Quarterly Recovery Management Checkups to Treat Chronic Substance Use Disorders

Regularly scheduled monitoring and counseling, the standard of care for chronic diseases like diabetes mellitus and hypertension, have been advocated for the treatment of addiction as a chronic relapsing disorder. Two clinical trials in Chicago randomized 894 adult chronic substance users who presented for publicly funded substance abuse treatment to usual care or recovery management checkups (RMCs). Checkups included quarterly monitoring, motivational interviewing, and early linkage to retreatment for participants who relapsed. On average, subjects were in their late thirties and female. More than 4/5ths were African-American, and most were cocaine dependent. Over 2-year follow-up,

• RMC subjects were significantly more likely than controls to return to treatment (60% versus 51% in study 1, and 55% versus 37% in study 2), and to return sooner (200 days earlier in study 1 and 384 days earlier in study 2).
• RMC subjects had a significantly greater proportion of days abstinent than controls in study 2 (70% versus 63%) but not in study 1.
• RMC subjects had fewer successive quarters of unmet need for treatment than controls in both studies.

Comments by Michael Levy, PhD
This study shows that RMCs can help treat chronic substance users. A critical issue is how providers can get reimbursed for this kind of work, which demands resources and increases expenses. Unfortunately, until this type of intervention is paid for, it is unlikely that treatment programs will be able to add this important intervention. Cost-effectiveness studies need to be conducted to convince payers to reimburse providers for this kind of ongoing care.

Comments by Peter D. Friedmann, MD, MPH
Recovery management checkups have obvious potential for reengineering the focus of formal addiction treatment away from episodic care and toward chronic care. However, only a small proportion of persons with substance use disorders have contact with formal treatment. An intriguing possibility is that RMC could be incorporated into other community service settings where substance-using persons already have longitudinal contact—primary care and the patient-centered medical home; community case management and social work; public-health and child-and-family services; and even probation and parole.