Review of Improving Treatment Compliance

Substance abuse and psychiatric disorders often co-occur, and treatment compliance can be especially problematic in this population. This concise yet comprehensive book provides an overview of the factors affecting compliance and an extensive set of recommendations for improving it. Too often treatment compliance is viewed as an all-or-none characteristic of the client, but here the authors present a model of compliance as encompassing a constellation of behaviors including entering treatment, keeping appointments, taking medication properly, and making lifestyle changes. They then go on to outline a number of factors affecting compliance, including client variables, illness and symptom-related variables, relationship and social support variables, and treatment and system variables. This broad-based understanding of compliance allows for a wide-ranging catalog of recommendations at the counselor and treatment system level.

The authors then present 43 counseling strategies, 22 systems strategies, and several motivational strategies that cut across levels to increase compliance. The motivational strategies constitute an integration of several counseling strategies within an approach derived from characteristics common to effective brief interventions (FRAMES), and delivered using a Motivational Interviewing style. They do not explicitly integrate systems-level strategies into their motivational approach, but it is clear that it will require a degree of system-level support to implement. Rather than being overwhelming, the extensive array of choices is encouraging and encourages the reader to consider a variety of novel options.

The more familiar (to most readers) counseling and systems strategies are described in brief passages of 1-3 paragraphs. The motivational strategies are described and illustrated in much greater detail, and further divided into pretreatment, transitional, and early recovery stages. These illustrations provide the reader unfamiliar with Motivational Interviewing a sense of how it works and can also provide some structure for those who have taken an MI workshop but aren’t entirely sure how to apply it in practice. In all cases, the authors are providing suggestions for getting started rather than detailed instruction on how to implement their strategies. The inclusion of so many strategies at multiple levels will surely empower the reader regarding his or her ability to improve treatment compliance among a difficult patient population.

Deborah H. A. Van Horn, Ph. D. - January 30, 2005