OBJECTIVE: This study analyzed data from a randomized trial to examine the impact on medication adherence of integrated treatment delivered via assertive community treatment (ACT) versus standard clinical case management (SCCM). METHOD: Data from the original study included 198 study participants with co-occurring psychotic and substance use disorders who were randomly assigned to receive integrated treatment via ACT or SCCM and were followed for 3 years. We applied mixed-effects logistic regression to estimate group (ACT vs. SCCM) by time effects on a self-report measure of medication adherence. Adherence was dichotomized as 20% or more missed medication days (“poor adherence”) versus less than 20% missed medication days (“adequate adherence”). RESULTS: Participants who were assigned to ACT reported significant improvement in medication adherence compared with those assigned to SCCM. CONCLUSIONS: Integrated treatment delivered via ACT may benefit persons with co-occurring psychotic and substance use disorders who are poorly adherent to medications.
Aquila, R., Weiden, P.J., & Emmanuel, M. ( 1999). Compliance and the rehabilitation alliance. Journal of Clinical Psychiatry, 60(Suppl. 19), 23-27.
2.
Becker, M.A., Young, M.S., Ochshorn, E., & Diamond, R. ( 2007). The relationship of antipsychotic medication class and adherence with treatment outcomes and costs for Florida Medicaid beneficiaries with schizophrenia. Administration of Policy in Mental Health and Mental Health Services Research, 34, 307-314.
3.
Bryk, A.S., & Raudenbush, S.W. (1992). Hierarchical linear models: Applications and data analysis methods. Newbury Park, CA : Sage.
4.
Chandler, D., & Spicer, G. ( 2006). Integrated treatment for recidivists with co-occurring psychiatric and substance use disorders. Journal of Substance Abuse Treatment, 42, 405-425.
5.
Cohen, J. ( 1988). Statistical power analysis for the behavioral sciences (2nd ed.). Mahwah, NJ: Lawrence Erlbaum.
6.
Drake, R.E., Mueser, K.T., Brunette, M.F., & McHugo, G.F. (2004). A review of treatments for people with severe mental illnesses and co-occurring substance use disorders . Psychiatric Rehabilitation Journal, 27, 360-374.
7.
Drake, R.E., O’Neal, E.L., & Wallach, M.A. ( 2008). A systematic review of psychosocial research on psychosocial interventions for people with co-occurring severe mental and substance use disorders. Journal of Substance Abuse Treatment, 34, 123-138.
8.
Essock, S.M., Mueser, K.T., Drake, R.E., Covell, N.H., McHugo, G.J., Frisman, L.K., . . . Swain, K. ( 2006). Comparison of ACT and standard case management for delivering integrated treatment for co-occurring disorders. Psychiatric Services, 57, 185-196.
9.
Gilmer, T.P., Dolder, C.R., Lacro, J.P., Folsom, D.P., Lindamer, L., Garcia, P., & Jeste, D.V. ( 2004). Adherence to treatment with antipsychotic medication and health care costs among Medicaid beneficiaries with schizophrenia. American Journal of Psychiatry, 161, 692-699.
10.
Jackson, C.T., Covell, N.H., Frisman, L.K., & Essock, S.M. ( 2004). Validity of self-reported drug use among people with co-occurring mental health and substance use disorders. Journal of Dual Diagnosis, 1, 49-63.
11.
Kane, J.M., Leucht, S., & Carpenter, D. ( 2003). Expert consensus guidelines for optimizing pharmacologic treatment of psychotic disorders. Journal of Clinical Psychiatry , 64, S95-S100.
12.
Lieberman, J.A., Stroup, T.S., McEvoy, J.P., Swartz, M.P., Rosenheck, R.A., Perkins, D.O., . . . Hsiao, J.K. ( 2005). Effectiveness of antipsychotic drugs in patients with chronic schizophrenia. New England Journal of Medicine, 353, 1209-1223.
13.
MacKinnon, D.P., Fairchild, A.J., & Fritz, M.S. ( 2007). Mediation analysis. Annual Review of Psychology, 58, 593-614.
14.
Marshall, M., & Lockwood, A. ( 2010). Assertive community treatment for people with severe mental disorders. Cochrane Database of Systematic Reviews , 3, CD001089.
15.
McGrew, J.H., Pescosolido, B., & Wright, E. ( 2003). Case managers’ perspectives on critical ingredients of assertive community treatment and on its implementation. Psychiatric Services, 54, 370-376.
16.
Mueser, K.T., Bond, G.R., Drake, R.E., & Resnick, S.G. ( 1998). Models of community care for severe mental illness: A review of research on case management. Schizophrenia Bulletin , 24, 37-74.
17.
Mueser, K.T., Noordsy, D.L., Drake, R.E., & Fox, L. ( 2003). Integrated treatment for dual disorders: A guide to effective practice. New York, NY: Guilford Press.
18.
Nose, M., Barbui, C., & Tansella, M. ( 2003). How often do patients with psychosis fail to adhere to treatment programmes? A systematic review. Psychological Medicine , 33, 1149-1160.
19.
Osterberg, L., & Blaschke, T. ( 2005). Adherence to medication. New England Journal of Medicine, 353, 487-497.
20.
Phillips, S.D., Burns, B.J., Edgar, E.R., Mueser, K.T., Linkins, K.W., Rosenheck, R.A., . . . McDonel Herr, E.C. (2001). Moving assertive community treatment into standard practice. Psychiatric Services, 52, 771-779.
21.
Velligan, D.I., Lam, Y.-W.F., Glahn, D.C., Barrett, J.A., Maples, N.J., Ereshefsky, L., & Miller, A.L. ( 2006). Defining and assessing adherence to oral antipsychotics: A review of the literature. Schizophrenia Bulletin, 32, 724-742.
22.
Zygmunt, A., Olfson, M., Boyer, C.A., & Mechanic, D. ( 2002). Interventions to improve medication adherence in schizophrenia . American Journal of Psychiatry, 159, 1653-1664.