Linking Individuals with Substance Use Disorders (SUDs) in Primary Care to SUD Treatment: the Recovery Management Checkups–Primary Care (RMC-PC) Pilot Study

  • Christy K Scott
  • Christine E. Grella
  • Michael L. Dennis
  • Lisa Nicholson
Article

Abstract

Linking individuals in primary care settings with substance use disorders (SUDs) to SUD treatment has proven to be challenging, despite the widespread use of Screening, Brief Intervention, and Referral to Treatment (SBIRT). This paper reports findings from a pilot study that examined the efficacy of the Recovery Management Checkups intervention adapted for primary care settings (RMC-PC), for assertively linking and engaging patients from Federally Qualified Health Centers into SUD treatment. Findings showed that patients in the RMC-PC (n=92) had significantly higher rates of SUD treatment entry and received more days of SUD treatment compared with those who receive the usual SBIRT referral (n=50). Receipt of RMC-PC had both direct and indirect effects, partially mediated through days of SUD treatment, on reducing days of drug use at 6 months post intake. RMC-PC is a promising intervention to address the need for more assertive methods for linking patients in primary care to SUD treatment.

Notes

Acknowledgements

The authors thank Rod Funk, Brittany Moody, Cheryl Peterson, and Belinda Willis for their assistance preparing the manuscript. The opinions are those of the authors and do not reflect official positions of the government. Comments and questions can be addressed to Dr. Scott.

Funding Information

This paper was supported by grant no. TI023455 from the Substance Abuse and Mental Health Service Administration (SAMHSA)’s Center for Substance Abuse Treatment (CSAT) to the Illinois Department of Human Services (IDHS)’ Division of Alcoholism and Substance Abuse (DASA). Completion of this paper was also supported by National Institute on Drug Abuse (NIDA) grant no. R21 DA045774.

Compliance with Ethical Standards

All procedures were reviewed and approved by the Chestnut Health Systems’ Institutional Review Board.

Conflict of Interest

The authors declare that they have no conflicts of interest.

