Predictors of Daily Adherence to Naltrexone for Alcohol Use Disorder Treatment During a Mobile Health Intervention

Abstract

Background Adherence to medications for treating alcohol use disorder (AUD) is poor. To identify predictors of daily naltrexone adherence over time, a secondary data analysis was conducted of a trial evaluating a mobile health intervention to improve adherence. Methods Participants seeking treatment for AUD (n = 58; M age = 38 years; 71% male) were prescribed naltrexone for 8 weeks. Adherence was tracked using the Medication Event Monitoring System (MEMS). In response to daily text messages, participants reported the previous day's alcohol use, craving, and naltrexone side effects. Using multilevel structural equation modeling (MSEM), we examined baseline dispositional factors and within-person, time-varying factors as predictors of daily adherence. Results Naltrexone adherence decreased over time. Adherence was higher on days when individuals completed daily mobile assessments relative to days when they did not (odds ratio [OR] = 2.53, 95% confidence interval [CI] 1.61 to 3.98), irrespective of intervention condition. Days when individuals drank more than their typical amount were related to lower next-day adherence (OR = 0.93, 95% CI 0.88 to 0.99). A similar pattern was supported for craving (OR = 0.88, 95% CI 0.79 to 0.98). Weekend days were associated with lower adherence than weekdays (OR = 0.71, 95% CI 0.58 to 0.86); this effect was partly mediated by heavier daily drinking (indirect effect = −0.02, 95% CI −0.04 to −0.003) and stronger-than-usual craving (indirect effect = −0.01, 95% CI −0.02 to 0.00) on weekend days.Conclusions The results further demonstrate the need to improve adherence to AUD pharmacotherapy. The present findings also support developing interventions that target daily-level risk factors for nonadherence. Mobile health interventions may be one means of developing tailored and adaptive adherence interventions.

The Endocannabinoid System and Cannabidiol's Promise for the Treatment of Substance Use Disorder

“…Treatment to date has had minimal success, with a high likelihood of relapse (3). There is also no reliably established pharmacotherapy for SUDs, such as cannabis, and stimulant use disorder; and current pharmacotherapies (e.g., opiate substitution with methadone; naltrexone for alcohol use disorder; nicotine replacement) have limited efficacy in relapse prevention (4, 5). SUD has been conceptualized as a maladaptive and relapsing cycle of intoxication, binging, withdrawal and craving that results in excessive substance use despite adverse consequences (6).…”

OPRM1 Moderates Daily Associations of Naltrexone Adherence With Alcohol Consumption: Preliminary Evidence From a Mobile Health Trial

“…Specifically, genotype was added as a predictor of the within‐person associations (i.e., the random slope factors), along with covariates. In addition to the level 2 covariates described above, weekend day (Friday, Saturday, Sunday) versus weekday at level 1 (group‐mean‐centered to facilitate parameter interpretation as a weighted average across weekend vs. weekday) was controlled for to account for day‐of‐the‐week fluctuations in alcohol use, craving, and adherence previously identified in this sample (Dermody et al, ).…”

“…Because detecting pharmacogenetic associations requires sufficient medication exposure, another important consideration is medication adherence. Adherence to AUD medications in clinical settings is typically poor (Mark et al, , ) and declines over the course of treatment (Dermody et al, ), presenting challenges for pharmacogenetic studies. Importantly, naltrexone’s neuropharmacological profile suggests that daily changes in adherence could have implications for fluctuations in craving and consumption.…”

Concurrent, successful management of bipolar I disorder with comorbid alcohol dependence via aripiprazole long‐acting injection: A case report

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