Poor Medication Compliance Research Articles

Gout in primary care: can we improve patient outcomes?

BackgroundGout is a red flag indicator for cardiovascular disease and comorbidity. Despite this, there are no incentivised treatment protocols and suboptimal management in the primary care setting is common.AimImprovement cycles aimed to educate patients, improve uric acid monitoring, and support medication compliance. It was ultimately hoped that these measures would reduce gout flares and GP practice attendance.MethodA computer-based retrospective search at a large inner-city GP practice between January 2014–December 2014 identified 115 patients with gout. Baseline measurements revealed multiple gout related consultations, poor medication compliance, high uric acid levels, and deficiencies in uric acid monitoring. All patients in the cohort received a telephone consultation regarding their gout followed by a diet, lifestyle, and advice sheet in the post. A new gout phlebotomy order set was devised to include full blood count, urea and electrolytes, cholesterol, urate, random blood sugar, and HbA1c. Letters were sent out to arrange for these blood tests in patients who had not received them during the previous 12 months.ResultsThe improvement cycles contributed towards reduction in uric acid levels from 0.37 to 0.3 (P = 0.14), 20% reduction in patients experiencing one or more gout flares, and 77% reduction in GP related consultations between March 2015 and March 2016 compared to baseline. The proportion of patients fully compliant with taking their urate lowering therapies improved from 63% to 91% (P = 0.0001).ConclusionThe improvement and Plan, Do, Study, Act cycles have demonstrated that simple interventions can be a sustainable way of improving disease control and patient outcomes.

Poor management of hypertension is an important precipitating factor for the development of acute aortic dissection.

Hypertension is considered a key risk factor for acute aortic dissection (AAD). However, there is limited evidence demonstrating if hypertension management affects AAD development. The objective of this study was to investigate the role of hypertension management in AAD development in a Chinese population. A total of 825 AAD patients and 3300 age- and sex-matched controls were included. The authors analyzed data on demographics, chronic comorbidities, and hypertension management of all participants. Multiple logistic regression analysis was used to estimate the adjusted odds ratios (AOR) and 95% confidence intervals (95% CI) for the relationship between chronic comorbidities, as well as the management of hypertension and AAD risk. After adjusting for other related factors, multivariate logistic regression identified hypertension, chronic kidney disease, Marfan syndrome, history of cardiovascular surgery, and history of smoking as risk factors for AAD. Among the identified risk factors, hypertension was an important and controllable risk factor for AAD development. Thus, the authors further evaluated how hypertension management affects AAD development. A total of 848 controls and 585 AAD patients with hypertension were enrolled in this part of the study. Hypertensive patients with AAD had a longer history, higher stage, poorer medication compliance, and poor control rates of blood pressure, among which poor medication compliance (Irregular vs Regular P<0.001; Never treated vs Regular P<0.001) and uncontrolled hypertension (P<0.001) significantly increased the risk of AAD development. In conclusion, uncontrolled hypertension and poor medication compliance are important precipitating and controllable factors for AAD development.

Two Birds with One Stone: Regular Use of PDE5 Inhibitors for Treating Male Patients with Erectile Dysfunction and Cardiovascular Diseases.

Patients with cardiovascular disease (CVD) frequently have erectile dysfunction (ED) because the two conditions have similar risk factors and potential mechanisms. The therapeutic effect of CVD is strongly dependent upon long-term management of the condition. Patients with CVD tend to have poor medication compliance, and the coexistence of ED often discourages patients with CVD from continuing their long-term CVD management, thus worsening CVD treatment compliance. The two major reasons for poor compliance are that (i) the adverse effects of cardiovascular medications on erectile function drive people to reduce the prescribed dosage or even stop taking the medications to obtain satisfactory sexual arousal and (ii) a worsening mental state due to ED reduces medication compliance. The regular administration of phosphodiesterase-5 inhibitors (PDE5is) guarantees that the prescribed medication dosages are easy to comply with and that they improve the mental status of patients by enhancing their erectile function, resulting in improved long-term management of CVD through medication compliance. PDE5is themselves also play a role in reducing cardiovascular events and improving the prognosis. We recommend prescribing PDE5is for ED and suggest that PDE5i administration is a promising strategy to improve the long-term management of patients with both ED and CVD.

