A recent study by Bryson et al. has found that moderate to severe alcohol misuse increases the likelihood that patients won’t take their medication properly.
Many patients do not take their medications as often as they should – i.e. on at least 80% of the days they are supposed to. In fact, a recent study found that over the space of a year, 40% of patients taking cardiovascular or diabetes medications didn’t take their medications often enough. Such ‘medication nonadherence’ is associated with worsening of disease, increased health care costs, and even death.
Bryson et al. looked at more than 20,000 patients who were receiving treatment for high blood pressure, high cholesterol levels, or diabetes. All participants undertook a three-point questionnaire to evaluate their alcohol use on the basis of frequency and typical quantity of drinking during the past year, and the frequency of heavy episodic drinking (at least 6 drinks per occasion). Medication adherence over the space of a year was measured by how often patients went back to their pharmacy for a refill.
Among patients taking medication for high blood pressure or high cholesterol levels, nonadherence increased as the severity of alcohol misuse increased. Compared with patients who did not drink, the proportion of patients who did not stick to their cardiovascular medications was significantly higher among those who moderately or severely misused alcohol. Interestingly, there was no difference in adherence to diabetes medications between diabetic patients who did not drink and those who did.
This research might seem like it’s straight from the department of the obvious: “Of course people with alcohol problems don’t take their medications properly!” There are a couple of key findings that are important to bear in mind though. For one, the authors were able to assess alcohol consumption with a brief questionnaire , unlike previous studies on this subject that used lengthy, time consuming interviews. Thus the approach used in this study could be used easily in clinical practice.
In addition, a fair few studies have examined the problem of medication nonadherence, but most have found that the factors responsible for nonadherence are ones that would be very difficult to modify, such as older age (over 80 years old) or low socioeconomic status. The study by Bryson et al. is important because it identifies a modifiable factor responsible for medication nonadherence. Counsel a patient to cut their drinking and, in theory, they should be more likely to take their medication properly, which would keep their condition in check and enable them to get on with their life unhindered.
Bryson CL et al. (2008) Alcohol screening scores and medication nonadherence. Ann Intern Med 149 (11): 795-803. PMID: 19047026