Supporting Medication Adherence for People Living with Mental Illness and Addiction

Medication adherence presents significant challenges for people living with mental illness, particularly when they are struggling with a co-occurring substance use disorder. By understanding the causes of nonadherence and the benefits of integrated dual diagnosis treatment, you can support your loved one and open up new possibilities for healing.

Over the past 30 years, we have seen remarkable innovations in medications for mental health disorders. From the proliferation of SSRIs to the introduction of a new generation of antipsychotics to the release of more sophisticated mood stabilizers, people struggling with mental illness now have more pharmacological options than ever before. Now genetic testing exists, so that psychiatrists can get information about how well an individual may metabolize different medications, so that they can get to therapeutic levels more effectively. For many, these medications are necessary and life-changing, acting as the cornerstone of treatment and restoring psychiatric wellness in ways we could previously only dream of.

Despite these advances, however, medication adherence (or medication compliance, as it is sometimes called) remains a challenge for many. Nonadherence can be one of the most frustrating experiences loved ones of people with mental illness face, and it can often lead to feelings of helplessness, anger, and fear. For people with a co-occurring substance use disorder, the risk of nonadherence is particularly high. As such, it is essential to seek out comprehensive or integrated dual diagnosis treatment to address the full scope of their needs and promote medication adherence to give them every chance to heal.

Mental Illness and Medication Adherence


In the simplest terms, medication adherence means taking medication as directed most of the time. Meanwhile, nonadherence is typically defined as missing at least 20% of doses but may include outright treatment refusal. Adherence is a challenge for people with all types of chronic illnesses, both physical and psychiatric, but adherence rates vary widely according to diagnosis and medication.

People with schizophrenia have amongst the lowest medication adherence rates, with studies indicating approximately 40-50% nonadherence depending on methodology. A study published in the Journal of Clinical Psychiatry found that “32% of patients with bipolar disorder who were prescribed mood stabilizing medication had been nonadherent within the past month and that 50% had been nonadherent during the previous 2 years.” Meanwhile, research suggests that the 6-month nonadherence rate for people with depression is approximately 50%.

While all people with pharmacologically treated mental health disorders may struggle with nonadherence, those suffering from a co-occurring substance use disorder are at heightened risk. In fact, addiction is the primary predictor of nonadherence, profoundly disrupting treatment efficacy and endangering your loved one’s well-being.

The risks of nonadherence extend beyond decreasing the overall effectiveness of one’s treatment plan. It is associated with higher rates of:

  • Hospitalization and emergency psychiatric services;
  • Aggression and even violence;
  • Incarceration;
  • Homelessness;
  • Victimization;
  • Decreased cognitive functioning;
  • Poorer life satisfaction; and
  • Substance use and abuse, including alcohol-related problems

As such, nonadherence severely threatens stability, quality of life, and the ability to function independently.

Causes of Nonadherence


Families of those with mental illness often struggle to understand the reason behind nonadherence. To people without a disorder, it can seem bewildering that someone would refuse to follow the treatment plan that’s designed to help them get better. But nonadherence isn’t someone simply being difficult; rather, it is often driven by multiple complications that compromise your loved one’s ability and/or desire to take their medication as prescribed.

  • Lack of Insight: Mental health disorders can severely impact your loved one’s ability to accurately understand themselves and the world around them. As such, they may not appreciate the severity of their symptoms or even acknowledge their condition, causing them to see treatment as unnecessary. In other cases, successful treatment causes them to feel better and believe that treatment is no longer needed.
  • Relapse: Relapse is a common experience for people with chronic mental illness, even if they take their medication regularly. Unfortunately, relapse may cause your loved one to lose faith in the treatment process and stop taking medication because they believe it to be ineffective or because they believe they are beyond help. Additionally, relapse symptoms such as mania, psychosis, and depression may further interfere with your loved one’s ability to make healthy, logical choices.
  • Side Effects: All psychotropic medications carry the risk of side effects. Some classes, such as antipsychotics, are particularly notable for their interference with normal function. Weight gain, lethargy, cognitive impairments, tremors and ticks, low libido, and sleep disturbances may all severely impact your loved one’s functionality, self-esteem, and overall quality of life. As Dr. Jane Framingham says, “Some patients report that side effects of the medications seem worse than the illness itself.”
  • Substance Use: Substance use is strongly related to nonadherence for a number of reasons. The use of drugs or alcohol may impair judgment and increase risk-taking behavior. Meanwhile, the effects of substance use may temporarily mask their symptoms or interfere with medication efficacy, causing them to assume that treatment is unnecessary or ineffective. In some cases, the medication itself interferes with the effects of substance use, minimizing or eliminating the pleasurable effects of the substance. In these cases, your loved one may stop adhering to treatment in order to regain their ability to experience the high of drug use.

While some people have one specific reason for nonadherence, for others it’s a combination of factors that prevent them from participating in treatment. In some cases, people even find some aspects of their disorder enjoyable and resist treatment in order to continue enjoying seemingly positive aspects, such as manic or hypomanic episodes.

Supporting Medication Adherence Through Dual Diagnosis Treatment


It is essential to understand and address the causes of nonadherence in order to promote healing. It is essential to speak openly about their situation and form a plan for how to tailor treatment in a way that addresses their concerns and allows them to experience the full benefit of pharmacotherapy. For some, this may be as simple as switching to a more tolerable medication or connecting them with supports to address specific side-effects like weight gain. However, if your loved one is struggling with a severe mental health disorder and co-occurring substance use disorder, more intensive intervention is necessary.

Long-term dual diagnosis treatment programs offer your loved one the time, space, and support necessary to deeply investigate the causes of their substance use and the circumstances nonadherence. Specific benefits of long-term residential treatment include:

  • Safe detox. Under the care of trained medical professionals, your loved one can heal their body and mind and break free from addiction, secure in the knowledge that they are in good hands.
  • Accurate diagnosis. Various assessments, including psychological and genetic testing, can be performed once the client is detoxed in order to ensure an accurate diagnosis and effective treatment plan.
  • Support for medication adherence. Your loved one’s medical team will ensure that the appropriate medications are prescribed and work with your loved one to help them manage their medications and practice adherence.
  • Opportunities for increasing knowledge and understanding. Many long-term residential treatment plans include education on topics such as coping skills and managing side effects in order to ensure that your loved one has the tools they need for continued healing and growth even after their treatment program is complete.

The duration of these treatment programs allows for unique, long-term observation of clients. This means that the efficacy of pharmacotherapy can be continuously evaluated and the treatment plan can be fine-tuned to address both symptomatology and side effects. The level of oversight and support your loved one can experience in these treatment environments mean that they can gradually move toward independent medication management at a pace that’s right for them. Meanwhile, specialized family programming can give your family the resources you need to better understand your loved one’s illness, nourish your relationships, and discover how you can better support your loved one’s medication adherence and recovery.

Nonadherence is a serious issue that can cause deep distress for both people struggling with mental illness and their loved ones. But with the guidance of compassionate clinicians, your family can create a roadmap for increased wellness and treatment engagement, opening up the door to a more stable, fulfilling future for everyone.

Hanbleceya offers comprehensive long-term treatment for people struggling with complex mental illness as well as co-occurring substance use disorders. Contact us to learn more about our renowned San Diego-based program and how we can help you or your loved one start the journey toward recovery.

Lead image source: Unsplash user Ant Rozetsky