Erectile dysfunction among male patients diagnosed with schizophrenia being treated with antipsychotic medication, and the impact on quality of life

IntroductionErectile dysfunction is a distressing side effect of antipsychotics, which leads to poor medication compliance and poor quality of life. There is a scarcity of studies on antipsychotic-induced sexual dysfunction in Sri Lanka. We assessed the prevalence of erectile dysfunction among patients with schizophrenia who have been prescribed antipsychotic medication. MethodsA cross sectional, descriptive study was conducted among patients attending the outpatient clinics of Colombo North Teaching Hospital and National Hospital, Sri Lanka. The five item International Index for Erectile Dysfunction, Erection Hardness Score and World Health Organization Quality of Life Brief Scale were used to assess erectile dysfunction and quality of life. ResultsOf the 102 patients in the study, 80 (79%) were found to have erectile dysfunction. The largest proportion of erectile dysfunction was seen in patients who were prescribed clozapine (87.9%), followed by risperidone (82.1%), olanzapine (73.9%) and fluphenazine (68.8%). There was no significant correlation between erectile dysfunction and quality of life. None of the patients had initiated a discussion about sexual side effects, while only 8.3% reported that their psychiatrist had inquired about the sexual dysfunction. ConclusionsThe results of this study suggest that sexual dysfunction is a common but often overlooked phenomenon among patients with schizophrenia. This study highlights the need for Sri Lankan psychiatrists to explore sexual problems in this cohort of patients.

Depression after stroke: The role of the GP

Around a third of people will experience depression after having a stroke. Depression after stroke is associated with reduced quality of life, poorer medication compliance, and greater morbidity and mortality. It has historically been underdiagnosed and undertreated, despite recommendations that all individuals who have had a stroke be screened for mental health problems. The following article describes what is known about depression after stroke, drawing on National Institute for Health and Care Excellence guidelines. Steps to overcome challenges in assessment within general practice are presented, in addition to ways of achieving an effective biopsychosocial management strategy that promotes recovery, community engagement and effective carer support.

Diabetic ketoacidosis; Annual Incidence and Precipitating Factors at King Abdulaziz Medical city, Jeddah

Introduction: Diabetes is a recognizable and major health burden in Saudi Arabia. The incidence of Diabetes Mellitus Type 1 (DM1) reached 109.5 per 100,000 child and adolescent. One of the major life-threatening complications of DM1 is Diabetic Ketoacidosis (DKA). This study aims to estimate DKA incidence among DM1 patients and possible risk factors. Methods: Retrospective review for DM1 patients at King Abdul-Aziz Medical City, and who was presented with DKA during the past six and half years. Results: Three hundred and fifty DM1 patients were included and (72) experienced DKA during study period. The average annual DKA onset was (6.2%). Mean age was (22.82 ± 5.567) years, and females constituted (66.7%) of this group. Poor medication compliance was the commonest risk factor associated with DKA, and this relationship was found significant (P-value 0.003). Out of the total DKA sufferers, (28) patients experienced recurrent or multiple DKA episodes, and those had higher HbA1C levels (11.7 ± 2.9 Vs 12.4 ± 3.3). Patients who had multiple DKA episodes reported less visits to the diabetes educator when compared to the single DKA group. (On average (9) Vs (11) per year). Conclusion: DKA was found relatively uncommon among our DM1 patients, and usually seen in young females with poor medication compliance. More comprehensive education on DKA is needed to protect against life threatening complications.

T158. THE VALUE OF ACTIGRAPHY FOR MEASURING APATHY IN PATIENTS WITH SCHIZOPHRENIA: ASSOCIATIONS WITH CLINICAL MEASURES AND NEUROIMAGING OF ACTION INITIATION

