Recovery Checkups

Recovery Checkups.jpgThe American Society of Addiction Medicine (ASAM) recently released Standards of Care:  For the Addiction Specialist Physician.  The Standards outline the responsibilities of addiction medicine specialists in the areas of assessment and diagnosis, withdrawal management, treatment planning, treatment management, care transitions and care coordination, and continuing care management.  There is one sentence in the Standards that deserves particular acknowledgement:  “Recovery check-ups by addiction specialist physicians, just as those by primary care physicians or other providers, may promote sustained recovery and prevent relapse” (p. 13). 

Considerable resources have been devoted in recent decades to enhance the role of physicians in caring for patients with alcohol and other drug problems.  Nearly all of these efforts have focused on frontend interventions:  screening, brief intervention, and linkage of patients to addiction treatment.  The new ASAM Standards extend these functions to embrace the physician’s role in long-term addiction recovery management.  The “recovery check-up” language marks an important milestone in the history of addiction medicine and the history of ASAM.  Projects are underway in Philadelphia, Pennsylvania and Ann Arbor, Michigan to develop recovery checkup protocol for primary care physicians.  Those projects mark the next step in integrating addiction treatment and primary medicine and the next step in extending acute care models of addiction treatment to models of sustained recovery management.

Imagine a day when everyone entering recovery will have an addiction-trained primary care physician and an addiction medicine specialist as sustained resources through the long-term recovery process.  On that day, we will have finally escaped acute care models of medical intervention that have treated addiction like it was a broken arm or a bacterial infection.  On that day, addiction recovery and addiction medicine will have come of age in America.

Full and sustained recovery should be an expectation of everyone with an alcohol or other drug problem as should the expectation of sustained support of recovery from one’s personal physician.  ASAM’s Standards and the recovery checkup projects in Philadelphia and Ann Arbor suggest that such a day may be on the horizon.       

Those interested in the potential of recovery checkups in enhancing long-term recovery outcomes will find the following resources of interest.

Blodgett, J.C., Maisel, N.C., Fuh, I.L., Wilbourne, P.L. & Finney, J. (in press)  How effective is continuing care for substance use disorders?  A meta-analytic review.  Journal of Substance Abuse Treatment.

Chi, F. W., Parthasaranthy, S., Mertens, J. R., & Weisner, C. M. (2011).  Continuing care and long-term substance use outcomes in managed care:  Early evidence for a primary care-based model.  Psychiatric Services, 62(10), 1194-1200.

Dennis. M., Scott, C. K., & Funk, R. (2003).  An experimental evaluation of recovery management checkups (RMC) for people with chronic substance use disorders.  Evaluation and Program Planning, 26(3), 339-352.

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, 10-17.

Godley, M. D., Godley, S. H., Dennis, M. L., Funk, R., & Passetti, L. L. (2002).  Preliminary outcomes from the assertive continuing care experiment for adolescents discharged from residential treatment.  Journal of Substance Abuse Treatment, 23, 21-32.

Godley, M. D., Godley, S. H., Dennis, M. L., Funk, R. R., & Passetti, L. L. (2007).  The effect of assertive continuing care on continuing care linkage, adherence, and abstinence following residential treatment for adolescent substance use disorders. Addiction, 102, 81-93.

Godley, S. H., Godley, M. D., & Dennis, M. L. (2001).  The assertive aftercare protocol for adolescent substance abusers.  In. E. Wagner & H. Waldron, (Eds.), Innovations in adolescent substance abuse interventions (pp. 311-329).  New York:  Elsevier Science Ltd. 

Hser, Y-I, Fu, L., Wu, F, Du, J. & Zhao, M. (2013).  Pilot trial of a recovery management intervention for heroin addicts released from compulsory rehabilitation in China.  Journal of Substance Abuse Treatment, 44, 78-83.

Kim, T.W., Saitz, R., Cheng, D.M., Winter, M.R., Witas, J. & Samet, J.H. (2012).  Effect of quality chronic disease management for alcohol and drug dependence on addiction outcomes.  Journal of Substance Abuse Treatment, 43, 389-396. 

Kim, T.W., Saitz, R., Cheng, D.M., Winter, M.R., Witas, J. & Samet, J.H. (2011).  Initiation and engagement in chronic disease management care for substance dependence.  Drug and Alcohol Dependence, 115(1-2), 80-6.

Klein, A. A., Slaymaker, V .J., Dugosh, K. L., & McKay, J. R. (2012).  Computerized continuing care support for alcohol and drug dependence:  A preliminary analysis of usage and outcomes.  Journal of Substance Abuse Treatment, 42, 25-34.

McCollister, K.E., French, M.T., Freitas, D.M., Dennis, M.L., Scott, C.K., & Funk, R.R. (2013).  Cost-Effectiveness analysis of Recovery Management Checkups (RMC) for adults with chronic substance use disorders: evidence from a four-year randomized trial, Addiction, 108, 2166-2174.

McKay, J. R., Lynch, K. G., Shepard, D. S., Morgenstern, J., Forman, R. F., & Pettinati, H. M. (2005b). Do patient characteristics and initial progress in treatment moderate the effectiveness of telephone-based continuing care for substance use disorders? Addiction, 100(2), 216-226.

McKay, J. R., Lynch, K. G., Shepard, D. S., & Pettinati, H. M. (2005).  The effectiveness of telephone-based continuing care for alcohol and cocaine dependence.  Archives of General Psychiatry, 62(2), 199-207.  

McKay, J. R., Lynch, K. G., Shepard, D. S., Ratichek, S., Morrison, R., Koppenhaver, J., & Pettinati, H. M. (2004). The effectiveness of telephone-based continuing care in the clinical management of alcohol and cocaine use disorders: 12-month outcomes. Journal of Consulting and Clinical Psychology, 72(6), 967-979.

McKay, J. R., Van Horn, D., Oslin, D. W., Ivey, M., Drapkin, M. L., Coviello, D. M., & Lynch, K. G. (2011). Extended telephone-based continuing care for alcohol dependence: 24-month outcomes and subgroup analyses. Addiction, 106, 1760-1769. 

Rush. B.R., Dennis, M.L., Scott, C.K., Castel, S. & Funk, R. (2008).  The interaction of co-occurring mental health disorders and recovery management checkups on substance abuse treatment participation and recovery.  Evaluation Review, 32, 7-38.

Saitz, R., Cheng, D.M., Winter, M., Kim, T.W., Meli, S.M., Allenswoertjh-Davies, D., Lloyd-Travagini, C.A. & Samet, J.H. (2013).  Chronic care management for dependence on alcohol and other drugs.  Journal of the American Medical Association, 310(11), 1156-1167.

Scott, C. K., Dennis, M. L., & Foss, M. A. (2005).  Utilizing recovery management checkups to shorten the cycle of relapse, treatment re-entry, and recovery.  Drug and Alcohol Dependence, 78, 325-338.

Scott, C. K., Dennis, M. L., & White, W. L. (2004).  Recovery management checkups:  A future function of addiction professionals?  Addiction Professional, 2(5), 33-39.

Stanford, M., Banerjees, K. & Garner, R. (2010).  Chronic care and addictions treatment:  A feasibility study on the implementation of posttreatment continuing recovery monitoring.  Journal of Psychoactive Drugs, SARC Supplement 6, September, 295-302.