Measuring Drug Use and Medication Adherence Among Mentally Ill Parolees

David Farabee, University of California, Los Angeles
Sylvia Sanchez, University of California - Los Angeles

Among the seriously mentally ill, substance abuse, psychotic symptoms, and insufficient contact with appropriate mental health service have been shown to be significant predictors of adult-lifetime violence (Swanson et al., 1997). Moreover, the combination of psychiatric medication nonadherence and substance abuse is significantly associated with the likelihood of committing a serious violent act, given after controlling for other demographic and clinical variables (Swartz et al, 1998). Given its clinical and societal implications, medication adherence and co-occurring substance abuse among seriously mentally ill offenders must be closely monitored. While there are advantages (e.g., non-invasive, inexpensive, etc.) to using self-report data to monitor the use of prescription drugs and illicit substances while on parole, it is likely that such measures will result in positively biased estimates for this population. To assess the validity of self-report data concerning these behaviors, the present study compares self-reported anti-psychotic medication adherence and substance use with urinalyses and hair assays provided by a sample of mentally ill parolees. As expected, positive concordance levels were quite low. However, a number of individual differences emerged as predictors of veracity.

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Updated 05/20/2006