The Interaction of Co-Occurring Mental Disorders and Recovery Management Checkups on Substance Abuse Treatment Participation and Recovery

Abstract

This article examines the effectiveness of quarterly Recovery Management Checkups (RMCs) for people with substance disorders by level of co-occurring mental disorders (34% none, 27% internalizing disorders, and 39% internalizing and externalizing) across two randomized experiments with 92% to 97% follow-up. The 865 participants are 82% African American, 53% female, and age 37 on average. RMC involves identification of those in need of treatment, motivational interviews, and treatment linkage assistance. It is effective in linking participants in need to treatment, with equal or better outcomes among those with more mental disorders. The data support the utility of monitoring and re-intervention for clients with co-occurring disorders.Keywords co-occurring disorders; recovery management; substance abuse treatment outcome Given that substance use disorders are often chronic conditions that may last decades, it is hardly surprising that it takes an average of three to four admissions to treatment for 9 years to reach a sustained recovery Dennis et al. 2005;Grella and Joshi 1999;Hser et al. 1997;Hser et al. 1998). In recognition of these findings and other Reprints: http://www.sagepub.com/journalsReprints.nav Please address correspondence to Brian R. Rush, Center for Addiction and Mental Health, Room T304, 33 Russell St., Toronto, Ontario, M5S 2S1 Canada; phone: (416) 535-8501 (ext. 6625); brian_rush@camh.net. Questions about the Recovery Management Checkup intervention can be addressed to Christy K. Scott, Chestnut Health Systems, 221 W. Walton, Chicago, IL 60610; phone: (312) 664-4321; fax: (312) 664-4324; cscott@chestnut.org. Questions about the broader early re-intervention studies can be addressed to Michael L. Dennis, Chestnut Health Systems, 720 West Chestnut, Bloomington, IL 61701; mdennis@chestnut.org. Matzger, and Kaskutas 2003). This public health approach to longitudinal monitoring and early re-intervention (ERI) provides the foundation for Recovery Management Checkups (RMCs; Scott and Dennis 2003), an evidence-based approach for managing substance users through multiple episodes of treatment. The RMC intervention targets individuals who have previously participated in treatment and are now living in the community using substances. The intervention (described in more detail later) aims to provide immediate linkage back to substance abuse treatment on the basis of need, thus expediting the recovery process. Key components include, for example, assessing eligibility for the intervention and need for treatment, transferring participants in need of treatment from the interviewer to a linkage manager for a brief intervention, linking participants to the intake assessment, and ultimately linking participants to treatment. The intervention does not target or address concurrent disorders specifically. In two closely related experiments (Dennis, Scott, and Funk 2003; Scott and Dennis under review), participants randomly assigned to RMC or a control group were just as likely to be in need of treat...

Effect of co-occurring disorders and intimate partner violence on substance abuse treatment outcomes

“…In addition, similar patterns of risk were revealed in substance use-specific analyses. Previous studies focused on treatment completion and reentry have revealed comparable results, in that clients with COD are less likely to complete treatment and more likely to return to treatment (Green et al, 2002;Ilgen et al, 2008;Luchansky et al, 2000;Moos et al, 1995;Rush et al, 2008). Although this study could not distinguish specific mental health problems, outcomes may vary by type of psychiatric disorder.…”

“…Overall, COD appears to be negatively associated with treatment retention (Comfort & Kaltenbach, 2000) and completion (Green, Polen, Dickinson, Lynch, & Bennett, 2002;Mangrum, 2009) and positively associated with relapse or return to treatment (Bradizza, Stasiewicz, & Paas, 2006;Ilgen, Hu, Moos, & McKellar, 2008;Luchansky, He, Krupski, & Stark, 2000;Moos, Pettit, & Gruber, 1995;Rush, Dennis, Scott, Castel, & Funk, 2008), although findings have varied by mental disorder and diagnostic measures. Mixed results have also been reported with regard to gender differences in the relationship between COD and treatment outcomes (Galen, Brower, Gillespie, & Zucker, 2000;Greenfield et al, 1998;Kranzler, Del Boca, & Rounsaville, 1996;Mann, Hintz, & Jung, 2004;Walitzer & Dearing, 2006;Westermeyer, Kopka, & Nugent, 1997).…”

Probability and predictors of cannabis use disorders relapse: Results of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC)

“…Although the presence of other axis I disorders may constitute an important risk factor for relapse in certain clinical subgroups (Arendt et al, 2007a; Chen et al, 2011; Okuda et al, 2010) their role in the remission and relapse of individuals with CUD in the community appears more limited in comparison to the effect of conduct disorder or major depressive disorder. Lower rates of co-occurring psychiatric disorders in community samples compared to clinical ones may also explain part of the difference (Rush et al, 2008; Shane et al, 2003). …”

A comparison of treatment outcomes for adolescent community reinforcement approach participants with and without co-occurring problems

“…Prior research has demonstrated that scores on the GAIN Internalizing and Externalizing scales have high agreement with independent clinical diagnoses based on other established diagnostic scales, clinical reports, and tests of construct/predictive validity (Chan et al, 2008; Conrad et al, 2010, 2012; Rush, Castel, Brands, Toneatto, & Veldhuizen, 2013; Rush, Dennis, Scott, Castel, & Funk, 2008; Shane et al, 2003; Subramaniam, Ives, Stitzer, & Dennis, 2010; Womack et al, 2004). The “non-comorbid” group included those participants who did not endorse symptoms that met criteria for any psychiatric problem.…”