Screening and Brief Intervention (SBI) in primary care for risky adult alcohol use has been demonstrated effective in reducing use among heavy alcohol users. While the process also identifies 5-10% of the patients who have substance use disorders (SUD) that require referral to alcohol and other drug (AOD) treatment, the most recent meta-analysis indicates that the procedures had little to no effect on actual treatment linkage and utilization. Patient and system level barriers present challenges and new linkage models are needed that can successfully overcome the barriers. Results from three clinical trials conducted by the applicant team have demonstrated the effectiveness of Recovery Management Checkups (RMC) as a linkage model for individuals needing AOD treatment. Moreover, RMC participants were significantly more likely to enter treatment, enter sooner, and stay longer, having fewer days of use and fewer SUD symptoms. Outcomes were also associated with lower health care utilization, decreased criminal activity, and substantial savings to society, thereby offsetting the costs of additional treatment. RMC was modified for primary care (RMC-PC) and pilot results indicated RMC-PC significantly increased linkage rates to treatment relative to a baseline cohort (12% vs. 75%, OR=22.0, p<.0001). In the proposed trial, we will: a) recruit 300 adult patients with SUD through SBIRT programs operating in five sites operated by three FQHC organizations, b) randomly assign half to a referral as usual control and half to RMC-PC, and c) conduct quarterly follow-ups for 12-months post enrollment. Hypotheses include: H1 Relative to the control patients, RMC-PC patients will be more likely to initiate AOD treatment sooner, receive any AOD treatment, and receive more days of AOD treatment; H2 Relative to the control patients, RMC-PC patients and those who receive more AOD treatment will report fewer days of heavy alcohol use, other drug use, any AOD use and SUD problems; H3 The days of treatment will mediate the relationship between RMC-PC and changes in the pre and post measures of these AOD related behaviors; H4 Relative to the control patients, 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; and H5 The days of AOD use will mediate the relationship between RMC-PC and the cost of health care utilization.