References

  1. 1.
    Dennis M, Scott CK. Managing addiction as a chronic condition. Addiction Science & Clinical Practice. 2007;4(1):45–55.CrossRefGoogle Scholar
  2. 2.
    Scott CK, Dennis ML, Laudet A, et al. Surviving drug addiction: The effect of treatment and abstinence on mortality. American Journal of Public Health. 2011;101(4):737–744.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Hser YI, Evans L, Grella C, et al. Long-term course of opioid addiction. Harvard Review of Psychiatry. 2015;23(2):76–89.CrossRefPubMedGoogle Scholar
  4. 4.
    Scott CK, Dennis ML, Foss MA. Utilizing recovery management checkups to shorten the cycle of relapse, treatment reentry, and recovery. Drug and Alcohol Dependence. 2005;78(3):325–338.CrossRefPubMedGoogle Scholar
  5. 5.
    McLellan AT, Lewis DC, O’Brien CP, et al. Drug dependence: A chronic medical illness. The Journal of the American Medical Association. 2000;284:1689–1695.CrossRefPubMedGoogle Scholar
  6. 6.
    Martire LINKAGE MANAGER, Lustig AP, Schulz R, et al. Is it beneficial to involve a family member? A meta-analysis of psychosocial interventions for chronic illness. Health Psychology. 2004;23(6):599–611.CrossRefGoogle Scholar
  7. 7.
    Hartmann M, Bäzner E, Wild B, et al. Effects of interventions involving the family in the treatment of adult patients with chronic physical diseases: A meta-analysis. Psychotherapy & Psychosomatics. 2010;79(3):136–148.CrossRefGoogle Scholar
  8. 8.
    Scott CK, Dennis ML. Recovery Management Checkups with adult chronic substance users. In J.F. Kelly and W.L. White (eds.), Addiction Recovery Management: Theory, Research and Practice, Current Clinical Psychiatry. New York, NY: Springer Science+Business Media, LLC, 2011 pp. 87–101.Google Scholar
  9. 9.
    Cucciare MA, Timko C. Bridging the gap between medical settings and specialty addiction treatment. Addiction. 2015;110(9):1416–1420.CrossRefGoogle Scholar
  10. 10.
    Cucciare MA, Coleman EA, Timko C. A conceptual model to facilitate transitions from primary care to specialty substance use disorder care: a review of the literature. Primary Health Care Research & Development. 2015;16(5):492–505.CrossRefGoogle Scholar
  11. 11.
    Ducharme LJ, Chandler RK, Harris AHS. Implementing effective substance abuse treatments in general medical settings: Mapping the research terrain. Journal of Substance Abuse Treatment. 2016;60:110–118.CrossRefPubMedGoogle Scholar
  12. 12.
    Samet JH, Friedmann P, Saitz R. Benefits of linking primary medical care and substance abuse services: patient, provider, and societal perspectives. Archives of Internal Medicine. 2001;161(1):85–91.CrossRefPubMedGoogle Scholar
  13. 13.
    U.S. Department of Health and Human Services (DHHS), Health Resources and Services Administration (HRSA). (2017). Federally Qualified Health Centers. Available online at https://www.hrsa.gov/opa/eligibility-and-registration/health-centers/fqhc/index.html. Accessed on November 21, 2017.
  14. 14.
    Otiniano Verissimo AD, Grella CE. Influence of gender and race/ethnicity on perceived barriers to help-seeking for alcohol or drug problems. Journal of Substance Abuse Treatment. 2017;75:54–61.CrossRefGoogle Scholar
  15. 15.
    Wells K, Klap R, Koike A, et al. Ethnic disparities in unmet need for alcoholism, drug abuse, and mental health care. American Journal of Psychiatry. 2001;158:2027–2032.CrossRefPubMedGoogle Scholar
  16. 16.
    Benson DS, Townes PJ, Dobbs D. Quality Management Plan: A practical, patient-centered template. Bethesda, MD: National Association of Community Health Centers; 2011.Google Scholar
  17. 17.
    D'Onofrio G, Bernstein SL. Screening, brief intervention and referral of emergency department patients with unhealthy drug use: Efficacious or not? Evidence Based Mental Health. 2015;18(4):e8.CrossRefPubMedGoogle Scholar
  18. 18.
    Saitz R. Commentaries on Glass et al. (2015). SBIRT is the answer? Probably not. Addiction. 2015;110(9):1416–1420.CrossRefPubMedGoogle Scholar
  19. 19.
