The clinical utility of the Medication Adherence Questionnaire (MAQ) in an alcohol pharmacotherapy trial

Abstract

Background Medication nonadherence is a ubiquitous problem in pharmacology treatment for alcohol use disorders. Unintentional and purposeful nonadherence as measured by the Medication Adherence Questionnaire (MAQ) has been shown to predict problems with medication adherence; however, feedback from the MAQ has never been incorporated into a behavioral intervention to facilitate medication adherence. We assessed the integration of the MAQ into Medical Management (MM), a counseling approach frequently employed in conjunction with alcohol pharmacotherapy, to determine whether prior patterns of nonadherence could be addressed effectively to promote medication adherence. Methods We conducted a post-hoc analysis of data from 131 alcohol dependent smokers who participated in a double blind, placebo controlled study of varenicline for the treatment of alcohol dependence. At baseline, participants completed a single administration of the MAQ, which asks 2 questions about unintentional nonadherence (e.g., forgetting) and 2 questions about purposeful nonadherence (e.g., stopping because feeling good or feeling bad). Based on these responses, participants were divided into 1 of 3 three categories. Adherent (n=60), Unintentional or Purposeful Nonadherent (n=50) and Unintentional and Purposeful Nonadherent (n=21). Over the course of the 16-week treatment period, patients were expected to participate in 12 Medical Management (MM) sessions; a brief psychosocial treatment. Feedback based on the MAQ responses was integrated into the MM sessions to facilitate medication and treatment adherence. Results The 3 adherence groups were compared on baseline characteristics, medication adherence, treatment attendance and end-of-treatment patient ratings of treatment helpfulness. Baseline demographics and characteristics were not significantly different among the three categories. We found no statistically significant differences among the three groups with respect to pill adherence, treatment attendance, and treatment satisfaction ratings. Conclusions The findings suggest that the incorporation of MAQ feedback into the MM approach could be effective in mitigating risks associated with prior patterns of nonadherence suggesting that further testing of the integrated behavioral approach is warranted.

Longitudinal Findings from a Randomized Clinical Trial of Varenicline for Alcohol Use Disorder with Comorbid Cigarette Smoking

“…These findings differ somewhat from the results of a recent meta-analysis of smoking cessation trials that indicated a sustained benefit of varenicline (vs. placebo) through 12 months, but a decline in quit rates across both groups over time (Rosen et al, 2018). The sustained effects in the current study may also indicate a longitudinal benefit of behavioral counseling since all participants received 12 weeks of medical management for alcohol use (Zweben et al, 2017), a behavioral intervention adapted from the COMBINE study (Anton et al, 2006;Pettinati et al, 2005). Other studies indicate that behavioral treatments for substance use can produce lasting benefits beyond the end of treatment (e.g., (Carroll et al, 1994;O'Malley et al, 1996).…”

“…After week 16, use of medication was tapered over 2 weeks (0.5 mg twice daily and then 0.5 mg daily). Participants also received 12 brief counseling sessions with a healthcare professional for medical management (MM) (Zweben et al, 2017) adapted from the COMBINE study (Anton et al, 2006;Pettinati et al, 2005). The first 4 weeks of treatment focused on medication adherence and stabilization on medication.…”

Effect of Varenicline Combined With Medical Management on Alcohol Use Disorder With Comorbid Cigarette Smoking

“…Following randomization, participants attended 12 treatment research sessions (weeks 1, 2, 3, 4, 5, 6, 7, 9, 11, 13, 15, and 17) and met with a medical professional for MM adapted from the COMBINE study . The first 4 sessions addressed tolerability and supported medication adherence; the remaining sessions addressed finalizing drinking goals as well as developing and implementing strategies for changing drinking.…”