Alcohol use, mental disorder comorbidity and personality factors as a reason for anti-tubercular drug discontinuation in a tertiary health care centre in south India – A pilot study

Introduction
Tuberculosis (TB) is a chronic debilitating infectious disease with high morbidity and mortality. The anti-TB treatment (ATT) has been associated with major adversities and non-adherence to the specified regimen is one of the main drawbacks in its management. Mental disorder comorbidities and alcohol abuse contribute to altered lifestyle and thus were evaluated for possible non-adherence factor in our study. The aim of this study was to estimate the impact of mental disorder comorbidity and alcohol use on TB treatment in a government tertiary care centre in south India.

Material and methods
A cross-sectional observational study was conducted at a government centre where 110 subjects were recruited by convenience sampling. The Modified Kuppuswamy Scale was used to obtain socio-demographic and habit data, the Alcohol Use Disorder Identification Test (AUDIT), Young Mania Rating Scale (YMRS) and Hamilton Depression Rating Scale were used for recording on the alcohol dependence, manic symptoms and associated depression levels respectively. Structured Clinical Interview for DSM Disorders was used to score on mental illness along with diagnosis reported as per ICD-10 criteria.

Results
The results showed that 64 patients (58.7%) stating that alcohol consumption to be the reason for ATT non-adherence, followed by nausea (n = 9, 8.3%), work (n = 5, 4.6%) and feeling good after the intensive phase of treatment (n = 4, 3.7%). Personality factors like anger and impulsivity were found to be highly prevalent with a positive correlation (p < 0.005).

Discussion
Alcohol dependence syndrome was found to be vital reason for anti-TB drug discontinuation following intensive phase as patients started to feel better. There was a positive correlation with AUDIT score in our study. Personality factors like vulnerability or hostility had a positive correlation with alcohol dependence. Our study replicates the results of previous studies from other part of India and other countries.

Conclusions
Alcohol use was the important reason for non-adherence to ATT. Alcohol dependence therapy can be planned in such cases for better anti-TB treatment effectiveness.