    Saitz R, Alford PA, Bernstein J, et al. Screening and brief intervention for unhealthy drug use in primary care settings: Randomized clinical trials are needed. Journal of Addiction Medicine. 2010;4(3):123–130.CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Babor TF, McRee BG, Kassebaum PA, et al. Screening, Brief Intervention, and Referral to Treatment (SBIRT): Toward a public health approach to the management of substance abuse. Substance Abuse. 2007;28(3):7–30.CrossRefPubMedGoogle Scholar
  21. 21.
    Madras BK, Compton WM, Avula D, et al. Screening, brief interventions, referral to treatment (SBIRT) for illicit drug and alcohol use at multiple healthcare sites: Comparison at intake and 6 months later. Drug and Alcohol Dependence. 2009;99(1):280–295.CrossRefPubMedGoogle Scholar
  22. 22.
    Glass JE, Hamilton AM, Powell BJ, et al. Specialty substance use disorder services following brief alcohol intervention: A meta-analysis of randomized controlled trials. Addiction. 2015;110(9):1404–1415.CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Kim TW, Bernstein J, Cheng DM, et al. Receipt of addiction treatment as a consequence of a brief intervention for drug use in primary care: A randomized trial. Addiction. 2017;112(5):828–827.Google Scholar
  24. 24.
    Abraham AJ, Knudsen HK, Rieckmann T, et al. Disparities in access to physicians and medications for the treatment of substance use disorders between publicly and privately funded treatment programs in the United States. Journal of Studies on Alcohol and Drugs. 2013;74:258–265.CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Weisner CM, Mertens J, Tam TW, et al. Factors affecting the initiation of substance abuse treatment in an HMO. Addiction. 2001;96(5):705–716.CrossRefPubMedGoogle Scholar
  26. 26.
    Collins C, Hunson DL, Munger R, et al. Evolving models of behavioral health integration in primary care. New York: Milbank Memorial Fund, 2010.CrossRefGoogle Scholar
  27. 27.
    Chaple M, Sacks S, Randell J, et al. A technical assistance framework to facilitate the delivery of integrated behavioral health services in Federally Qualified Health Centers (FQHCs). Journal of Substance Abuse Treatment. 2016;60:62–69.CrossRefPubMedGoogle Scholar
  28. 28.
    Kessler R, Miller BF, Kelly M, et al. Mental health, substance abuse, and health behavior services in patient-centered medical homes. American Board of Family Medicine. 2014;27(5):637–644.CrossRefGoogle Scholar
  29. 29.
    Andrews CM. The relationship of state Medicaid coverage to Medicaid acceptance among substance abuse providers in the United States. Journal of Behavioral Health Services & Research. 2014;41:460–472.CrossRefGoogle Scholar
  30. 30.
    Scott, CK, Dennis, ML, Recovery Management Check-ups: An Early Re-Intervention Model. Lighthouse Institute; Chicago, IL: 2003. Retrieved on 12/19/16 from http://chestnut.org/Lighthouse-Institute/Bookstore/Product-Details/manuals/recovery-management-check-ups Google Scholar
  31. 31.
    Dennis ML, Scott CK. Four-year outcomes from the Early Re-Intervention Experiment (ERI) with recovery management checkups (RMC). Drug and Alcohol Dependence. 2012;121(1):10–17.CrossRefPubMedGoogle Scholar
  32. 32.
    Dennis ML, Scott CK, Funk R. An experimental evaluation of recovery management checkups (RMC) for people with chronic substance use disorders. Evaluation and Program Planning. 2003;26(3):339–352.CrossRefGoogle Scholar
  33. 33.
    Scott CK, Dennis ML, Lurigio AJ. The effects of specialized probation and Recovery Management Check-Ups (RMCs) on treatment participation, substance use, HIV-risk behaviors, and recidivism among female offenders: Main findings of a three-year experiment using subject by intervention interaction analysis. Journal of Experimental Criminology. 2017;13(1):53–77.Google Scholar
  34. 34.
    Scott CK, Dennis ML. Results from two randomized clinical trials evaluating the impact of quarterly recovery management checkups with adult chronic substance users. Addiction. 2009;104(6):959–971.CrossRefPubMedPubMedCentralGoogle Scholar
  35. 35.
    Atanda R, Podrasky-Mattia L, Benton A. Developing a data collection system. Evaluation and Program Planning. 2005;28(3):335–339.CrossRefGoogle Scholar
  36. 36.
