• Chris L Bryson, David H Au, Haili Sun, Emily C Williams, Daniel R Kivlahan, and Katharine A Bradley.
• Health Services Research & Development Northwest Center of Excellence, Veterans Affairs Puget Sound Health Care System, and University of Washington, Seattle, Washington 98101, USA.
• Ann. Intern. Med. 2008 Dec 2;149(11):795-804.

BackgroundMedication nonadherence is common and is associated with adverse outcomes. Alcohol misuse may be a risk factor for nonadherence; however, evidence is limited.ObjectiveTo identify whether alcohol misuse, as identified by a simple screening tool, is associated in a dose-response manner with increased risk for medication nonadherence in veterans attending primary care clinics.DesignSecondary analysis of cohort data collected prospectively from 1997 to 2000 as part of a randomized, controlled trial.Setting7 Veterans Affairs primary care clinics.Participants5473 patients taking a statin, 3468 patients taking oral hypoglycemic agents, and 13 729 patients taking antihypertensive medications.MeasurementsPatients completed the Alcohol Use Disorder Identification Test-Consumption (AUDIT-C) questionnaire, a validated 3-question alcohol misuse screening test. Their scores were categorized into nondrinkers; low-level alcohol use; and mild, moderate, and severe alcohol misuse. Medication adherence, defined as having medications available for at least 80% of the observation days, was measured from pharmacy records for either 90 days or 1 year after the alcohol screening date. Logistic regression was used to estimate the predicted proportions of adherent patients in each AUDIT-C group and adjusted for demographic and clinical covariates.ResultsThe proportion of patients treated for hypertension and hyperlipidemia who were nonadherent increased with higher AUDIT-C scores. For 1-year adherence to statins, the percentage of adherent patients was lower in the 2 highest alcohol misuse groups (adjusted percentage of adherent patients, 58% [95% CI, 52% to 65%] and 55% [CI, 47% to 63%]) than in the nondrinker group (66% [CI, 64% to 68%]). For 1-year adherence to antihypertensive regimens, the percentage of adherent patients was lower in the 3 highest alcohol misuse groups (adjusted percentage of adherent patients, 61% [CI, 58% to 64%]; 60% [CI, 56% to 63%]; and 56% [CI, 52% to 60%]) than in the nondrinker group (64% [CI, 63% to 65%]). No statistically significant differences were observed for oral hypoglycemics in adjusted analyses.LimitationThis observational study cannot address whether changes in drinking lead to changes in adherence and may not be generalizable to other populations.ConclusionAlcohol misuse, as measured by a brief screening questionnaire, was associated with increased risk for medication nonadherence.

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