Magazine article Clinical Psychiatry News

Strategies Can Improve Treatment Adherence: If Alcohol Abusers Don't Improve, They May Need to Be Reeducated about Their Medications

Magazine article Clinical Psychiatry News

Strategies Can Improve Treatment Adherence: If Alcohol Abusers Don't Improve, They May Need to Be Reeducated about Their Medications

Article excerpt

SCOTTSDALE, ARIZ. -- Sometimes an alcohol abuser prescribed a medication such as disulfiram, acamprosate, or naltrexone has no improvement in their drinking behavior. Sometimes the reason is that the patient has not been adherent to the medication, but not willfully so. In those cases, there are strategies a physician can use to help, Dr. Roger D. Weiss said at the annual meeting of the American Academy of Addiction Psychiatry.

No one knows for sure what level of adherence is necessary for the drugs used to treat alcohol dependence, and it is probably different for each drug, but it is clear that adherence does dictate efficacy, said Dr. Weiss, clinical director of the alcohol and drug abuse treatment program at McLean Hospital in Belmont, Mass.

In a classic study of disulfiram, patients who were largely adherent to their medication had an 80% likelihood of becoming abstinent during the study, whereas those who were nonadherent had only a 20% chance. Most patients were nonadherent, Dr. Weiss said.

In a study of naltrexone treatment, the relapse rates were 10% for those adherent to naltrexone and 34% for those adherent to placebo. But in nonadherent patients, the relapse rates were roughly the same: 42% and 40%.

When a patient's treatment is not working, the treating physician needs to ask about adherence, Dr. Weiss said. He said he does not ask the patient if he or she is taking their medication. Instead, he asks, "How much are you taking your medication?" The more specific question invites discussion that can be enlightening.

"By doing that, I found a lot of people who are taking more than prescribed, less than prescribed, and all kinds of odd dosing patterns," he said.

Nonadherence can involve patients who, often because they are impatient, take too much of a medication, and this can be as big a problem as omission because they run out or develop side effects that discourage them from continuing the regimen.

Dr. Weiss said he also keeps in mind that patients tend to exaggerate their adherence, for a variety of reasons apart from conscious deception, and that the most common reason patients miss a dose of medication is that they forget--and then they forget that they forgot.

When the patient is nonadherent, possible strategies include:

* Reeducation. Be certain the patient understands his or her condition, the need for the medication, and the importance of following the drug regimen, Dr. Weiss recommended. If the physician has doubts or uncertainty about a medication, that can be communicated to the patient and needs to be dealt with. …

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