    Babor TF, Higgins-Biddle JC, Saunders JB, et al. AUDIT: The alcohol use disorders identification test guidelines for use in primary care. Second Edition. Geneva, Switzerland: World Health Organization, 2001.Google Scholar
  37. 37.
    Skinner HA. The drug abuse screening test. Addictive Behaviors. 1982;7:363–371.CrossRefPubMedGoogle Scholar
  38. 38.
    D’Onofrio G, Pantalon MV, Degutis LC, Larkin GL, O’Connor PG, Fiellin D. BNI Training Manual For Opioid Dependent Patients in the ED. New Haven, CT: Yale University School of Medicine; 2009.Google Scholar
  39. 39.
    World Health Organization. Brief Intervention: The ASSIST-linked brief intervention for hazardous and harmful substance use manual for use in primary care; 2010. Geneva, Switzerland: WHO Press. Available online at http://apps.who.int/iris/bitstream/10665/44321/1/9789241599399_eng.pdf. Accessed on December 19. 2016.Google Scholar
  40. 40.
    Center for Substance Abuse Treatment. Enhancing Motivation for Change in Substance Abuse Treatment. Treatment Improvement Protocol (TIP) Series, No. 35. Report No.: SMA13–4212. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2013.Google Scholar
  41. 41.
    Hingson R, Compton WM. Screening and brief intervention and referral to treatment for drug use in primary care: Back to the drawing board. The Journal of the American Medical Association. 2014;312(5):488–489.CrossRefPubMedGoogle Scholar
  42. 42.
    Dawson DA, Grant BF, Stinson FS, et al. Estimating the effect of help-seeking on achieving recovery from alcohol dependence. Addiction. 2006;101(6):8245–834.CrossRefGoogle Scholar
  43. 43.
    Kadden R, Carbonari J, Litt M, et al. Matching Alcoholism Treatments to Client Heterogeneity: Project MATCH Three-Year Drinking Outcomes. Alcoholism: Clinical and Experimental Research. 1998;22(6):1300–1311.Google Scholar
  44. 44.
    Weisner C, Matzger H, Kaskutas LA. How important is treatment? One-year outcomes of treated and untreated alcohol-dependent individuals. Addiction. 2003;98(7):901–911.CrossRefPubMedGoogle Scholar
  45. 45.
    Rudd RA, Aleshire N, Zibbell JE, et al. Increases in drug and opioid overdose deaths — United States, 2000–2014. Centers for Disease Control and Prevention Morbidity and Mortality Weekly Report. 2016;64(50):1378–1382. Downloaded from: https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6450a3.htm CrossRefGoogle Scholar
  46. 46.
    Tuyet M. State Opioid Crisis Response Advisory Council: Data from the Illinois Department of Public Health. Presentation to the Illinois Opioid Crisis Response Advisory Council on January 21, 2017.Google Scholar
  47. 47.
    Kirby D. State Opioid Crisis Response Advisory Council: Data from the Illinois Department of Human Services, Division of Alcoholism and Substance Abuse. Presentation to the Illinois Opioid Crisis Response Advisory Council on January 21, 2017.Google Scholar
  48. 48.
    Volkow ND, Frieden TR, Hyde PS, et al. Medication-assisted therapies: Tackling the opioid-overdose epidemic. New England Journal of Medicine. 2014;370:263–266.CrossRefGoogle Scholar
  49. 49.
    Degenhardt L, Whiteford HA, Ferrari AJ, et al. Global burden of disease attributable to illicit drug use and dependence: Findings from the Global Burden of Disease Study 2010. The Lancet. 2013;382:1564–1574.CrossRefGoogle Scholar
  50. 50.
    French MT, McGeary KA, Chitwood DD, et al. Chronic illicit drug use, health services utilization, and the cost of medical care. Social Science and Medicine. 2000;50(12):1703–1713.CrossRefPubMedGoogle Scholar
  51. 51.
    Parthasarathy S, Weisner CM. Five-year trajectories of health care utilization and cost in a drug and alcohol treatment sample. Drug and Alcohol Dependence. 2005;80(2):231–240.CrossRefPubMedGoogle Scholar

Copyright information

© National Council for Behavioral Health 2017

Authors and Affiliations

  • Christy K Scott
    • 1
  • Christine E. Grella
    • 1
  • Michael L. Dennis
    • 2
  • Lisa Nicholson
    • 1
  1. 1.Lighthouse InstituteChestnut Health SystemsChicagoUSA
  2. 2.Lighthouse InstituteChestnut Health SystemsNormalUSA

Personalised recommendations