AbstractBackground and AimsRecovery management checkups (RMC) have established efficacy for linking patients to substance use disorder (SUD) treatment. This study tested whether using RMC in combination with screening, brief intervention, and referral to treatment (SBIRT), versus SBIRT alone, can improve linkage of primary care patients referred to SUD treatment.DesignA randomized controlled trial of SBIRT as usual (n = 132) versus SBIRT plus recovery management checkups for primary care (RMC‐PC) (n = 134) with follow‐up assessments at 3 months post‐baseline.SettingFour federally qualified health centers in the United States serving low‐income populations.ParticipantsPrimary care patients (n = 266, 64% male, 80% Black, mean age, 48.3 [range, 19–53]) who were referred to SUD treatment after SBIRT.InterventionsSBIRT alone (control condition) compared with SBIRT + RMC‐PC (experimental condition).MeasurementThe primary outcome was any days of SUD treatment in the past 3 months. Key secondary outcomes were days of SUD treatment overall and by level of care, days of alcohol and other drug (AOD) abstinence, and days of using specific substances, all based on self‐report.FindingsAt 3‐month follow‐up, those assigned to SBIRT + RMC‐PC (n = 134) had higher odds of receiving any SUD treatment (46% vs 20%; adjusted odds ratio = 4.50 [2.49, 8.48]) compared with SBIRT only, including higher rates of entering residential and intensive outpatient treatment. They also reported more days of treatment (14.45, vs 7.13; d = +0.26), more days abstinent (41.3 vs 31.9; d = +0.22), and fewer days of using alcohol (27.14, vs 36.31; d = −0.25) and cannabis (19.49, vs 28.6; d = −0.20).ConclusionsRecovery management checkups in combination with screening, brief intervention, and referral to treatment are an effective strategy for improving linkage of primary care patients in need to substance use disorder treatment over 3 months.