Psychiatry 2008 - September 2008 - (Page 45)

[the interface] sample, Rowan and colleagues23 and Butt and colleagues24 both found that alcohol and drug use impaired treatment. In two studies from the UK, Singh and Press25 found that poor and/or substance use impairs adherence with medical treatment, whether with medications, appointments, or treatment recommendations. In the aftermath REFERENCES 1. Tucker JS, Burnam MA, Sherbourne CD, et al. Substance use and mental health correlates of nonadherence to antiretroviral medications in a sample of patients with human immunodeficiency virus infection. Am J Med. 2003;114:573–580. Ingersoll K. The impact of psychiatric symptoms, drug use, and medication regimen on nonadherence to HIV treatment. AIDS Care. 2004;16:199–211. Hinkin CH, Hardy DJ, Mason KI, et al. Medication adherence in HIVinfected adults: effect of patient age, cognitive status, and substance abuse. AIDS. 2004;18:S19–25. Mohammed H, Kieltyka L, Richardson-Alston G, et al. Adherence to HAART among HIVinfected persons in rural Louisiana. AIDS Patient Care STDS. 2004;18:289–296. Murphy DA, Marelich WD, Hoffman D, Steers WN. Predictors of antiretroviral adherence. AIDS Care. 2004;16:471–484. Braithwaite RS, McGinnis KA, Conigliaro J, et al. A temporal and dose-response association between alcohol consumption and medication adherence among veterans in care. Alcohol Clin Exp Res. 2005;29:1190–1197. Chander G, Lau B, Moore RD. Hazardous alcohol use: a risk factor for non-adherence and lack of suppression in HIV infection. J Acquir Immune Defic Syndr. 2006;43:411–417. Hinkin CH, Barclay TR, Castellon SA, et al. Drug use and medication adherence among HIV-1 infected individuals. AIDS Behav. 2007;11:185–194. Hicks PL, Mulvey KP, Chander G, et al. The impact of illicit drug use and substance abuse treatment on adherence to HAART. AIDS Care. 2007;19:1134–1140. Lazo M, Gange SJ, Wilson TE, et al. regardless of disease process, ethnicity of the sample, or specific adherence parameter under study, these data consistently indicate that alcohol and/or substance use impairs adherence with medical treatment, whether with medications, appointments, or treatment recommendations. glycemic control in people with diabetes was associated with alcohol excess, and Connor and Mahdi26 found that alcohol misuse by men was associated with a higher rate of diabetes-related foot ulcerations. In a US study, Unruh and colleagues found that elopement from dialysis treatment was associated with the illicit use of drugs.27 In a Turkish study, Yavuz and colleagues found that failed appointments for renal transplant patients were associated with alcohol intake.28 In a US study of patients with nonvalvular atrial fibrillation who were on warfarin, those with substance abuse had a higher risk of complications.29 In a US study examining treatment adherence with recommendations from emergency department staff, Hejazi and colleagues determined that heavy alcohol users were less likely to adhere to prescribed therapy.30 Finally, Evangelista, Doering, and Dracup31 examined a sample of US veterans for hospital readmissions for heart failure, which were associated with current alcohol use. of nonadherence, we suspect that there is a subsequently higher utilization of healthcare services and/or greater mortality as well. 2. 3. 4. CONCLUSIONS While evident to most clinicians, the preceding data reinforce the unequivocal conclusion that alcohol and substance misuse by patients may impair successful medical treatment through nonadherence. This finding is explicit and consistent throughout a variety of studies with different populations, varying methodologies, and various illness states. This conclusion indicates that physicians, both in psychiatry and primary care, need to be highly vigilant about the potential impact on adherence of alcohol and substance usage. Indeed, being aware of the potential risk of nonadherence may enable the physician to undertake additional educational efforts with alcohol/substance-using patients by emphasizing the importance of treatment adherence; scrutinizing ongoing medication usage and disease response; and preparing for supportive confrontation, if indicated, about nonadherence. These clinician efforts, of course, must be undertaken in the spirit of compassion and understanding because, for many, alcohol and drug use is a fatal attraction, particularly with regard to adherence with medical care. 5. 6. 7. 8. SUMMARY In summarizing the preceding empirical literature, regardless of disease process, ethnicity of the sample, or specific adherence parameter under study, these data consistently indicate that alcohol 9. 10. [SEPTEMBER] Psychiatry 2008 45

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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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