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Mental Health and Substance Use Affect Adherence

May 20, 2003

Adherence means taking medications correctly. So why is adherence to HIV drugs such a big deal? Because if you miss too many doses, the virus in your body can change to avoid the effects of the medications. When this happens your medications can stop working. Studies show that taking your HIV medications correctly 95% of the time gives the drugs the best chance of working well to control your virus.

Taking your medication correctly nearly 100% of the time can be hard for some obvious reasons, including too many doses per day or pills per dose, side effects, lack of support, food restrictions, simple forgetfulness or being too busy. But in many studies, two of the biggest reasons for non-adherence are substance abuse and mental health problems.

If you use drugs or alcohol excessively, you may skip doses because you are high, drunk or hung over. If so, it's time to cut down or clean up. Ask your physician or AIDS service agency for help. If you drink or use drugs, but are really good about adherence -- for instance, you didn’t miss a dose of HIV medications for the past month -- it's still important to inform your physician about what you use, so that he/she can think about drug interactions, liver function tests, etc.

Mental health issues can also keep you from taking your medications correctly. Depression is a key factor and is very common in HIV+ people. Other problems include bipolar illness (manic-depression), psychotic disorders (such as schizophrenia) and post-traumatic stress disorder (PTSD). Some of the warning signs for these conditions are:

  • Depression: No energy, lack of enjoyment, short temper, sleep problems, no appetite and/or lack of sex drive.
  • Manic Phase of Bipolar Illness: Feeling like you’re on speed, too buzzed to sleep, shopping binges, sex binges and/or unclear or unrealistic beliefs.
  • PTSD: Vivid “flashback” memories of traumatic incidents, nightmares about the past, being easily startled, avoidance of area where incident occurred and/or problems in personal relationships.

If you think you may have one of these conditions, the good news is that they are very treatable through therapy (either individual or group), medications or alternative treatments. If you decide to try medications, work with both a psychiatrist and your HIV provider to make sure there are no drug interactions. Once you go on medications for mental health problems, don’t go off without close supervision.

The bottom line? If you suspect any substance abuse or mental health issue is preventing you from taking your medications correctly, get help! Addressing these issues will not only make it more likely that you will be adherent to your HIV medications, it could improve your overall quality of life as well.


NAMI at 800-950-NAMI or

SAMSHA at 800-729-6686 or

Sandra K. Trisdale, Ph.D., an expert in HIV and mental health, writes frequently for HIV-related publications. She lives in San Diego, CA.

This article was provided by PositiveWords.
See Also
Guide to Conquering the Fear, Shame and Anxiety of HIV
Trauma: Frozen Moments, Frozen Lives
More on Coping With Stress and Anxiety