A systematic review of the relationship between substance abuse and psychotropic medication adherence: opportunities to improve outcomes for patients with a dual-diagnosis Poster Tyler J Dunn, BS, MS Pharmacy Administration candidate; Khalid M Kamal, MPharm, PhD; Vincent Giannetti, PhD; Jordan R Covvey, PharmD, PhD, BCPS; Duquesne University School of Pharmacy, Pittsburgh PA BACKGROUND RESULTS/TABLES DISCUSSION Patients with dual diagnosis, the co-morbid diagnosis of substance use disorder (SUD) and mental illness (MI), exhibit more persistent, severe, chronic and treatment- resistant symptoms than patients with substance abuse disorder or a mental illness alone Poor medication adherence is associated with negative health outcomes, especially in patients with MI or SUD Currently, in patients with dual diagnosis, there is an incomplete understanding of how medication adherence for MI relates to SUD relapse Further research in this area is needed to understand how interventions can target patients more effectively and improve health outcomes Author, year Objective Study population Location Methods Relevant outcomes Limitations Herbeck et al, 2005 To examine clinical and non-clinical factors associated with treatment compliance problems in patients with comorbid psychiatric and SUD 342 patients with comorbid psychiatric and SUD US Cross-sectional, questionnaire The clinical variables most strongly associated with compliance were: a comorbid personality disorder (OR=2.6), lower functioning ability (OR=3.6), a current illicit drug problem (OR=4.0), and medication side effects (OR=2.5) Small sample size, could not establish temporality Magura et al, 2002 To examine associations between attendance at self-help meetings, medication adherence, and mental health outcomes in those with a dual diagnosis 240 Double Tree in Recovery (DTR) self-help group participants with both chronic MI and a SUD Prospective, interview The variables associated with adherence were living in supported housing, having fewer stressful life events, and having a lower severity of psychiatric symptoms Non-standardized measures, adherence measurement may be inaccurate Magura et al, 2014 To examine the risk factors of nonadherence in psychiatric patients with substance misuse history 229 patients with a mental illness diagnosis, lifetime history of substance misuse, and a current prescription for psychiatric medication Cross-sectional, interview Medication side effects, excessive alcohol use, and a diagnosis of depression were associated with lower adherence. A diagnosis of schizophrenia was associated with higher adherence Limited generalizability, could not establish causation Magura et al, 2011 To measure and determine factors related to nonadherence in psychiatric patients with substance abuse histories 131 patients in a psychiatric continuing day treatment program who had substance misuse histories and are prescribed psychiatric medication Factors correlated with lower adherence in the substance misuse population were: lower friends' support for drug/alcohol abstinence, less recovery-promoting behaviors, lower satisfaction with medication, more medication side effects, lower self-efficacy for drug avoidance, and lower social support for recovery Manwani et al, 2007 To examine patterns of adherence to mood stabilizers in patients with bipolar disorder 115 patients with bipolar disorder (58 with SUD and 57 without SUD) Patients with co-occurring SUD were less adherent than those without SUD Adherence measurement may be inaccurate Okpataku et al, 2015 To determine medication adherence behavior in psychiatric out-patients with psychoactive substance use comorbidity 208 psychiatric out-patients with psychoactive substance use comorbidity in a Nigerian Tertiary Hospital Nigeria No statistically significant relationship was found between substance use and medication adherence No limitations reported Swanson et al, 1999 To investigate the effect of motivational interviewing on adherence among psychiatric and dually diagnosed inpatients 121 psychiatric inpatients, 93 whom had a SUD Prospective, assessment of motivational interviewing intervention Brief motivational interventions show promise improving adherence among dually diagnosed patients Limited generalizability, no control group Wilk et al, 2006 To compare clinical characteristics of nonadherence among schizophrenia patients with and without past comorbid SUD 190 patients with schizophrenia and 105 patients with a comorbidity of SUD and schizophrenia Patients with a substance use disorder were less likely to discuss the risks of nonadherence with their provider (p=0.05), link adherence to personal goals (p=.006), or explore the meaning of taking antipsychotic medications with their provider (p=0.01) Adherence measurement may not be accurate, no clinical diagnosis, limited generalizability 51 studies were included in the literature review 36 studies (71%) concluded that comorbid SUD was significantly associated with psychotropic medication nonadherence Six studies (12%) found no significant relationship between SUD and psychotropic medication adherence One study (2%) found nonadherence to be significantly associated with nicotine dependence, cannabis use and stimulant use but not problem drinking Eight studies (16%) specifically observed the dual diagnosis population (Table) Factors associated with a higher level of adherence included living in supported housing, having fewer stressful life events and lower mental illness symptom severity Factors associated with lower adherence levels were lower social support for drug and alcohol abstinence, less recovery-promoting behaviors, lower satisfaction with medication, more severe medication side effects, lower self-efficacy for drug avoidance, lower social support for recovery, the diagnosis of a comorbid personality disorder versus other mental illnesses, lower functioning ability, and the current use of illicit substances The most commonly reported limitation was the potential inaccuracy of the adherence measurement used (21 studies, 41%) OBJECTIVES To conduct a systematic literature review to evaluate the relationship between psychotropic medication adherence and SUD relapse in dually-diagnosed patients. METHODS A systematic literature review was conducted and reported per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines Search was conducted in PubMed, SCOPUS, and PsychINFO electronic databases up to March 2017 Inclusion criteria were primary research articles assessing the relationship between SUD, psychotropic medication and adherence Reviews, grey literature, and non-English articles were excluded Descriptive data was extracted from each article, including objective, study population, location, methodology, outcomes and limitations CONCLUSION Overall, the literature shows that alcohol and illicit substance use is associated with psychotropic medication nonadherence in the MI population No studies in the review observed relapse rates or the impact of medication adherence upon SUD relapse, which is a vital health outcome of SUD treatment Future research should observe adherence factors specifically in the dual diagnosis population and assess the affect of adherence on relapse rates Further data could help interventions tailor treatment to patients more effectively, help overcome barriers to treatment and improve overall health outcomes