Study offers reasons why alcohol medication adherence poses challenge

Weekends represent a danger zone for some patients with alcohol dependence. If they are on anti-craving medication treatment, such as naltrexone, they are less likely to take the drug on the weekend days when they might need it most. Researchers led by an assistant professor at Oregon State University recently studied the factors that influence alcohol patients' medication adherence, hoping greater knowledge in this area will allow for more effective interventions to help keep patients on course.

Sarah Dermody, an assistant professor at the university's School of Psychological Science, tells Addiction Professional that the data for the study were originally collected as part of an evaluation of a texting intervention designed to remind patients to take their medication. The intervention failed in the research. “What, then, is getting in the way for people?” says Dermody.

She and her colleagues thus tracked 58 individuals who were prescribed naltrexone for eight weeks, in order to understand the factors that affected how consistently patients took their medication. As part of this study, participants each day received a text message asking them to complete a daily diary to report on their drinking patterns, alcohol cravings, and any medication side effects they experienced.

The researchers found that patients were twice as likely to take their medication on days in which they completed the text assessments. “Just completing those messages was related to helping remind the patients,” Dermody says.

Findings were published this month in the Annals of Behavioral Medicine.

These were some of the other patterns seen in the research:

• Medication adherence declined over time. While around 8 in 10 patients were taking their naltrexone at week one, that share dropped to around 4 in 10 by the eighth and final week of the study.

• Symptoms of the patients' addiction influenced patients' medication adherence. They were less likely to take their medication on the day after drinking heavily or experiencing strong cravings.

• In addition, they were less likely to take the naltrexone on weekends. “Weekends are a huge part of people's drinking life,” Dermody said in a news release from the university. “That is often when people drink more heavily and when their cravings are strongest. But they also tend not to be taking naltrexone on the days when the medication is particularly needed.”

Dermody says that prior to this research, most studies of factors that potentially influence medication adherence focused on variables such as age, gender and income, which have not been found to be consistently related to adherence.

Takeaways from findings

Based on the findings of this study, some ideas for improving medication adherence come to mind immediately, Dermody says. “Maybe we need to consider long-acting formulations of medications,” she says, such as the existing monthly injectable formulation of naltrexone (brand name Vivitrol). That would counteract any weekday/weekend fluctuations experienced with oral medication.

Perhaps most importantly, however, “We need to do more than just write and provide a prescription,” Dermody says.