How Virtual PHP and IOP Programs Can Ease the Stigma of Seeking Addiction Treatment

Daniel^* knew he needed help, yet he canceled his first intake appointment twice before showing up for the third, because he couldn’t stop picturing himself in that particular waiting room. A coworker’s cousin worked nearby. Someone from his gym parked in that lot every morning. The treatment itself didn’t scare him nearly as much as the idea of being seen walking into it. When he started a virtual program, logging in from his own desk, that fear ceased to apply.

That fear is more common than most people admit, and virtual partial hospitalization programs (PHP) and intensive outpatient programs (IOP) can reduce this barrier, though the research on how it plays out is more layered than a simple before-and-after story.

Being Watched Is Part of What Keeps People Away

Stigma around addiction operates on three levels: what someone fears the public thinks, what they fear a clinician thinks, and what they privately think about themselves for needing help. Any one of these can be enough to keep someone from calling, let alone showing up. A waiting room gives all three a physical form, a place where a stranger’s glance can feel like confirmation of what someone feared people would think, even when the glance means nothing.

Many people who avoid getting help believe treatment could work, and they weigh that belief against a concrete fear: being recognized and having someone connect the dots between an appointment and a diagnosis they haven’t chosen to share. That weighing happens before a person considers whether the program itself is any good.

Removing the waiting room changes where and how stigma shows up, with effects that vary from person to person and resist a single conclusion.

What the Research Shows

A 2024 qualitative study published in the Harm Reduction Journal, led by researchers at Oregon Health & Science University, interviewed 30 people receiving treatment for opioid use disorder about their experiences with telehealth. The findings were mixed. Patients described telehealth as giving them the space they wanted and more control over their treatment setting, and several said the physical and emotional distance from a clinic eased the shame and anxiety of being seen in person. “You feel like you’re being watched or judged by everyone, and telehealth can reduce that sense whether it’s real or perceived,” said Dr. Ximena Levander, the study’s senior author and an assistant professor of general internal medicine and geriatrics in the OHSU School of Medicine. “Telehealth can lower that barrier.”

One participant quoted in the study said, “I didn’t feel like it was as personal at first because you’re not there in-person sweating and talking. I felt like it was easier to get through it, get started with the program in the first place.”

The same study also found that public stigma and privacy concerns appeared in both telehealth and in-person settings, in different forms. Some patients who lived with roommates or family, or in cramped housing, found virtual sessions harder to keep private than a clinic visit, since they had to find a moment alone in a shared space rather than leave the house. The researchers concluded that stigma around opioid use disorder is complex and that no single format suits everyone, which makes a real choice between formats the most useful thing a program can offer.

What This Means for Choosing a Format

Virtual care is not the more private option for everyone, so the useful questions depend on the person’s situation:

• Whether home offers a private space for sessions beyond a closed door
• Whether the fear driving avoidance centers on being seen in public or being judged by a clinician
• Whether a hybrid approach, virtual most days with occasional in-person contact, would fit better than an all-or-nothing choice
• Whether flexibility in scheduling matters as much as privacy
• Whether the person was offered a choice or defaulted into whichever format was easiest to schedule

Virtual care removes one common barrier for people like Daniel and calls for different privacy planning for people in other living situations.

Where This Fits for Someone Weighing the Decision

For someone whose hesitation centers on being seen, learning what a virtual care PHP or IOP involves can address the fear that has held them back. In practice that can mean a conversation, before anyone commits to a format, about what feels risky, such as being seen by a neighbor or sharing a thin-walled apartment, so the program can plan around it.

Daniel remembers the parking lot he never had to pull into, week after week. He had known for a long time that he needed help, and treatment began once it stopped requiring a place where he imagined being watched.

* Daniel is a fictional character created to illustrate this article and does not represent a specific individual.

Sources
Couch, J. V., Whitcomb, M., Buchheit, B. M., Dorr, D. A., Malinoski, D. J., Korthuis, P. T., Ono, S. S., & Levander, X. A. (2024). Patient perceptions of and experiences with stigma using telehealth for opioid use disorder treatment: a qualitative analysis. Harm Reduction Journal, 21(1), 125. https://doi.org/10.1186/s12954-024-01043-5

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