title: Does assertive community treatment increase medication adherence for people with co-occurring psychotic and substance use disorders?
abstract: OBJECTIVE
  This study analyzed data from a randomized trial to examine the impact on medication adherence of integrated treatment delivered via assertive community treatment (ACT) versus standard clinical case management (SCCM).
  
  
  METHODS
  Data from the original study included 198 study participants with co-occurring psychotic and substance use disorders who were randomly assigned to receive integrated treatment via ACT or SCCM and were followed for 3 years. We applied mixed-effects logistic regression to estimate group (ACT vs. SCCM) by time effects on a self-report measure of medication adherence. Adherence was dichotomized as 20% or more missed medication days ("poor adherence") versus less than 20% missed medication days ("adequate adherence").
  
  
  RESULTS
  Participants who were assigned to ACT reported significant improvement in medication adherence compared with those assigned to SCCM.
  
  
  CONCLUSIONS
  Integrated treatment delivered via ACT may benefit persons with co-occurring psychotic and substance use disorders who are poorly adherent to medications.
authors.affiliation: Department of Psychiatry, College of Physicians and Surgeons, Columbia University and New York State Psychiatric Institute, New York, NY 10032, USA. jm703@columbia.edu
authors.forename: Jennifer I
authors.initials: JI
authors.lastname: Manuel
authors.forename: Nancy H
authors.initials: NH
authors.lastname: Covell
authors.forename: Carlos T
authors.initials: CT
authors.lastname: Jackson
authors.forename: Susan M
authors.initials: SM
authors.lastname: Essock
mesh_terms: D019090:Case Management / Q000706:statistics & numerical data; D003156:Community Mental Health Services / Q000379:methods*; D017831:Diagnosis, Dual (Psychiatry); D006801:Humans; D055118:Medication Adherence / Q000523:psychology; D011618:Psychotic Disorders / Q000150:complications* / Q000188:drug therapy*; D019966:Substance-Related Disorders / Q000150:complications* / Q000188:drug therapy*; D016896:Treatment Outcome; D016903:Drug Monitoring