BackgroundApathy is a highly debilitating and frequently occurring behavioral characteristic, present in approximately half of the patients with schizophrenia. Apathy is considered a core negative symptom that relates strongest to lack of initiative and is the strongest predictor of poor functional outcome, poor medication compliance, and high caregiver burden. Notwithstanding, measuring apathy is still a challenge. Therefore, we aimed to investigate whether actigraphy, an objective and continuous measurement of activity levels, could yield an objective quantitative measure of apathy severity in schizophrenia patients. Moreover, we aimed to investigate whether actigraphy related to relevant functional neuroimaging underpinnings of apathy, i.e. self-initiated goal-directed behavior.MethodsQuantity, variability, and initiation of motor behavior were studied in relation to apathy severity as measured with clinical measures, and in relation to neural correlates of self-initiated behavior using functional Magnetic Resonance Imaging (fMRI). All patients (N=58) suffered from clinical significant apathy, as measured with the Apathy Evaluation Scale and Scale for the Assessment of Negative Symptoms and wore an actigraph for 48 continuous hours. Physical activity was quantified as the total activity counts over the patients’ ten most active hours of each day, summed over two weekend days (Activity-total, i.e. 20 hours in total). Variability of motor behavior (Activity-variability) was calculated by taking the root of the Mean Squared Successive Difference of the activity counts. For 31 of these patients, fMRI data during a task tapping into self-initiative was available.ResultsResults showed that quantity, variability, and initiation of motor behavior were associated with negative symptoms, but not specifically with apathy. Motor behavior parameters were associated with brain activation during the self-initiative task in various brain regions including inferior parietal regions. The results were only observed during the condition wherein participants were asked to promptly reply to specific cues and not during the condition where more freedom in timing and selection of behavior was allowed.DiscussionActigraphy can be used to measure quantity as well as variability of motor behavior in patients with schizophrenia and with specific relevance for negative symptoms, and that it correlates with selective neural substrates of action selection and activation of motor programs. However, actigraphy may not capture higher-order motivational processes that contribute to apathy severity.

Disseminated Mycobacterium avium-Intracellulare Complex Infection Presenting With Disseminated Intravascular Coagulation in an AIDS Patient.

Disseminated Mycobacterium avium-intracellulare complex (MAC) infection is one of the relatively common opportunistic infections seen in severely immunocompromised AIDS patients. A constellation of clinical, laboratory, and pathological features involving multiple organ systems are often present in disseminated MAC infection but disseminated intravascular coagulation (DIC) has not been previously described in association with this condition. To our knowledge, this is the first reported case of DIC complicating disseminated MAC infection in an AIDS patient. In this article, we present the case of a 33-year-old AIDS patient with high viral load, CD4 lymphocyte count of 1/mm3, who presented with nonspecific symptoms, anemia, thrombocytopenia, and increased lactate dehydrogenase, alkaline phosphatase, and ferritin. She also had abnormal coagulation parameters and features compatible with chronic DIC. Bone marrow biopsy assisted in making the correct diagnosis. She also later grew MAC from blood and sputum cultures. There were no other factors identified after a complete workup to explain DIC in this patient. After commencement of appropriate MAC therapy, she initially had a good response with some improvement of her coagulation parameters. Few months later, however, probably attributable to poor medication compliance, her condition deteriorated with development of thromboembolism, full-fledged DIC, sepsis, and an eventual fatal outcome. This case illustrates the importance of including disseminated MAC in the differential diagnosis of DIC in an AIDS patient.

Facteurs de risque de passage à l’acte d’homicide chez des patients marocains atteints de schizophrénie

BackgroundPersons with schizophrenia are thought to be at increased risk of committing violent crime – 4 to 6 times the level of general population individuals without this disorder. The relationship between schizophrenia and homicide is complex and cannot be reduced to a simple causal link. ObjectivesThe objectives of this study were to describe the characteristics of homicide in Moroccan patients suffering from schizophrenia and to determine the correlated sociodemographic, clinical and toxic variables. MethodsThe study included two groups of patients with a DSM IV diagnosis of schizophrenia who attended the “Ibn Nafis” university psychiatric hospital of Marrakech in Morocco. The first group was composed of 30 patients hospitalized for homicide in the forensic unit between 1 January 2005 and 31 August 2015. The second group included 90 patients without any criminal record. These two groups have been matched according to age and gender. Demographic, clinical and therapeutic variables were analyzed and compared between the two groups. ResultsData analysis has objectified the following results: the mean of age in the first group was 37.03 (±9.09) and in the second group was 31.4 (±8.76). No significant differences were found between the two groups regarding the different sociodemographic variables and the age of onset of disease. Significant differences were found between the two groups regarding: personal antecedents of attempt of homicide (P=0.003), personal antecedents of attempt of suicide (P<0.001), a history of previous violence (P=0.005), untreated psychosis before the act (P<0.001), poor medication compliance and a low familial support (P<0.001), antisocial behavior (P<0.001) and addictive behavior (P=0.005). DiscussionSeveral studies identified some possible predictor factors for violent behavior: poor compliance, lack of insight impulsivity and paranoid–hallucinatory symptoms, systematized delusions and addictive behavior seem to considerably increase the risk of turning to violence. Demographic variables as suggested by other studies are less valuable predictors of homicide in patients with schizophrenia. ConclusionAwareness of these factors will allow us to provide improved prevention of violence within schizophrenic subjects. Interventions for reducing such behavior should focus on clinical variables and integrate an early diagnosis of the disease and an improvement of medication compliance.

