Original Research

Alcohol use in Tanzanians with chronic psychotic disorders and poor medication adherence

Emily Simon, Jennifer B. Levin, Jessie Mbwambo, Carol Blixen, Isaac Lema, Michelle Aebi, Godwin Njiro, Kristin Cassidy, Sylvia Kaaya, Martha Sajatovic
South African Journal of Psychiatry | Vol 27 | a1570 | DOI: https://doi.org/10.4102/sajpsychiatry.v27i0.1570 | © 2021 Emily Simon, Jennifer B. Levin, Jessie Mbwambo, Carol Blixen, Isaac Lema, Michelle Aebi, Godwin Njiro, Kristin Cassidy, Sylvia Kaaya, Martha Sajatovic | This work is licensed under CC Attribution 4.0
Submitted: 03 June 2020 | Published: 19 March 2021

About the author(s)

Emily Simon, School of Medicine, Case Western Reserve University, Cleveland, United States
Jennifer B. Levin, Department of Psychiatry, School of Medicine, Case Western Reserve University, Cleveland; Neurological & Behavioral Outcomes Center, School of Medicine, Case Western Reserve University, Cleveland, United States
Jessie Mbwambo, Department of Psychiatry and Mental Health, School of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania, United Republic of
Carol Blixen, Department of Psychiatry, School of Medicine, Case Western Reserve University, Cleveland; Neurological & Behavioral Outcomes Center, School of Medicine, Case Western Reserve University, Cleveland, United States
Isaac Lema, Department of Psychiatry and Mental Health, School of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania, United Republic of
Michelle Aebi, Department of Psychiatry, School of Medicine, Case Western Reserve University, Cleveland; University Hospitals Cleveland Medical Center, Cleveland, United States
Godwin Njiro, Department of Psychiatry and Mental Health, School of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania, United Republic of
Kristin Cassidy, Department of Psychiatry, School of Medicine, Case Western Reserve University, Cleveland; University Hospitals Cleveland Medical Center, Cleveland, United States
Sylvia Kaaya, Department of Psychiatry and Mental Health, School of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania, United Republic of
Martha Sajatovic, Department of Psychiatry, School of Medicine, Case Western Reserve University, Cleveland; University Hospitals Cleveland Medical Center, Cleveland; Department of Neurology, School of Medicine, Case Western Reserve University, Cleveland, United States


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Abstract

Background: The burden of chronic psychotic disorders (CPDs) in sub-Saharan Africa (SSA) is significant. Poorly medically adherent patients are more likely to have worse outcomes and require more resources. However, factors impacting effective treatment of CPD in this population are unclear.

Aim: Examine the relationship between alcohol use and disease management and compare alcohol risk stratification between the Alcohol Use Disorders Identification Test (AUDIT) and Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) in poorly medication adherent Tanzanians with CPD.

Setting: Muhimbili National Hospital and ambulatory clinics in Dar es Salaam, Tanzania.

Methods: 100 Tanzanians with CPDs and suboptimal medication adherence were dichotomized into low and moderate-to-high risk alcohol use based on AUDIT scores and compared regarding medication attitudes, adherence and psychiatric symptoms. Patients completed the ASSIST for comparison to AUDIT risk stratification.

Results: Moderate-to-high risk alcohol users had worse medication attitudes (p < 0.01), medication adherence (previous week, p = 0.01; previous month, p < 0.001), and psychiatric symptoms (p = 0.03). They were younger, predominately male and more likely to have a family history of alcohol abuse. A logistic regression analysis found age, gender and family history of abuse as significant predictors of hazardous alcohol use (p = 0.02, 0.02, < 0.01, respectively). Risk stratification between AUDIT and ASSIST aligned in 85% of participants.

Conclusion: Alcohol use is an important consideration in treating poorly adherent Tanzanians with CPD. The ASSIST was comparable to the AUDIT in stratifying risky alcohol use with the additional benefit of screening for other substances.


Keywords

schizophrenia; medication adherence; treatment adherence; alcohol abuse; AUDIT; ASSIST; chronic psychotic disorders; sub-Saharan Africa; substance abuse

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