Defense Date


Graduation Date

Spring 5-19-2018


One-year Embargo

Submission Type


Degree Name



Pharmacy Administration


School of Pharmacy

Committee Chair

Jordan Covvey

Committee Member

Khalid Kamal

Committee Member

Vincent Giannetti


Adherence, Dual Diagnosis, Mental Illness, Substance Use Disorder, Relapse


Objectives: The aims of the study were to (1) identify personal, social, and clinical history for patients with substance use disorder (SUD) and mental illness, (2) measure agreeance between patient self-report versus facility record history for mental illness, substance abuse, and psychotropic medication, (3) investigate the specific role of medication adherence and barriers to use for psychotropic medications upon SUD relapse, and (4) assess follow-up changes in mental illness severity and medication adherence in dual diagnosis patients enrolled in a substance abuse rehabilitation program.

Methods: The pilot study utilized a mixed methodology. Inclusion criteria included male patients at least 18 years of age who were newly admitted at a 90-day residential rehabilitation program with a self-reported diagnosis of SUD, and either major depressive disorder (MDD), bipolar disorder, generalized anxiety disorder (GAD) or schizophrenia. Patients were evaluated within their first week of treatment and follow-up interviews were conducted at 1 and 2 months. Facility records were accessed to cross-reference patient reported data, using Cohen’s kappa coefficient to determine agreement. Patient demographic characteristics, substance abuse characteristics, health-related characteristics, and attitude towards medications stratified by adherence rates and relapse rates utilizing ANOVA and t-tests. Pearson’s correlation coefficient was utilized to analyze the relationship between medication adherence and SUD relapse. A multivariable logistic regression model was created to assess the impact of adherence on relapse frequency. Patient and clinical characteristics were stratified according to follow-up interviews completed utilizing ANOVA and t-tests. Lastly, changes in patients’ self reported adherence from interview to interview were analyzed using mean difference. SPSS Statistics (IBM Corp; Armonk, NY) was utilized for all analyses, with a two-tailed level of significance at 0.05.

Results: The final sample consisted of 38 patients. The majority of patients were white (n=27, 71.1%), unemployed (n=32, 84.2%), and homeless (n=30, 78.9%). Heroin was the most common primary drug of use (n=19, 50%), followed by alcohol (n=12, 31.6%), and crack cocaine (n=4, 10.5%). The average length of substance use was 20.3 years. Half of the patients (n=19, 50%) had two or more mental illness diagnoses and the most common was the combination of MDD and GAD (n=9, 23.7%), followed by MDD alone (n=7, 18.4%), and bipolar disorder (n=6, 15.8%). Significant agreeance was found between patient self-reported data to facility records for primary substance of use (κ=0.753, p

Conclusions: The study provided valuable insight into the relationship between psychotropic medication adherence and SUD relapse in patients with dual diagnosis which can be used by healthcare professionals and drug abuse rehabilitation programs.