Does Recovery From Substance Use Disorders Among Patients With Bipolar Disorder Predict Improved Medication Taking Behaviors and Drug Attitudes?

Christian J. Teter, PharmD; Anthony E. Falone; Amanda Lower, BS; and Roger D. Weiss, MD
Northeastern University, Belmont, Massachusetts (Dr Teter, Mr Falone, and Ms Lower); McLean Hospital, Belmont, Massachusetts (Drs Teter and Weiss, Mr Falone, and Ms Lower); and Harvard Medical School, Boston, Massachusetts (Dr Weiss)

This poster presentation was supported by a faculty development grant.

Background: Very high rates of medication nonadherence are found among patients with bipolar disorder (BD). Patients with BD and a co-occurring substance use disorder (SUD) are particularly at risk for medication nonadherence,^1,2 although the exact reasons for this finding remain unknown. Only recently have studies began to consider patients with BD and past history of SUD (BD-PH) and those with current history of SUD (BD-CH) separately within the same sample. Based on recent findings demonstrating that BD-PH is associated with significantly better role functioning as compared to BD-CH,³ we conducted a naturalistic study to determine whether there are differences between BD-PH and BD-CH with regards to medication adherence and drug attitudes.

Methods: Face-to-face interviews were conducted with psychiatric inpatients admitted to the Schizophrenia and Bipolar Disorder Program at McLean Hospital in Belmont, MA. Formal diagnostic instruments and measures to assess attitudes and beliefs towards psychiatric medications were administered during the interviews. Medication adherence behaviors were recorded for the first seven days of each patient’s hospitalization. The primary outcome variable was a standardized dose ratio of medication taken/medication prescribed (standardized medication adherence ratio [SMAR]).

Results: Fifty-four patients completed the interviews and received a formal diagnosis of BD. Among this sample, there were patients with BD and no history of SUD (n=26), patients with BD-CH (n=9), and patients with BD-PH (n=19). The SMAR was significantly lower among patients with BD-CH (74.38) as compared to those without any history of SUD (88.11) or BD-PH (98.02) (F=7.088, df=2, p<0.01). Post-hoc analysis showed that patients with BD-CH demonstrated lower rates of medication adherence as compared to those with BD-PH (p<0.01). Furthermore, drug attitude scores, as measured by the Drug Attitude Inventory (DAI), were negative among a significantly higher proportion of patients with BD-CH (62.5%) as compared to no history of SUD (37.5%) and BD-PH (11.1%; p<0.01).

Conclusions: Results of the present study indicate that hospitalized patients with BD and past history of SUD (i.e., in recovery) are doing quite well regarding their medication adherence. They also appear to have a more positive attitude towards psychiatric medications. Perhaps helping patients with BD achieve recovery from substance use improves their medication taking behaviors and attitudes.

References

1. Keck PE Jr, McElroy SL, Strakowski SM, et al. Compliance with maintenance treatment in bipolar disorder. Psychopharmacol Bull. 1997;33(1):87–91.
2. Weiss RD, Greenfield SF, Najavits LM, et al. Medication compliance among patients with bipolar disorder and substance use disorder. J Clin Psychiatry. 1998;59(4):172–174.
3. Weiss RD, Ostacher MJ, Otto MW, et al, for STEP-BD Investigators. Does recovery from substance use disorder matter in patients with bipolar disorder? J Clin Psychiatry. 2005;66(6):730–735

Back      Poster