Relapse is the most serious problem in alcoholism treatment. The overall aim of the present study is to determine if a treatment directed at changing the patient's social network, from one that reinforces drinking behavior to one that reinforces sobriety, can create the conditions necessary for long-term treatment success. In addition, we intend to determine if explicit reinforcement for this change of social network (Contingency Management or ContM) will be more effective than the same network support intervention without contingent reinforcement for change. 207 alcohol dependent men and women will be recruited and assigned to one of three treatments in a dismantling design intended to evaluate the relative contributions of Network Support and Contingency Management over a Case Management control condition. The three conditions will be: Case Management, Network Support, and Network Support + ContM. The Network Support only condition (Condition 2) will allow us to determine the effect of focusing on the social support network in achieving reduction of alcohol use compared to the Case Management control condition. The Network support intervention is based on the 12- Step Facilitation intervention used in Project MATCH, but will focus more on AA as an alternative social network, with additional network-building activities built in. Network Support + ContM (Condition 3) should yield the best results. Reinforcement will be provided contingent upon completing steps of treatment (e.g., Steps 1-6 of 12-step treatment, attending AA meetings, non-drinking social activities) is expected to result in high adherence to treatment and therefore a more complete change of social network. Change in social network should lead to more enduring abstinence. More favorable long-term outcomes should result as a function of network support for sobriety, measured at follow-up points up to 2 years posttreatment. We will also explore the possibility, introduced in Project MATCH, that a change in network support will be maximally beneficial to those whose social networks were initially most supportive of drinking to start with.
