Psychiatry 2008 - September 2008 - (Page 44)

[the interface] use, was associated with medication nonadherence.3 In a sample of 273 patients in several HIV clinics in Louisiana, 34.4 percent of participants were nonadherent with medications; in this study population, problematic drinking was associated with nonadherence to treatment.4 Finally, among 115 HIV-positive patients who were identified as having difficulty adhering to their medication treatment, Murphy and colleagues found that alcohol use during the last month was a contributory variable.5 Additional studies continue to support the conclusions of the preceding investigators. For example, Braithwaite and colleagues examined veterans who were HIV-positive and found that abstainers from alcohol missed 2.4 percent of medication doses on query days, nonbinge drinkers 3.5 percent of doses, and binge drinkers 11.0 percent of doses.6 Chander, Lau, and Moore examined 1,711 HIV-infected individuals from an urban setting and reported that “hazardous” alcohol use was independently associated with decreased medication adherence.7 In colleagues examined 659 HIV-positive patients for adherence patterns and found that current substance users were significantly less likely to be adherent (60% adherence) than former users (68% adherence) or those who had never used drugs (77% adherence).9 Finally, in a study by Lazo and colleagues, investigators found that the use of alcohol predicted reduced medication adherence in women, but not men.10 In a related study, among HIVinfected drug users, Maru and colleagues found that one of the major causes of medication discontinuation was entry into a drug treatment program.11 With the exception of one negative finding with regard to alcohol use3 and one finding of alcohol effects in women but not men,10 the preceding studies all indicate that alcohol/substance misuse compromises adherence with medication in the treatment of HIV infection. Non-US studies. Do these nonadherence patterns transcend US study samples? Apparently so! Various French investigators have reported NONADHERENCE IN TUBERCULOSIS TREATMENT Compared with HIV treatment, where there are more US studies than those from other countries, there are more non-US studies in the area of tuberculosis (TB) treatment and nonadherence. US studies. Oscherwitz and colleagues examined the reasons for the court-ordered detention of 67 TB patients who were from 12 different counties in California; 81 percent suffered from alcohol and/or drug abuse.17 In an urban treatment program for TB, Burman and colleagues found that 18 percent of 294 patients were nonadherent with medications; one of several identified factors was alcohol abuse.18 (Note that the dates of publication for these studies are 1997; we were unable to locate more recent articles on this topic.) Non-US studies. As we noted earlier, there are a number of non-US studies relating to nonadherence with the treatment of TB. In two Russian studies, Bumburidi and colleagues19 and Jakubowiak and colleagues20 found that alcohol abuse was a significant risk factor for medication nonadherence among patients with TB. In a third Russian study, Gelmanova and colleagues21 found that substance abuse was associated with medication nonadherence. Finally, in an Indian study, Jaggarajamma and colleagues22 confirmed that both alcohol consumption and drug use accounted for treatment default among patients with TB. Braithwaite and colleagues examined veterans who were HIV-positive and found that abstainers from alcohol missed 2.4 percent of medication doses on query days, nonbinge drinkers 3.5 percent of doses, and binge drinkers 11.0 percent of doses.6 a sample of 150 HIV-positive individuals, Hinkin and colleagues tracked medication adherence over a six-month period using an electronic monitoring device; compared with drug-negative participants, drugpositive participants demonstrated significantly less adherence with treatment medications.8 In this study, drug use by participants was associated with a four-fold greater risk of adherence failure. Hicks and 44 Psychiatry 2008 [ S E P T E M B E R ] nonadherence to retroviral therapy as a result of alcohol consumption,12 injecting drugs,13 and poly-drug usage.14 These associations are also evident in Spanish15 as well as Chinese16 samples; intravenous drug use and heroin use were associated with nonadherence with HIV medications in a sample of 320 Spanish patients15 and a sample of 308 Chinese patients, respectively.16 OTHER MEDICAL CONDITIONS While studies in the areas of nonadherence with HIV and TB treatment are the most numerous, there are studies of medication and treatment nonadherence due to alcohol/drug misuse in other disease states as well. For example, in the treatment of hepatitis C in a US

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Psychiatry 2008 - September 2008 Editor’s Message Editorial Advisory Board Contents Psych Rx Letters to the Editor Use of Benzodiazepines in the Treatment of Anxiety Functional Neurosurgery in the Treatment of Severe Obsessive Compulsive Disorder and Major Depression: Overview of Disease Circuits and Therapeutic Targeting for the Clinician Treatment of Comorbid Adolescent Cannabis Use and Major Depressive Disorder Risperidone Long-acting Injections: Successful Alternative Deltoid Muscle Injections for Refractory Schizophrenia Alcohol/Substance Misuse and Treatment Nonadherence: Fatal Attraction Transforming the Psychiatric Inpatient Unit from Short-term Pseudo-asylum Care to State-of-the-art Treatment Setting Journal Watch Classified Advertising Information for Authors

Psychiatry 2008 - September 2008

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