Pre-transplant depression as a predictor of adherence and morbidities after orthotopic heart transplantation

BackgroundPsychosocial factors are useful predictors of adverse outcomes after solid organ transplantation. Although depression is a known predictor of poor outcomes in patients who undergo orthotopic heart transplantation (OHT) and is actively screened for during pre-transplant evaluation, the effects of early identification of this entity on post-transplant outcomes are not clearly understood. The purpose of this study was to evaluate the impact of pre-transplant depression on outcomes after OHT.MethodIn this retrospective study, 51 patients that underwent psychosocial evaluation performed by a social worker prior to the transplant and followed up in our center post-transplant were enrolled. Patients were stratified by the presence/absence of depression during the initial encounter. Primary end-points were overall survival, 1st-year hospitalizations, overall hospitalizations, rejections, and compliance with medications and outpatient appointments.ResultsDepressed patients were 3.5 times more likely to be non-compliant with medications; RR = 3.5, 95% CI (1.2,10.2), p = 0.046 and had higher incidence of first year hospitalizations (4.7 ± 3.1 vs. 2.2 ± 1.9, p = 0.046), shorter time to first hospitalization 25 days (IQR 17–39) vs. 100 days (IQR 37–229), p = 0.001. Patients with depression also had higher overall hospitalizations (8.3 ± 4.4 vs. 4.6 ± 4.2, p = 0.025,) and higher number of admissions for infections (2.8 ± 1.3 vs. 1.5 ± 1.4, p = 0.018) compared to patients without depression. There were no statistically significant differences in total number of rejections or compliance with outpatient appointments. Kaplan-Meier survival analysis did not reveal differences between the two groups (mean 3705 vs. 3764 days, log-rank p = 0.52).ConclusionDepression was a strong predictor of poor medication compliance and higher rates of hospitalization in transplant recipients. No difference in survival between depressed and non-depressed patients after OHT was noted.

Risk factors hindering asthma symptom control in Saudi children and adolescents.

Maintaining good control of asthma symptoms can help to prevent exacerbations and its associated complications. The Asthma Control Test (ACT) can rapidly assess the effectiveness of asthma management plan and therapy. The aim of this study was therefore to identify risk factors associated with uncontrolled asthma symptoms in young Saudi asthmatic children (3-17 years old). In this cross-sectional hospital-based survey, the ACT was administered to 297 asthmatic children/adolescents, recruited at the emergency department (ED) of two major hospitals. Most recruited patients had intermittent (63.5%) and mild persistent (27.6%) asthma; few had moderate persistent (8.9%) and none had severe asthma. These patients visited the ED four times (3.9 ± 3.2), on average. Almost half of the patients stated that they had not received education about asthma (47%) or education about medication use (43%). Most patients (60.3%) had uncontrolled symptoms (ACT score ≤19), of whom the intermittent asthma patients had better scores than those with more severe symptoms. Children ≤6 years old, with symptoms diagnosed <5 years previously and who were not attending school, had significantly worse control than older patients. Poor medication compliance and inappropriate inhaler device use were ascribed to younger patients (<12 years old) and worse scores; particularly in relation to stopping inhaled corticosteroid therapy when their symptoms improve. Patients with poor control also stated that they had not received education about inhaler device use. Most Saudi asthmatic children/adolescents visiting the ED had poor control of symptoms; indeed, none achieved complete control, which is related to deficient medication compliance and improper medication inhaler device use; deficient knowledge about asthma was also another factor hindering control.

Risk factors related to homicide in Moroccan patients with schizophrenia

BackgroundThe relationship between schizophrenia and homicide is complex and cannot be reduced to a simple causal link.ObjectivesThe objectives of this study were to describe the characteristics of homicide in Moroccan patients suffering from schizophrenia and to determine the correlated socio-demographic, clinical and toxic variables.MethodsThe study included two groups of patients with a DSM-IV diagnosis of schizophrenia who attended the “Ibn Nafis” university psychiatric hospital of Marrakech in Morocco. The first group was composed of 30 patients hospitalized for homicide in the forensic unit between the first January 2005 and the 31st of August 2015. The second group included 90 patients without any criminal record. These two groups have been matched according to age and gender. Demographic, clinical and therapeutic variables were analyzed and compared between the two groups.ResultsThe mean of age in the first group was 37.03 and in the second group was 31.4. No significant difference was found between the two groups regarding the different socio-demographic variables and the age of onset of disease. Significant difference was found between the two groups regarding: personal antecedents of attempt of homicide a (P &lt; 0.003), personal antecedents of attempt of suicide (P &lt; 0.001), a history of previous violence (P = 0.005), untreated psychosis before the act (P &lt; 0.001) poor medication compliance and a low familial support (P &lt; 0.001), antisocial behavior (P &lt; 0.001), addictive behavior (P = 0.007).ConclusionAwareness of these factors will allow us to provide improved prevention of violence within schizophrenic subjects.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Gout in primary care: Can we improve patient outcomes?

