Research Article| Volume 20, ISSUE 4, P166-174, August 2006

Stages of Change for Psychotropic Medication Adherence and Substance Cessation

      Psychotropic medication nonadherence has significant consequences for patients, more so if they abuse substances. This descriptive study examined two stages-of-change measures: one for psychotropic medication adherence and one for substance cessation. Findings for these measures are presented for a sample of 105 patients on admission, a sample of 51 patients on 30-day follow-up, and a cohort of 39 patients who had measures for both time points. Stage advancement for dual behaviors was evident. Integrated treatment programs for this population may be further enhanced by providing interventions that promote psychotropic medication adherence.
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        • American Society of Addiction Medicine
        Patient placement criteria for the treatment of substance-related disorders.
        2nd ed. Author, Chevy Chase, MD1996
        • Belding M.A.
        • Iguchi M.Y.
        • Lamb R.
        Stages and processes of change as predictors of drug use among methadone maintenance patients.
        Experimental and Clinical Psychopharmacology. 1997; 5: 65-73
        • Bellack A.S.
        • DiClemente C.C.
        Treating substance abuse among patients with schizophrenia.
        Psychiatric Services. 1999; 50: 75-80
        • Carey K.B.
        • Purnine D.M.
        • Maisto S.A.
        • Carey M.P.
        Enhancing readiness-to-change substance abuse in persons with schizophrenia: A four-session motivation-based intervention.
        Behavior Modification. 2001; 25: 331-384
        • Carey K.B.
        • Purnine D.M.
        • Maisto S.A.
        • Carey M.P.
        Correlates of stages of change for substance abuse among psychiatric outpatients.
        Psychology of Addictive Behaviors. 2002; 16: 283-289
        • Connors G.J.
        • Donovan D.M.
        • DiClemente C.C.
        Substance abuse treatment and the stages of change: Selecting and planning interventions.
        Guilford Press, New York2001
        • Cook C.L.
        • Perri III, M.
        Single-item vs. multiple-item measures of stage of change in compliance with prescribed medications.
        Psychological Reports. 2004; 94: 115-124
        • Drake R.E.
        • Essock S.M.
        • Shaner A.
        • Carey K.B.
        • Minkoff K.
        • Kola L.
        • et al.
        Implementing dual diagnosis services for clients with severe mental illness.
        Psychiatric Services. 2001; 52: 469-476
        • Drake R.E.
        • Mueser K.T.
        Psychosocial approaches to dual diagnosis.
        Schizophrenia Bulletin. 2000; 26: 105-118
        • Finnell D.S.
        Monthly medication journal: Taking an active role in managing your mental health.
        Merlin International, Rochester, NY2005
      1. Finnell, D.S. (2005b). A stage-based medication program. Unpublished manuscript.

