FRN Research Report November 2015: Encouraging Medication Compliance to Alleviate Mental Health Symptoms

Background

Patients struggling with mental health symptoms face a unique juggling act in America. Working with their care providers, they must find the right medications and counseling protocols to effectively manage symptoms all while navigating a fractured health care system. Integrated treatment models that coordinate care in a single setting are considered ideal (SAMHSA, 2005).

Foundations Recovery Network (FRN) is nationally recognized for its evidence-based integrated treatment for individuals with co-occurring addiction and mental health disorders. Integrated treatment models are more effective and produce better long-term outcomes than addiction treatment alone (Drake, O’Neal, & Wallach, 2008).

Patients with co-occurring conditions are complex to treat. Addictive substances exacerbate mental health symptoms, such as paranoid thoughts or feelings of depression. Patients with severe mental illness, such as schizophrenia or major depressive disorder, have a difficult time fighting the cycle of negative thoughts and behaviors that lead to addictive substances.

Adults who experience any form of mental illness during a year are more than three times as likely (20% vs. 6.1%) to abuse or be dependent on substances. People with serious mental illness, such as schizophrenia, are even more likely (25.2% vs. 6.1%) to abuse substances or show signs of dependence (SAMHSA, 2010). On the whole, one in five adults (43.8 million Americans) experience mental illness in a one-year period (SAMHSA, 2014).

Teaching patients about their medications and encouraging them to take psychiatric medications as needed is an integral part of comprehensive integrated care. Individuals with co-occurring disorders experience more severe symptoms and require more support services and longer treatment stays to have better outcomes (Minkoff & Cline, 2004).

Factors Influencing Medication Compliance

For some patients, medications play an instrumental role in the management of mental health symptoms. Poor mental health management can lead to addiction relapse as well as the worsening of one’s physical, emotional and spiritual health. Getting patients to take medications regularly on their own has its challenges. Psychiatric patients have similar reactions to taking medication as other chronically ill populations, including HIV-positive patients and cancer patients. Some people may refuse pills for the following reasons:

• They believe the side effects of the medication are worse than their disease.
• They want to avoid the stigma of taking medication.
• They refuse to take medication because it is a reminder of being ill.
• They believe the medication doesn’t work (Deegan & Drake, 2006).

Integrated treatment encourages healthy management of medications in a number of ways. Here are three elements of integrated treatment that strongly influence medication compliance:

Education from Staff. Encouraging patients to stay on track with medications is an integral part of the treatment process. FRN facility staff members educate patients about the importance of taking medications on time and at the right dose. This high level of education improves compliance rates (Eckman, Liberman, Phipps, & Blair, 1990). Patients who are engaged in the process and become educated about the medication and its purpose are more likely to stay on track instead of mismanaging medication, such as taking pills erratically, self-diagnosing or doubling dosage. Internal research from Foundations facilities shows the effectiveness of these treatment protocols.

Peer Support. In addition to being provided accurate information about psychiatric medications from staff, patients also benefit from information offered by peers. Advice from peers is more meaningful because of relatable experiences and temptations. Peers support the worth of staying sober and taking actions that promote sobriety, including taking appropriate medications for mental health management. Patients benefit from a fully formed picture of both the risks and benefits of medication to make their own decisions and incorporate medication management into a sober lifestyle (Minkoff, 2005).

Therapeutic Alliance and Involvement in the Treatment Process. Staff members at FRN facilities use compassion and empathy to form a strong therapeutic alliance with patients. Not only is this a crucial step for getting a patient engaged in the treatment process, it also encourages medication compliance (Eckman, Liberman, Phipps, & Blair, 1990). As part of the therapeutic alliance, patients are encouraged to become fully involved in their treatment plans and regularly participate in peer support groups that educate them about life management skills and coping techniques (SAMHSA, 2005).

FRN’s Internal Research: Medication Management for Mental Health Symptoms

Patients who enter treatment at FRN residential centers are offered the opportunity to participate in an ongoing study. Participants must sign Institutional Review Board approved consent prior to participation, and the follow-up study includes interviews at intake and again at 30 days, six months and one year post-discharge. Data is collected using validated instruments, including the Addiction Severity Index, Treatment Service Review and University of Rhode Island Change Assessment (URICA – Readiness for Change Instrument).

FRN maintains scientifically sound research models, and an independent third party verifies research results. Enrollment in its research programs and corresponding response rates exceed federal minimum standards, supporting the validity of findings. SAMHSA requires 80% of patients to enroll in programs and 60% of them to respond in order for data to be considered reliable. With 90% of patients participating in research programs, FRN’s research response rates range from 65% to 75%.

