Achieving individually sustained commitment to treatment through self-constructed models of medical adherence

One of the main challenges facing medication adherence research is to provi de a framework that allows patients and practitioners to effectively use th e many efficacious treatments that will undoubtedly be developed in the new millennium. This framework, especially for chronic disorders, must be base d on requiring patients to make the long-term behavioral changes needed to achieve a high level of commitment to these treatments. The best way to gen erate this high level of commitment is through a paradigm shift away from m edical and patient models toward models that incorporate the social psychol ogical literature focusing on how people's sense of self is constructed, en acted, and sustained over the life course. This review demonstrates the nee d, value, and appearance of this shift. First, it describes a previous para digm shift in the medication adherence literature and then argues that a ne w paradigm shift is necessary. Second, it identifies and describes the mode ls currently used in adherence research and notes three critical shortcomin gs of these models. Finally, it demonstrates how symbolic interaction's ide ntity theory may be used creatively to overcome these shortcomings and conv ert efficacious treatments into effective treatments. Developing such an ap proach would well position the medication adherence research field for exce llent contributions to the treatment of chronic disorders in the twenty-fir st century.