In this chapter, adherence is seen as a common problem among patients with dual disorders. These adherence problems occur in multiple ways related to professional service and self-help group program utilization. Adherence problems identified include: (1) delay or failure to follow through with an initial scheduled assessment; (2) failure to make the transition from one level of care to another; (3) missing scheduled treatment sessions and early attrition; (4) failure to adhere to medication regiments, stopping medications prematurely, or mixing medications with alcohol or other drugs; (5) failure to attend self-help programs or other community support programs as agreed upon; (6) failure to abstain from alcohol or other drugs; (7) failure to make lifestyle changes; (8) failure to involve the family or significant others; (9) failure to self-disclose problems in treatment sessions; and (10) failure to complete individualized therapeutic assignments. Adherence problems can be viewed on a continuum from total adherence to total nonadherence. Poor adherence affects patients with dual disorders, their families, professional caregivers, and payors. Poor adherence can cause patients to drop out of treatment early. A variety of clinical and systems strategies have the ability to impact positively on patient adherence with both psychological and pharmacologic treatment. By implementing clinical and systems strategies to enhance motivation and readiness to change, providers can make a positive impact on adherence, leading to improved clinical outcomes for dual-diagnosis patients. References