Risk factors for medication non-adherence among psychiatric patients with substance misuse histories

Abstract

Medication non-adherence among psychiatric patients is known to be associated with poorer treatment outcomes. The study examined a comprehensive set of modifiable risk factors for non-adherence in a theoretical framework among a diverse, high risk sample of psychiatric patients with substance misuse histories (N=299). Medication side effects and excessive alcohol use were related to lower medication adherence and higher motivation for mental health treatment and recovery support were related to greater adherence. The results suggest that a multifaceted model for intervention to increase psychiatric medication adherence should be developed and tested.

The clinician–patient working alliance: is it a significant predictor of psychiatric medication adherence in a sample of recently released parolees?

“…The use of alcohol and illegal drugs during the follow-up period emerged as the only significant predictor of low psychiatric medication adherence in this study, which is consistent with findings from previous research (Czobor et al, 2015; García et al, 2016; Magura et al, 2014; Olfson et al, 2000). While it was not possible to determine why substance use was associated with low psychiatric medication adherence in this study, one possible explanation for this relationship is that alcohol and substance use leads to cognitive impairments that increase the likelihood that a person will forget to take their medications.…”

“…Findings from a recent meta-analysis suggest that the working alliance-outcome relationship is weaker among patients with substance use problems when compared to patients without substance use problems (Flückiger et al, 2013). Additionally, substance misuse has been found to negatively impact medication adherence in several studies (Czobor et al, 2015; García et al, 2016; Magura, Mateu, Rosenblum, Matusow, & Fong, 2014; Olfson et al, 2000). Due to the variability in findings across studies, several researchers stress the importance of including contributing and/or confounding factors in the analyses when assessing the working alliance-clinical outcome relationship (Doran, 2016; Flückiger et al, 2013).…”

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

“…Finally, non-adherence may occur to avoid medication side effects. For instance, individuals who report more side effects show increased non-adherence to ART (30) and psychiatric medications (31, 32). While naltrexone is generally well-tolerated, compared to control or no treatment conditions, several common side effects have been identified in AUD treatment, including nausea, dizziness, weakness, sleep difficulties, and anxiety (33, 34).…”

Delivering Cognitive Behavioral Therapy for Insomnia in Military Personnel and Veterans

“…While substances such as alcohol and cannabis may induce drowsiness or relaxation, sleep fragmentation is increased as substances are metabolized, and tolerance to sedation develops with continued use. 45 CBT-I in substance users may require multi-model interventions for co-occurring diagnoses as problematic alcohol use is associated with reduced treatment adherence, 46 and treatment for insomnia typically is not initiated until the recovery phase of substance use disorders. CBT-I techniques are practical and effective interventions for sleep disturbance in individuals with a history of substance use disorders.…”