Drinking and Drugs: When Is Enough Too Much?

Studies have consistently shown that patients with chronic, often asymptomatic diseases, such as diabetes and hypertension, frequently do not adhere to their medication regimens. One meta-analysis demonstrated that only 40% of chronically ill patients take all of their prescribed doses (1). Not only is poor adherence common in treatment of chronic illness, but several studies have shown that it leads to a broad range of important adverse health outcomes in patients with coronary artery disease, HIV, diabetes, and hypertension (2–6). Thus, effective interventions to help patients achieve and maintain optimal adherence are crucial to providing high-quality, cost-effective medical care.

A first step toward developing effective interventions is to understand factors that affect adherence and that clinicians can influence. The effect of substance abuse on adherence to HIV treatment has been the target of much research, perhaps because substance abuse is common among persons living with HIV and because survival depends on adherence to antiretroviral therapy. Many recent studies have found an inverse association between alcohol use and antiretroviral therapy adherence (3, 7), but few of them have involved general medical patients. Although the association between alcohol misuse and antiretroviral therapy adherence does not necessarily indicate that persons with other chronic illnesses who misuse alcohol will have poorer adherence to therapy, the findings from HIV studies have opened the door to investigating this association for other chronic diseases, which is long overdue.

Alcohol misuse is common in the general population and may cause poor adherence to treatment of many diseases. Successful interventions could therefore be an avenue to better adherence in many …