“I’m so tired of hearing people blame treatment because a client has started using drugs again,” complained the director of a large public-funded treatment center. “We enroll every single client  in  continuing care. It’s free, and we can even help with transportation. But we can’t force somebody to accept it.”

True enough. This is a classic compliance problem, of a sort found throughout healthcare, from pre-natal services to post-transplant recovery.  As the saying goes, even the most effective medication won’t work unless the patient takes it.

Here’s a recent article on the subject.

I quote: “Studies have consistently shown that 20 to 30% of medication prescriptions are never filled… approximately 50% of medications for chronic disease are not taken as prescribed.” They’re talking about diabetes, chronic lung disorders, serious heart disease– life-threatening stuff. Surely patients have motivation to comply. And yet, somehow, many don’t.

Healthcare economists insist this contributes to some 125,000 deaths annually, and yearly costs to society in the hundreds of billions. It’s a main reason that treatments that achieve impressive results in the research setting frequently perform far less well in the real world.

Does a patient’s reluctance to take a medication as prescribed mean that the medicine itself doesn’t work? Of course not.

To return to our disappointed director– If we could question his former clients, what would they tell us? Some educated guesses:

“I feel like I’ve been through enough. I need a break.”

“I have other responsibilities, commitments. No time for that.”

“I learned my lesson. It won’t happen again.”

“I just don’t feel like I need more treatment.”

Understandable, I suppose, but in practice, this line of reasoning usually results in a return to substance use. Once that happens, people look around for a scapegoat. But given the experience in other fields of healthcare, a return to the old lifestyle, however destructive, may be little more than human nature.

Still, can we take steps in treatment, proactively, to reduce the risk of such regression?

We’ll discuss that further in coming posts.