FRN conducted a study based on data collected from its residential treatment centers in previous years (2010-2013) to determine how integrated treatment protocols affected long-term management of mental health symptoms. The results found that, at one-year post discharge, FRN patients reduced the average number of days that they experienced psychiatric problems. At intake, the average number of days with problems was 21, while at one-year the number of days fell in a range from 7.5 to 9.4, cutting the number of days with symptoms by more than half.

Source: Foundations Recovery Network, 2015

Patients also experienced fewer mental health symptoms at 30 days, 180 days and one year post-treatment on a scale of one (not at all) to four (extreme difficulty). At one-year, the range was 0.9 to 1.2.

In addition, FRN patients reported a significant improvement in medication compliance rates. The average days of missed doses at intake was 4.5 days, and by one-year, the average fell to 1.8 days. In addition, the percentage of patients who reported missing one or more doses fell from 43% at intake to 29% at one-year post discharge.

Conclusion: The Benefits of Medication Compliance

It is challenging for patients struggling with mental health symptoms to find the right treatment protocol to manage symptoms. Balancing effective medications with the best counseling techniques is an ongoing process. For the millions of Americans who experience both addiction and mental health problems, the ability to manage symptoms is even more complex.

Patients who maintain the correct medication regimen more effectively manage their mental health symptoms and improve their emotional well being. The willingness to take medication also indicates patients’ confidence in the entire treatment process and the development of skills needed for living in recovery. High medication compliance rates indicate the success of FRN’s long-term, stagewise approach to treating patients. FRN incorporates Motivational Interviewing (MI) techniques at the beginning of treatment to encourage active participation. MI keeps patients engaged in recovery by reducing resistance to change and lowering feelings of ambivalence about the process.

As a patient progresses through treatment and reaches goals, he learns the advantages of actively monitoring his own symptoms. It may take several weeks or months to experience the full effectiveness of psychiatric medicines. Patients may also become tolerant over time and need a different dose or to switch to a different medication. This process requires teamwork between the patient and the physician and a willingness to find the best solution (Deegan & Drake, 2006).

For less severe mental health symptoms, medication may only be needed for a limited time. The changing nature of a mental health disorder, like other chronic disorders, requires ongoing maintenance to achieve the best outcomes over months and years. The ongoing support and connection with community-based groups that FRN encourages helps patients maintain compliance rates and sobriety at one-year post discharge and beyond.

Foundations Recovery Network is committed to research that improves treatment for all addicted individuals. FRN’s facilities excel at treating the complex needs of patients with co-occurring conditions and encouraging actions that improve overall health, including medication compliance. If you would like to speak with an admissions coordinator today or if you would like to learn more about our research methods and programs, please call us directly at 615-490-9376.

References

Deegan, P. E., & Drake, R. E. (2006). Shared decision making and medication management in the recovery process. Psychiatric Services , 57 (11), 1636-1639.

Drake, R., O’Neal, E., & Wallach, M. (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 (1), 123-138.

Eckman, T. A., Liberman, R. P., Phipps, C. C., & Blair, K. E. (1990). Teaching medication management skills to schizophrenic patients. Journal of Clinical Psychopharmacology , 10 (1).

Minkoff, K. (2005). Comprehensive continuous integrated system of care (CCISC): Psychopharmacology practice guidelines for individuals with co-occurring substance use disorders (COD). Acton, MA: Kenneth Minkoff.

Minkoff, K., & Cline, C. A. (2004). Changing the world: The design and implementation of comprehensive continuous integrated systems of care for individuals with co-occurring disorders. Psychiatric Clinics of North America , 27 (4), 727-43.

Substance Abuse and Mental Health Services Administration. (2004). Clinical Guidelines for the Use of Buprenorphine in the Treatment of Opioid Addiction. In (Treatment Improvement Protocol (TIP) Series, No. 40.) Appendix C DSM‐IV‐TR Material. Available from: ncbi.nlm.nih.gov. Rockville, MD: SAMHSA.

Substance Abuse and Mental Health Services Administration. (2010). Results from the 2009 National Survey on Drug Use and Health: Mental health findings. Office of Applied Studies, NSDUH Series H-39, No. SMA 10-4609. Retrieved August 11, 2011, from samhsa.gov.

Substance Abuse and Mental Health Services Administration, Results from the 2012 National Survey on Drug Use and Health: Summary of National Findings, NSDUH Series H-46, HHS Publication No. (SMA) 13-4795. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2013.

Substance Abuse and Mental Health Services Administration. (2014). The NSDUH Report: Substance Use and Mental Health Estimates from the 2013 National Survey on Drug Use and Health: Overview of Findings. Center for Behavioral Health Statistics and Quality. Rockville: SAMHSA.