2025 National Survey on Drug Use and Health. Among adolescents ages 12 to 17, the rate was even higher at 8.9%, while young adults ages 18 to 25 came in at 3.6%. These numbers have held fairly steady: in 2024, 5.4% of people with past-year SUD, about 2.6 million individuals, used telehealth for treatment.

Zoom out and the bigger problem remains access itself. Fewer than one in five people who needed SUD treatment in 2025, just 16.0%, actually received it, according to SAMHSA's release of the 2025 survey findings. Of the 7.6 million people who did get treatment, 4.4 million received outpatient care, 3.6 million used telehealth, and 2.2 million received inpatient care, with plenty of overlap since many people combine formats. Flexibility in how treatment is delivered will not solve the access gap on its own, but it removes one real barrier for a meaningful share of people.

What each format actually offers

In-person care brings the full weight of a room: the connection of a group physically together, the structure of leaving home for treatment, the accountability of showing up somewhere. For many people, that presence is genuinely part of what helps.

Virtual care removes barriers that keep people from starting treatment at all: distance, transportation, childcare, a job that will not flex, or simply the discomfort of walking into an unfamiliar clinic. It lets someone join a session from wherever they are, which for a lot of people is the difference between getting help and not getting help.

SAMHSA defines telehealth in its national survey as treatment delivered over the telephone or by video, without distinguishing provider type or physical setting. That broad definition matters because it means "virtual treatment" can look like a lot of different things: a therapy session, a psychiatric medication check-in, a group counseling call, or a brief follow-up between in-person visits.

What the evidence actually shows

The research on whether virtual care works as well as in-person care is more encouraging than a lot of people assume, with some real caveats attached.

A 2025 systematic review and meta-analysis in Addiction looking at remote and digital interventions for alcohol and drug treatment found that remote approaches can meaningfully contribute to treatment and recovery, though effects vary depending on the specific intervention, the substance involved, and how much professional support is built in.[5] Separately, a 2025 peer-reviewed study summarizing updated reviews found similar effectiveness between in-person and videoconference delivery for many alcohol and drug use treatments.

But effectiveness on paper is not the whole story. A 2024 systematic review of patient and provider preferences found people were more likely to actually engage with mental health or substance use services when those services were convenient, affordable, effective, personalized, and included some face-to-face contact. That last point is worth sitting with: even people who value virtual convenience often still want a human connection somewhere in the mix. This is part of why hybrid models, not a strict either/or, tend to serve people best.

NIDA's FY 2024 congressional budget materials echoed this, reporting that observational research found telehealth can help engage and retain people in treatment, particularly those who are otherwise hard to reach. At the same time, NIDA flagged low digital literacy, limited internet access, and low referral rates as real barriers that virtual care does not automatically solve.[8]

Blending the two

The strongest approach is often a mix, matched to the person and the moment. Someone might attend in person while stabilizing early in treatment, then shift to more virtual sessions as work and family responsibilities resume. Someone in a rural area might do virtual therapy weekly but drive in monthly for lab work or a medication check. Flexibility is not a compromise on quality. It is what keeps people engaged long enough for treatment to actually work.

When virtual care tends to help most

Virtual treatment tends to be a good fit when someone lives far from behavioral health providers, faces transportation or scheduling constraints, wants more frequent check-ins between office visits, or is more willing to start treatment from home than to walk into an unfamiliar building. It can also support continuity after a move or a transition between levels of care.

That said, virtual care has its own prerequisites. Reliable internet, a private space to talk, a suitable device, and basic digital comfort all matter. Without those, virtual sessions become another barrier rather than a solution.[6][8]

When in-person care matters more

Some situations call for being in the room. Immediate assessment of intoxication, withdrawal, or severe psychiatric symptoms requires in-person evaluation. So does anything involving physical exams, lab testing, or medication administration. A structured, substance-free environment or close supervision for safety concerns also usually means in-person care.

A virtual visit should never delay emergency help. Signs of overdose, uncontrolled agitation, breathing problems, or dangerous withdrawal call for immediate in-person assessment or emergency services, not a scheduled telehealth appointment.

Safety, coordination, and coverage

A responsible virtual program confirms where the patient physically is at every visit, has a backup plan for dropped calls, screens for safety risks like suicidal thoughts or domestic violence, and knows exactly when to escalate to in-person or a higher level of care. Coordination with prescribers, pharmacies, and family supports (when authorized) still matters just as much virtually as it does in person.

Before starting treatment in any format, it is worth confirming with an insurer what is actually covered: whether video and audio-only visits count, what copays apply, whether prior authorization is needed, and whether the clinician is licensed in the state where the patient is physically located. Coverage rules shift by plan and by state, so a current plan document or a call to the insurer's behavioral health line is the most reliable way to check.

Finding the format that fits

Providers like East Point Behavioral Health offer both in-person and virtual sessions so care fits the life someone is actually living, not the other way around. The best format is the one a person will consistently attend, and having real options is what makes that consistency possible. If you or someone you care about is weighing where to start, a conversation with a treatment provider about clinical needs, schedule, and comfort level is the most useful next step.