In the United Kingdom, gout represents one of the most common inflammatory arthropathies predominantly managed in the primary care setting. Gout is a red flag indicator for cardiovascular disease and...

A cross-sectional survey of receiving no methadone maintenance treatment in HIV infected injecting drug users in Dehong Dai and Jingpo autonomous prefecture, Yunnan province

Objective: To understand the current status of receiving no methadone maintenance treatment (MMT) and influencing factors in HIV infected injecting drug users (IDUs) in Dehong Dai and Jingpo autonomous prefectures, Yunnan province. Methods: Data of survival of IDUs with AIDS in Dehong were collected from " Chinese National Comprehensive HIV/AIDS and Care Information System" in December, 2014. Results: There were 987 IDUs who should receive MMT, the majority of them were males (94.6%, 934/987), aged 35-44 years (53.0%, 523/987) and farmers (77.2%, 762/987). Among the 987 IDUs, 60.2% (592/987) received no MMT. Multivariate logistic regression analysis showed that being female (OR=2.66, 95%CI: 1.21-5.87), in Jingpo ethnic group (OR=3.05, 95% CI: 1.97-4.71) were the major risk factors for receiving no MMT; not being farmers (OR=0.46, 95%CI: 0.31-0.70), in Dai ethnic group (OR=0.53, 95%CI: 0.36-0.79), diagnosed HIV infection history ≥10 years (OR=0.60, 95%CI: 0.45-0.81) were the major protective factors for receiving no MMT. The reasons for receiving no MMT included long distance journey (289, 48.8%), fear of exposure (124, 20.9%), poor daily medication compliance (59, 10.0%), fear of side effects (47, 7.9%), others (73, 12.3%). Conclusions: The proportion of receiving no MMT in IDUs with AIDS in Dehong was high. Being female and farmer, in Jingpo ethnic group, low educational level, short diagnosed HIV infection history were influencing factors for receiving no MMT. The effective intervention measures should be taken to further improve MMT coverage according to the different characteristics of the patients.

Higher body mass index and lower intake of dairy products predict poor glycaemic control among Type 2 Diabetes patients in Malaysia.

This cross-sectional study was designed to determine factors contributing to glyceamic control in order to provide better understanding of diabetes management among Type 2 Diabetes patients. A pre-tested structured questionnaire was used to obtain information on socio-demographic and medical history. As a proxy measure for glycaemic control, glycosylated haemoglobin (HbA1c) was obtained as secondary data from the medical reports. Perceived self-care barrier on diabetes management, diet knowledge and skills, and diet quality were assessed using pretested instruments. With a response rate of 80.3%, 155 subjects were recruited for the study. Mean HbA1c level of the subjects was 9.02 ± 2.25% with more than 70% not able to achieve acceptable level in accordance to WHO recommendation. Diet quality of the subjects was unsatisfactory especially for vegetables, fruits, fish and legumes as well as from the milk and dairy products group. Higher body mass index (BMI), poorer medication compliance, lower diet knowledge and skill scores and lower intake of milk and dairy products contributed significantly on poor glycaemic control. In conclusion, while perceived self-care barriers and diet quality failed to predict HbA1c, good knowledge and skill ability, together with appropriate BMI and adequate intake of dairy products should be emphasized to optimize glycaemic control among type 2 diabetes patients.

Clinical Practice Guidelines for Management of Schizophrenia.

Clinical Practice Guidelines for Management of Schizophrenia.

Tea Tree Oil (Melaleuca alternifolia)-An Efficient Treatment for Warts: Two Case Reports

Traditional herbal medicines are a valuable natural resource for preventing and treating diseases, including some infectious diseases. Tea tree oil (TTO) has been used over many years as a traditional treatment for a variety of skin disorders. The oil of the tea tree was used twice daily on two patients to treat their skin warts on different anatomical locations. The wart on the first patient needed 10 days to be totally removed, while it took 20 days in the second patient due to poor medication compliance. This paper sheds light on TTO as an efficient and safe treatment for common warts.

