1. 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