Screening and Brief Intervention (SBI) for risky adult alcohol use consistently identifies 5-10% of patients in need of brief intervention and 2-5% in need of more formal alcohol treatment. SBI programs are often expanded to include Referral to Treatment (aka SBIRT) to address the latter patients' needs and in primary care have increased access to treatment by 15-20% via referrals leaving 80-85% still needing treatment. Effective models of linking adults with SUD to AOD treatment are clearly needed. Recovery Management Checkups (RMC) are an effective strategy for linking individuals with SUDs to AOD treatment. In 3 trials, compared to the control group, RMC participants were significantly more likely to enter treatment, enter sooner, and stay longer, contributing to fewer days of substance use and fewer SUD symptoms. RMC was recently modified for primary care settings (RMC-PC) and piloted in Federally Qualified Health Centers (FQHC). Modifications include a primary care population presenting for physical health care (as opposed to AOD treatment), a refusal conversion component, telephone vs. face-to-face linkage, and referrals back to primary care when health problems are indicated. Results indicated that RMC-PC converted 75% of those who initially refused a referral for AOD treatment at the FQHC and quadrupled the linkage rate to treatment for these individuals. In the proposed trial, we will: a) recruit 300 adults needing AOD treatment at 4 FQHCs, b) randomly assign half to SBIRT and half to SBIRT+RMC-PC, and c) conduct quarterly follow-ups for 12-months. Hypotheses include: 1) Relative to the SBIRT patients, SBIRT+ RMC-PC patients will be more likely to: a) initiate AOD treatment sooner, b) receive any AOD treatment, and c) receive more days of AOD treatment; 2) Relative to the SBIRT patients, SBIRT+RMC-PC patients and those who get more AOD treatment will report less days of: a) alcohol use, b) heavy alcohol use, c) cannabis use, d) other drug use, and e) SUD problems; 3) days of treatment will mediate the relationship between SBIRT+RMC-PC and changes in the these AOD related behaviors; 4) Relative to the SBIRT patients, SBIRT+RMC-PC patients and those with fewer days of AOD use will have significantly less total health care utilization costs after factoring in increases in AOD treatment; 5) Days of AOD use will mediate the relationship between SBIRT+RMC-PC and total cost of health care utilization.

Public Health Relevance

The proposed linkage model (RMC-PC) was designed to reduce high rates of unmet need for alcohol or other drug (AOD) treatment and primary care among people with substance use disorders. If effective, RMC-PC will provide a new clinical approach for linking patients to both AOD and primary care treatments they might otherwise never receive, resulting in improved patient health and well-being, as well as reduced health care utilization costs.

National Institute of Health (NIH)
National Institute on Alcohol Abuse and Alcoholism (NIAAA)
Research Project (R01)
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National Institute on Alcohol Abuse and Alcoholism Initial Review Group (AA)
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Kwako, Laura Elizabeth
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Chestnut Health Systems, Inc.
United States
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