Unhealthy Alcohol Use Is Associated with Medication Nonadherence
Unhealthy alcohol use (the spectrum from risky use through dependence) has known direct health consequences, but its effects on self-care for medical conditions have been less well described. Investigators performed a secondary analysis of data from a randomized trial testing the impact of a quality improvement initiative in general medicine clinics at 7 Veterans Affairs Medical Centers. The 22,670 patients in the analysis had been prescribed either a statin, oral hypoglycemic agents, or antihypertensive medications and had completed an alcohol screening questionnaire.* Twenty percent had scores indicating unhealthy use. Based on the screening scores, patients were categorized as nondrinkers, low-level drinkers, or (among those who screened positive) as having mild, moderate, or severe unhealthy use.
- More severe unhealthy alcohol use was associated with lower adherence† to both statin and antihypertensive medications. At 1 year, in analyses adjusted for potential confounders, adherence was 66% for nondrinkers, but 63% for those with mild unhealthy use, 58% for those with moderate unhealthy use, and 55% for those with severe unhealthy use (p<0.001).
- Despite a similar trend, scores were not significantly associated with oral hypoglycemic medication adherence.
- *Alcohol Use Disorders Identification Test—Consumption.
- †Defined as having medication available during at least 80% of the observation period based on pharmacy fill
Alcohol use can affect medication adherence in a number of ways. The obvious ones are intoxication and forgetfulness. But I have had many patients tell me they don’t take their medicines when they drink to avoid possible interactions and adverse effects. Alcohol screening has been rated one of the most effective—and cost-effective—preventive services. This study suggests it is valuable not only because it can identify a risky health behavior we can help change, but also because it can help us manage chronic medical conditions by improving adherence to medications.Richard Saitz MD, MPH
Bryson CL, Au DH, Sun H, et al. Alcohol screening scores and medication nonadherence. Ann Intern Med. 2008;149(11):795–804.