        • Haynes R.B.
        • McDonald H.
        • Garg A.X.
        • Montague P.
        Interventions for helping patients to follow prescriptions for medications.
        (Cochrane review)in: The Cochrane database of systematic reviews. 2. Cochrane database of systematic reviews, Ovid Evidence-Based Medicine Reviews2002 (Retrieved December 5, 2005 from)
        • Haywood T.W.
        • Kravitz H.M.
        • Grossman L.S.
        • Cavanaugh Jr., J.L.
        • Davis J.M.
        • Lewis D.A.
        Predicting the “revolving door” phenomenon among patients with schizophrenic, schizoaffective, and affective disorders.
        American Journal of Psychiatry. 1995; 152: 856-861
        • Hunt G.E.
        • Bergen J.
        • Bashir M.
        Medication compliance and comorbid substance abuse in schizophrenia: Impact on community survival 4 years after a relapse.
        Schizophrenia Research. 2002; 54: 253-264
        • Kemppainen J.K.
        • Buffum M.
        • Wilke G.
        • Kestner M.
        • Zappe C.
        • Hopkins R.
        • et al.
        Psychiatric nursing and medication adherence.
        Journal of Psychosocial Nursing. 2003; 41: 38-51
        • Kessler R.
        • Nelson D.
        • McGonagle K.
        • Edlund M.
        • Frank R.
        • Leaf P.
        The epidemiology of co-occurring addictive and mental disorders: Implications for prevention and service utilization.
        American Journal of Orthopsychiatry. 1996; 66: 17-31
        • Loffler W.
        • Killian R.
        • Tourmi M.
        • Angermeyer M.C.
        Schizophrenic patients' subjective reasons for compliance and noncompliance with neuroleptic treatment.
        Pharmacopsychiatry. 2003; 36: 105-112
        • McLellan A.
        • Luborsky L.
        • O'Brien C.
        • Woody G.
        An improved evaluation instrument for substance abuse patients: The Addiction Severity Index.
        Journal of Nervous and Mental Disorders. 1980; 168: 26-33
        • Minkoff K.
        Developing standards of care for individuals with co-occurring psychiatric and substance use disorders.
        Psychiatric Services. 2001; 52: 597-599
        • National Institute on Alcoholism and Alcohol Abuse (NIAAA)
        What you don't know can harm you.
        (NIH Publication No. 99-4323) U.S. Government Printing Office, Washington, DC1999
        • Olfson M.
        • Mechanic D.
        • Hansell S.
        • Boyer C.A.
        • Walkup J.
        • Weiden P.J.
        Predicting medication noncompliance after hospital discharge among patients with schizophrenia.
        Psychiatric Services. 2000; 51: 216-222
        • Osher F.C.
        • Drake R.E.
        Reversing a history of unmet needs: approaches to care for persons with co-occurring addictive and mental disorders.
        American Journal of Orthopsychiatry. 1996; 66: 4-11
        • Owen R.R.
        • Fischer E.P.
        • Booth B.M.
        • Cuffel B.J.
        Medication noncompliance and substance abuse among patients with schizophrenia.
        Psychiatric Services. 1996; 47: 853-858
        • Prochaska J.O.
        • DiClemente C.C.
        Stages and processes of self-change of smoking: Toward an integrative model of change.
        Journal of Consulting and Clinical Psychology. 1983; 51: 390-395
        • Prochaska J.O.
        • DiClemente C.C.
        The Transtheoretical approach: Crossing traditional boundaries of treatment.
        Dow Jones-Irwin, Homewood, IL1984
        • Prochaska J.O.
        • Velicer W.F.
        The transtheoretical model of health behavior change.
        American Journal of Health Promotion. 1997; 12: 38-48
        • Prochaska J.O.
        • Velicer W.F.
        • Rossi J.S.
        • Goldstein M.G.
        • Marcus B.H.
        • Rakowski W.
        • et al.
        Stages of change and decisional balance for 12 problem behaviors.
        Health Psychology. 1994; 13: 39-46
        • Rand C.S.
        • Weeks K.
        Measuring adherence with medication regimens in clinical care and research.
        in: Shumaker S.A. Schron E.B. Okene J.K. McBee W.L. The handbook of health behavior change. Springer Publishing, New York1998: 114-132
        • Ruscher S.M.
        • de Wit R.
        • Mazmanian D.
        Psychiatric patients' attitudes about medication and factors affecting noncompliance.
        Psychiatric Services. 1997; 48: 82-85
        • Sobell L.C.
        • Sobell M.B.
        Timeline follow-back: A technique for assessing self-reported alcohol consumption.
        in: Litten R. Allen J. Measuring alcohol consumption: Psychosocial and biochemical methods. Humana Press, Totawa, NJ1992: 41-72
        • Willey C.
        • Redding C.
        • Stafford J.
        • Garfield F.
        • Geletko S.
        • Flanigan T.
        • et al.
        Stages of change for adherence with medication regimens for chronic disease: Development and validation of a measure.
        Clinical Therapeutics. 2000; 22: 858-871
        • Yavinsky C.
        • O'Brien C.
        • Reagan L.
        • Staff I.
        • Maljanian R.
        • Jaroszewski E.
        The effect of a specialized RN intervention designed to maximize patient–provider relationships on adherence to anti-depressant medication.
        Yale University School of Nursing Yale University, New Haven, CT2003 (Retrieved on March 29, 2005, from the World Wide Web:)