Management of Older Inpatients Who Refuse Nonpsychiatric Medication Within Birmingham and Solihull Mental Health NHS Foundation Trust: Audit.

The effects of poor medication compliance are well documented and include increased morbidity, early mortality, and financial costs to the society. According to national guidelines, when a competent patient refuses medication, the doctor on duty has a responsibility to ensure the patient understands their proposed course of action. The aims of this audit were to evaluate whether this consultation was taking place within older in-patient units across Birmingham and Solihull Mental Health NHS Foundation Trust when patients refuse nonpsychiatric medicines. Poor compliance was defined as more than five refusals of a nonpsychiatric medication over a 4-week period. A discussion with the duty doctor occurred in 75% of cases (27/36), which resulted in a change in prescription or compliance in 59% (16/27 patients). After patient refusal of medication, a consultation with the duty doctor is likely to improve compliance and uncover salient issues particularly in regards to capacity and drug suitability.

Efficacy and safety of fixed-dose combination therapy with olmesartan medoxomil and rosuvastatin in Korean patients with mild to moderate hypertension and dyslipidemia: an 8-week, multicenter, randomized, double-blind, factorial-design study (OLSTA-D RCT: OLmesartan rosuvaSTAtin from Daewoong).

The pill burden of patients with hypertension and dyslipidemia can result in poor medication compliance. This study aimed to evaluate the efficacy and safety of fixed-dose combination (FDC) therapy with olmesartan medoxomil (40 mg) and rosuvastatin (20 mg) in Korean patients with mild to moderate hypertension and dyslipidemia. This multicenter, randomized, double-blind, factorial-design study included patients aged ≥20 years with mild to moderate essential hypertension and dyslipidemia. Patients were randomly assigned to receive FDC therapy (40 mg olmesartan medoxomil, 20 mg rosuvastatin), 40 mg olmesartan medoxomil, 20 mg rosuvastatin, or a placebo. The percentage change from baseline in low-density lipoprotein cholesterol levels was compared between FDC therapy and olmesartan medoxomil, and the change from baseline in diastolic blood pressure was compared between FDC therapy and rosuvastatin 8 weeks after treatment. A total of 162 patients were included. The least square mean percentage change (standard error) from baseline in low-density lipoprotein cholesterol levels 8 weeks after treatment was significantly greater in the FDC than in the olmesartan medoxomil group (−52.3% [2.8%] vs −0.6% [3.5%], P<0.0001), and the difference was −51.7% (4.1%) (95% confidence interval: −59.8% to −43.6%). The least square mean change (standard error) from baseline in diastolic blood pressure 8 weeks after treatment was significantly greater in the FDC group than in the rosuvastatin group (−10.4 [1.2] mmHg vs 0.1 [1.6] mmHg, P<0.0001), and the difference was −10.5 (1.8) mmHg (95% confidence interval: −14.1 to −6.9 mmHg). There were 50 adverse events in 41 patients (22.7%) and eight adverse drug reactions in five patients (2.8%). The study found that FDC therapy with olmesartan medoxomil and rosuvastatin is an effective, safe treatment for patients with hypertension and dyslipidemia. This combination may improve medication compliance in patients with a large pill burden.

Animal Models and the Development of Vaccines to Treat Substance Use Disorders.

The development of pharmacotherapies for substance use disorders (SUDs) is a high priority in addiction research. At present, there are no approved pharmacotherapies for cocaine and methamphetamine use disorders, while treatments for nicotine and opioid use are moderately effective. Indeed, many of these treatments can cause adverse drug side effects and have poor medication compliance, which often results in increased drug relapse rates. An alternative to these traditional pharmacological interventions is immunotherapy or vaccines that can target substances associated with SUDs. In this chapter, we discuss the current knowledge on the efficacy of preclinical vaccines, particularly immunogens that target methamphetamine, cocaine, nicotine, or opioids to attenuate drug-induced behaviors in animal models of SUDs. We also review vaccines (and antibodies) against cocaine, nicotine, and methamphetamine that have been assessed in human clinical trials. While preclinical studies indicate that several vaccines show promise, these findings have not necessarily translated to the clinical population. Thus, continued effort to design more effective vaccine immunogens using SUD animal models is necessary in order to support the use of immunotherapy as a viable option for individuals with SUDs.