Recovery Management Checkups (RMC) are a structured intervention designed to improve substance use disorder (SUD) treatment engagement, retention, and long-term outcomes through continuous, compassionate, and comprehensive care management and support. RMCs are an approach to monitor and support individuals with SUD, ensuring they receive ongoing care and interventions as needed to sustain long-term recovery. Unlike typical short-term treatment, the RMC adopts a chronic care approach, recognizing that recovery is a continuous journey.
Created by researchers at Chestnut Health Systems, RMC has been evaluated through numerous studies and clinical trials in various settings. Research shows that individuals who participate in RMC have higher rates of treatment linkage, engagement, and retention and lower rates of substance use compared to those who do not receive the intervention[1]. Similar results were determined in a study that assessed outcomes over a four-year period, demonstrating the impact of the model over the long term[2]. More recent studies have shown implementing RMC for primary care (RMC-PC) settings to be effective in facilitating linkage to care and reducing substance use compared to screening, brief intervention, and referral to treatment (SBIRT)[3].
What is the RMC model?
The RMC model involves consistent, long-term monitoring and early re-intervention through regular checkups to help detect relapse early, shorten the time to treatment re-entry, and improve long-term outcomes. The model works through a structured process designed to engage individuals with SUDs in ongoing, personalized care and treatment.
Key components of the model include:
Linkage Managers: The program has dedicated Linkage Managers who act as personal guides. They help develop linkage plans, make appointments, and ensure that the person feels supported throughout their recovery journey.
Develop and Maintain Motivation: Linkage managers use special techniques, such as motivational interviewing, to inspire and sustain participants' treatment commitment and recovery goals. For those who chose not to start treatment, they also encourage risk-reduction behaviors to promote safer practices.
Linkage to Treatment and Provider Relationships: The model focuses on strong relationships with various substance use treatment providers. This means that when someone needs help, they can quickly be connected to the right place without long waits, often through a warm handoff or expedited intake process.
Quarterly Checkups: Participants regularly meet with linkage managers every three months to assess their current situation, discuss any barriers to treatment, and plan the next steps. These checkups are crucial for staying on track.
Ongoing Support: Recovery isn’t a one-time event; it’s a journey. Linkage managers regularly check in with participants through calls, texts, or social media to offer continued support and encouragement.
Early Re-intervention/Re-linkage Support: If a participant disengages from treatment, the program actively works to re-engage them in treatment. The staff assesses the reasons for disengagement and develops a plan to address these issues, ensuring continuous support and care.
Outcomes of RMC-PC
To demonstrate its efficacy, researchers at Chestnut Health Systems conducted a randomized control trial that compared SBIRT+RMC-PC to SBIRT alone over 12 months; SBIRT is a public health approach that has been widely used in healthcare settings, but limited research has shown its effectiveness in primary care settings, especially in successful referral to SUD treatment[4]. Outcomes from the study, which were published in the journal Alcohol, Clinical and Experimental Research, suggest that RMC-PC, in combination with SBIRT, enhances treatment linkage and improves long-term substance use outcomes among primary care patients. Key findings from this study include[5]:
Improved treatment linkage and retention: SBIRT+RMC-PC participants were nearly four times more likely to start and sustain SUD treatment.
Increased days of treatment: Those assigned to SBIRT+RMC-PC attended significantly more days of SUD treatment over 12 months (average = 54 days) compared to SBIRT-only (average = 27 days).
Increased days of abstinence: The SBIRT+RMC-PC group reported more days abstinent from all substances over 12 months (average = 173 days) compared to SBIRT-only (average = 140 days)
Subsequent research has identified strategies for implementing RMC-PC in primary care settings, either in conjunction with SBIRT or as an alternative. These findings highlight the versatility of RMC-PC, showing that it can be effectively utilized by primary care providers regardless of their familiarity with screening and referral processes. Additionally, RMC-PC can be tailored to meet the unique needs of different patient populations by using robust protocols to ensure the intervention is accessible and beneficial for all primary care environments.
A Needed Intervention
SUD is a chronic disease that often requires long-term management and support. While initial treatment can set the stage for recovery, maintaining treatment engagement and preventing relapse pose ongoing challenges. Historically, treatment for SUDs has been episodic, focusing on short-term care or during acute crises – in which a person seeks treatment, receives an assessment, is treated, and is presumed cured – rather than maintained through continuous engagement with treatment and recovery support services, sometimes lasting years. Ongoing monitoring and early re-intervention models have been shown to improve long-term outcomes for other chronic conditions, such as asthma, cancer, diabetes, depression, and severe mental illness[6].
“Recovery Management Checkups fill a critical gap in long-term care and support by treating substance use disorders as the chronic condition they are,” says Dr. Dennis Watson, Senior Research Scientist at Chestnut Health Systems. “This approach acknowledges that recovery is not a one-time event but a lifelong journey, requiring sustained engagement and support. The RMC model has shown promise in not only enhancing individual outcomes but also contributing to a more effective and efficient healthcare system overall.”
Conclusion
The RMC model represents a transformative approach to addressing SUDs. By treating SUDs as chronic conditions and incorporating regular checkups, early intervention, and robust engagement strategies, RMC can significantly enhance treatment and long-term health outcomes. The improvements in treatment engagement and retention and long-term reductions in substance use underscore the model's effectiveness. Integrating RMC into primary care can offer a promising pathway to sustained recovery and better overall health for individuals struggling with SUDs. Study results also demonstrate the utility of the RMC intervention and its adaptability to suit the varying levels of experience among providers.
References
Scott, C. K., & Dennis, M. L. (2009). Results from two randomized clinical trials evaluating the impact of quarterly recovery management checkups with adult chronic substance users. Addiction (Abingdon, England), 104(6), 959–971. https://doi.org/10.1111/j.1360-0443.2009.02525.x
Dennis, M. L., & Scott, C. K. (2012). Four-year outcomes from the Early Re-Intervention (ERI) experiment using Recovery Management Checkups (RMCs). Drug and alcohol dependence, 121(1-2), 10–17. https://doi.org/10.1016/j.drugalcdep.2011.07.026
Scott, C. K., Dennis, M. L., Grella, C. E., Watson, D. P., Davis, J. P., & Hart, M. K. (2023). A randomized controlled trial of recovery management checkups for primary care patients: Twelve-month results. Alcohol, clinical & experimental research, 47(10), 1964–1977. https://doi.org/10.1111/acer.15172
Scott, C. K., Dennis, M. L., Grella, C. E., Watson, D. P., Davis, J. P., & Hart, M. K. (2023). Using recovery management checkups for primary care to improve linkage to alcohol and other drug use treatment: a randomized controlled trial three month findings. Addiction (Abingdon, England), 118(3), 520–532. https://doi.org/10.1111/add.16064
Scott, C. K., Dennis, M. L., Grella, C. E., Watson, D. P., Davis, J. P., & Hart, M. K. (2023). A randomized controlled trial of recovery management checkups for primary care patients: Twelve-month results. Alcohol, clinical & experimental research, 47(10), 1964–1977. https://doi.org/10.1111/acer.15172
Scott, C. K. & Dennis, M. L. (2003). Recovery Management Check-ups: An Early Re-Intervention Model. https://www.chestnut.org/resources/57bbde94-4030-4dbc-b018-3d2001c08408/Recovery-perc
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